Baker v. Greater Kansas City Laborers Welfare Fund

699 F. Supp. 210, 1988 U.S. Dist. LEXIS 12455, 1988 WL 117936
CourtDistrict Court, W.D. Missouri
DecidedNovember 1, 1988
DocketNo. 85-0816-CV-W-9
StatusPublished
Cited by1 cases

This text of 699 F. Supp. 210 (Baker v. Greater Kansas City Laborers Welfare Fund) is published on Counsel Stack Legal Research, covering District Court, W.D. Missouri primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Baker v. Greater Kansas City Laborers Welfare Fund, 699 F. Supp. 210, 1988 U.S. Dist. LEXIS 12455, 1988 WL 117936 (W.D. Mo. 1988).

Opinion

ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT, GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND REQUIRING PLAINTIFF AND HIS ATTORNEY TO SHOW CAUSE WHY AN AWARD OF ATTORNEY’S FEES SHOULD NOT BE MADE AGAINST THEM

BARTLETT, District Judge.

In 1980 plaintiff Joseph Baker incurred medical expenses arising from two separate incidents: First, during February and March, he was hospitalized and received outpatient treatment; second, in July his son Albert was hospitalized. After each incident, plaintiff sought reimbursement for the expenses by submitting a claim for benefits to defendant Greater Kansas City Laborers Welfare Fund (Fund), an employee welfare fund within the meaning of the Employment Retirement Income Security Act of 1974 (ERISA). The Fund denied both claims.

Plaintiff sought review by the Welfare Fund Appeals Committee of the denial of his claim for expenses due to his hospitalization and medical treatment. The committee upheld the Fund’s denial of this [211]*211claim. Plaintiff did not request review by the committee of the Fund’s denial of his claim for expenses resulting from his son’s hospitalization.

On June 22, 1985, plaintiff commenced this action in the Circuit Court of Jackson County, Missouri, pursuant to § 502 of ERISA, 29 U.S.C. § 1132. On July 12, 1985, defendant Fund filed a petition for removal to this court. After the case was set for trial, the parties agreed to submit the case by cross-motions for summary judgment. The case now pends on cross motions for summary judgment.

I. Standard of Review

Under § 502 of ERISA a claimant for benefits under a private pension plan can obtain judicial review of the denial of a claim. 29 U.S.C. § 1132. “Federal courts may overturn a decision of private pension fund fiduciaries only if the decision is arbitrary, capricious or an abuse of discretion.” Lawrence v. Westerhaus, 780 F.2d 1321, 1322 (8th Cir.1985). “If there is evidence supporting the decision, it is not arbitrary, capricious or an abuse of discretion.” Id. at 1322-23.

II. Facts

The Fund is an employee welfare benefit fund within the meaning of § 3 of ERISA, 29 U.S.C. § 1002. At all times material to this action Albert Baker was, plaintiff’s dependent within the meaning of Article II, Section 5 of the Rules and Regulations of the Fund (“The Plan”).

Between February 21, and March 29, 1980, plaintiff incurred medical expenses as a result of his hospitalization and out-patient treatment. Between July 13, and July 25, 1980, plaintiff incurred medical expenses as a result of the hospitalization and treatment of his son.

The eligibility rules for benefits are set forth on page 12 of the Summary Plan Description and Article XX of the Plan. An employee’s eligibility for benefits will terminate if the welfare fund’s records do not reflect that the employee has the following hours of employment for which contributions were paid to the fund: 1) 200 hours of employment during the last three months; 2) 400 hours of employment during the last six months; 3) 600 hours of employment during the last nine months; and 4) 800 hours of employment during the last 12 months.

As of February 21, 1980, plaintiff had accumulated the following number of employment hours for the period January 1979, through December 1979: 1) zero hours of employment during the last three months; 2) 120 hours of employment during the last six months; 3) 568 hours of employment during the last nine months; and 4) 795.5 hours of employment during the last 12 months.

The eligibility rules contained in the Summary Plan Description under the title “Special Continuation” and Article XX, Section 4 of the Plan, provide that an employee who loses eligibility because of lack of employment may make contributions on his/her own behalf to maintain his/her eligibility for benefits. Plaintiff was notified by the welfare fund that he must remit a self-payment to the Fund in order to maintain his eligibility for benefits for February 1980. Plaintiff failed to submit a self-payment.

In February and March 1980, plaintiff submitted claims for his medical expenses incurred between February 21, 1980, and March 29, 1980. Plaintiff received a letter on or about March 25, 1980, from the welfare fund denying him benefits. The stated reason for denial was that plaintiff failed to mail a self-payment to the Fund’s administrative office in order to maintain his eligibility for benefits. Plaintiff appealed the welfare fund’s denial of his eligibility for benefits in a letter dated April 7, 1980. In letters dated April 14, 1980, May 19, 1980, and June 5, 1980, plaintiff was informed of his right to appear at the next Welfare Fund Appeals Committee meeting, including his right to have legal courisel present.

The Appeals Committee meeting was held on June 20, 1980, as scheduled, but plaintiff did not appear. The Appeals Committee reviewed plaintiff’s claim and confirmed the denial decision. Plaintiff was informed of the Appeals Committee deci[212]*212sion by letter dated June 23, 1980. The stated reasons for denying the claim were that plaintiff had insufficient hours to maintain his eligibility and plaintiff had failed to submit a self-payment for the month of February 1980.

On or about July 28, 1980, plaintiff submitted expenses incurred by him on behalf of his son to the fund. Plaintiffs claims for benefits were denied by the welfare fund. The stated reason for denial was that plaintiff had insufficient hours worked and/or reported by his employers to be eligible for benefits during July 1980. Plaintiff was informed of this denial by letter received on or about September 11, 1980. Plaintiff did not appeal.

III. Discussion

Plaintiff contends that the Fund’s denial of his separately submitted claims for benefits arising from medical expenses incurred on behalf of himself and his son was arbitrary and capricious.

1. The trustees did not abuse their fiduciary responsibility in denying plaintiffs claim for payment of medical expenses resulting from his own hospitalization and treatment

With regard to plaintiff’s claim for benefits resulting from his own hospitalization and treatment, the trustees reasonably concluded that plaintiff failed to qualify for benefits in February 1980, because he was deficient 1) 200 hours during the last three months; 2) 280 hours during the last six months; 3) 32 hours during the last nine months; and 4) 4.5 hours during the last 12 months.

Plaintiff argues that he should not be totally denied benefits when he is only 4.5 hours short for the 12 month period. Whether the plan should have different provisions or whether a particular result is fair is not properly before me. The trustees were not acting arbitrarily when they adhered to the provisions of the Plan. Mestas v. Huge, 585 F.2d 450 (10th Cir.1978).

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Related

Baker v. Greater Kansas City Laborers Welfare Fund
716 F. Supp. 1229 (W.D. Missouri, 1989)

Cite This Page — Counsel Stack

Bluebook (online)
699 F. Supp. 210, 1988 U.S. Dist. LEXIS 12455, 1988 WL 117936, Counsel Stack Legal Research, https://law.counselstack.com/opinion/baker-v-greater-kansas-city-laborers-welfare-fund-mowd-1988.