Lester v. United Mine Workers of America Health & Retirement Fund

40 F. Supp. 2d 800, 1999 U.S. Dist. LEXIS 3302
CourtDistrict Court, S.D. West Virginia
DecidedFebruary 17, 1999
DocketCivil Action No. 298-0725
StatusPublished
Cited by1 cases

This text of 40 F. Supp. 2d 800 (Lester v. United Mine Workers of America Health & Retirement Fund) is published on Counsel Stack Legal Research, covering District Court, S.D. West Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lester v. United Mine Workers of America Health & Retirement Fund, 40 F. Supp. 2d 800, 1999 U.S. Dist. LEXIS 3302 (S.D.W. Va. 1999).

Opinion

MEMORANDUM OPINION AND ORDER

GOODWIN, District Judge.

Pending before the Court are cross-motions for summary judgment. Both parties argue that they are entitled to judgment as a matter of law because no genuine issue of material fact exists as to whether the defendants, trustees of the United Mine Workers of America’s (UMWA) 1974 Pension Plan (Pension Plan), abused their discretion in denying the plaintiff, Robert Lester, disability benefits under the Pension Plan. The plaintiff suffered a cervical sprain resulting from mine accidents in 1986 and 1987. In 1997, the Social Security Administration found that the plaintiff was disabled, partially due to his cervical sprain. When the plaintiff applied for disability benefits under the Pension Plan, the trustees concluded that the plaintiffs disability was not caused by a mine accident. The defendants hypothesized that the plaintiff was injured in a non-mine-related accident in 1991, and that this accident was the cause of the plaintiffs present disability.

The Court FINDS that the defendants improperly discounted the medical evidence in the record when they relied solely on the lapse of time between the plaintiffs mine accident and the Social Security disability determination in concluding that [802]*802the plaintiffs disability was not caused by an accident. The mere lapse of time in the face of contradictory medical evidence does not constitute substantial evidence supporting the decision to deny benefits. In addition, it was an abuse of discretion for the defendants to rely on pure speculation in concluding that-the plaintiffs disability was caused by a non-mine-related accident. The plaintiffs Motion for Summary Judgment is therefore GRANTED, and the defendant’s Motion for Summary Judgment is therefore DENIED.

I. Statement of Facts

A. Pension Plan Provisions

The plaintiff appeals the defendants’ decision to deny him disability benefits under the 1974 Pension Plan. The Pension Plan contains the following provision concerning disability benefits:

A Participant who (a) has at least 10 years of signatory service prior to retirement, and (b) becomes totally disabled as a result of a mine accident ... shall, upon retirement ... be eligible for a pension while so disabled. A Participant shall be considered to be totally disabled only if by reason of such accident such Participant is subsequently determined to be eligible for Social Security Disability Insurance Benefits under Title II of the Social Security Act or its successor.

(Dfts.’ Mot. for Summ.J., Ex. B at 5.) The trustees for the plan issued a series of interpretive guidelines called “Questions and Answers” (“Q. & A.”) to assist in the uniform application of the plan’s provisions. Q. & A. number 252 states that “miners who become disabled by progressive diseases or conditions such as black lung, silicosis, tuberculosis, arthritis, rheumatism, etc. cannot be considered disabled as the result of a mine accident.” (Dfts.’ Mot. for Summ.J., Ex. C at 2.) The same Q. & A. further states that “[m]iners who become disabled under the circumstances described in the following examples can be considered ‘disabled as a result of a mine accident’....” Id. at 1. The list of examples that follows includes, “a miner bumps his head on a solid object.” Id.

B. Medical Evidence of Physical Impairments

The plaintiff was first injured in 1986 when a steel canopy from a mine buggy struck him on the right side of his neck. After the accident, the plaintiff visited the emergency room at Logan General Hospital. The attending physician at Logan General diagnosed a cervical strain.

The plaintiff was injured again in November of 1987. The plaintiff was setting timbers, which fell on him, injuring his neck, back, and arm. The plaintiff was seen by Dr. R. Padmanaban, an orthopedic surgeon, who diagnosed a cervical sprain and prescribed pain medication, muscle relaxers, and a soft cervical collar. The plaintiff missed a week of work. Because of the injury, the plaintiff received a permanent partial disability award from workers compensation in the amount of 8%.

In the years after these neck and back injuries, the plaintiff suffered an ankle sprain and a laceration of the thumb. The plaintiff received workers compensation benefits for both of these injuries, and both injuries caused the plaintiff to miss work for a number of weeks.

The record contains no medical evidence relating to the plaintiffs cervical sprain or any neck or back injury between the years of 1987 and 1991.

In January of 1991, the plaintiff began to experience chest pains while at work. The medical record does not reflect that the plaintiff suffered a heart attack; but, initially, physicians do appear to have attributed the plaintiffs pain to a circulatory problem. On July 8, 1991 the plaintiff reported further chest pains at a hospital visit, and a physician prescribed cardiac medicine. The next day, the plaintiff was back at the hospital with complaints of pain radiating down his left arm. X-rays were taken of the cervical spine on that visit. The films showed degenerative [803]*803changes in the cervical spine. At this point, the focus of the plaintiffs treatment appears to have shifted from his possible heart/circulatory problems, to his spinal injury. It is also at this point that the plaintiff ceased working.

For the next six years, the plaintiff was seen by a number of physicians for his neck and back pain. Consistently, the focus of the medical examinations was the cervical spine. The medical record from this period reflects differing medical opinions as to the source of the plaintiffs pain. However, the record is clear that the plaintiff had cervical and spinal abnormalities. The only question raised relates to the severity and effect of the abnormalities.

The defendants argue that the plaintiffs disability is not related to the 1986-1987 mine accidents. In other words, the defendant’s argument rests on a lack-of-causation theory. Consequently, the medical evidence must be considered in light of the causation issue. With this discrete inquiry in mind, the Court turns to the medical evidence in the record.

On July 12, 1991, Dr. Joby Joseph, a neurologist from Logan General Hospital, examined the plaintiff. Dr. Joseph conducted Magnetic Resonance Imaging (“MRI”) and CT scans on July 17. The MRI revealed a “bony spurring producing mild central spinal stenosis.” Dr. Joseph also observed decreased sensation over the left deltoid and between the shoulder blade and left side. During the MRI examination, Dr. Joseph noted that the plaintiff attributed his current pain to his neck injury at work.

Dr. Hossein Sakhai saw the plaintiff on July 26. Dr. Hossein recorded the plaintiffs account of his injuries, including the neck and back injuries and chest pains. Dr. Hossein explained that a cardiology examination had revealed no abnormalities. He also explained that x-rays and MRIs of the neck had revealed degenerative changes. Dr. Hossein made a further radiographic study the cervical spine. This study revealed degenerative cervical changes and a calcium spur. However, Dr. Hossein opined that the cervical abnormalities were not the cause of the plaintiffs pain because there was no neurological signs and the changes were mild.

The plaintiff saw Dr.

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40 F. Supp. 2d 800, 1999 U.S. Dist. LEXIS 3302, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lester-v-united-mine-workers-of-america-health-retirement-fund-wvsd-1999.