Pratt v. Connors

857 F.2d 231, 1988 WL 95446
CourtCourt of Appeals for the Fourth Circuit
DecidedSeptember 19, 1988
DocketNo. 87-2221
StatusPublished
Cited by4 cases

This text of 857 F.2d 231 (Pratt v. Connors) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pratt v. Connors, 857 F.2d 231, 1988 WL 95446 (4th Cir. 1988).

Opinion

K.K. HALL, Circuit Judge:

Eugene D. Pratt, a retired coal miner, appeals an order of the district court granting summary judgment in favor of defendants Joseph P. Connors, Sr., et al, the Trustees of United Mine Workers of America Health and Retirement Fund (“the Trustees” or “the Fund”). Adopting the recommendation of the United States magistrate in this civil action brought pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), the district court concluded that the Fund properly denied Pratt’s application for enhanced retirement benefits. We disagree and reverse.

[232]*232I.

Pratt worked intermittently in the bituminous coal industry from December, 1946, until his retirement in July of 1981. He subsequently applied for pension benefits under the 1974 United Mine Workers Pension Plan (“the Plan”) as administered by the Trustees. The Plan provides for two different levels of pension benefits: (1) a basic Deferred Vested Pension which requires 10 years of signatory service in the coal mining industry, and (2) a Deferred Vested Pension-Special, which pays higher benefits but requires 20 years of signatory service. It is the level of benefits to which Pratt is entitled that is at issue.

In his initial application, Pratt sought benefits under the “Special.” The Trustees, however, concluded that Pratt could establish no more than 19% years of signatory service. Accordingly, benefits were awarded only at the lower of the two pension levels.

Pratt subsequently requested and received an administrative hearing in which he sought to establish an entitlement to an additional period of credited service. This claim for additional service was based upon a period between March, 1959, and October, 1959, when he was hospitalized and recovering from surgery on his back for a herniated disk. Pratt contended that this period constituted time during which he was unable to work as a result of an “occupational disease” and thus should have been credited to him under a Trustees’ policy statement adopted as part of the court-approved settlement in Maggard, et al v. Huge, et al, Civil Action No. 76-2219 (D.D.C. March 14, 1979).1

In support of his position Pratt introduced the only medical evidence of record in this matter. That evidence consisted of the hospital records from 1959 and two letters from his treating physician, Dr. Jus-tus C. Pickett, M.D., who reviewed those records and expressed his medical opinion on the nature of Pratt’s back ailment.

In a letter dated April 11, 1983, Dr. Pickett noted that disk problems were common among miners. He further stated that the condition “most occurred ... as a result of prolonged stress on the back with constantly lifting, straining and so forth. I therefore am fully of the opinion that this condition is the result of his [Pratt’s] occupation.” This view was reiterated in a subsequent letter dated June 22, 1983, wherein Dr. Pickett stated that Pratt’s 1959 back condition constituted “if not a specific mine injury, certainly a related mine problem.”

Notwithstanding Dr. Pickett’s undisputed medical opinion, the Trustees determined, in a report issued by the Fund’s Office of Regional Operations on September 16, 1983, that additional service credit would not be granted. The report concluded that Pratt’s proffered evidence did not establish the existence of “a recognized occupational disease.”

On July 11, 1986, Pratt filed the instant civil action in district court invoking federal jurisdiction under ERISA and alleging that the Trustees’ denial of enhanced benefits was arbitrary and capricious. Cross-motions for summary judgment were filed and referred to the United States magistrate for report and recommendation. In the ensuing report, the magistrate concluded that Pratt’s back condition had arisen “out of and in the course of classified coal industry employment.” The magistrate reasoned, however, that the Trustees had acted within their limits of discretion when they imposed a limiting definition of “occupational disease” that restricted the term to conditions “endemic” or “peculiar” to coal mining. Since, in the magistrate’s view, Pratt had not shown that a herniated disk was an ailment “endemic to coal mining,” it was proper for the Fund to refuse to recognize the condition as an “occupational disease.”

Based upon the magistrate’s analysis and recommendation, the district court granted summary judgment in favor of the Trustees. This appeal followed.

[233]*233II.

On appeal, Pratt contends that the Trustees’ interpretation of the Fund’s pension requirements is arbitrary and capricious. Specifically, appellant argues that the addition of the term “endemic” to the plain language of the Maggard settlement is an unjustified distortion that produces a result utterly at odds with the intent of that settlement. We find appellant’s argument persuasive.

The policy statement adopted by the Trustees in 1973 to give concrete form to the Maggard settlement defines an occupational disease as one “arising out and in the course of coal industry employment.” The statement further provides that a disease shall be deemed to arise out of such employment only if it is apparent that:

a. A direct causal connection exists between the conditions under which work is performed and the occupational disease;
b. The applicant’s inability to work in the coal industry is caused by the disease and can be fairly traced to the employment as the proximate cause; and
c. Such disease must appear to have had its origin in a risk connected with the employment and to have flowed from that source as a natural consequence.

As the magistrate’s report recognized, the undisputed medical evidence conclusively establishes that Pratt’s 1959 back problems did arise from the nature of his employment and that his inability to work for approximately nine months was due to that ailment.2 The Trustees have consistently maintained, however, that the “direct causal connection” prong of the Maggard statement can only be satisfied by demonstrating that the ailment asserted is particularly related to coal mining. Although the Trustees’ decision is entitled to a deferential standard of judicial review, e.g. LeFebre v. Westinghouse Electric Corp., 747 F.2d 197 (4th Cir.1984), we find their position flawed for a variety of reasons.

The most obvious defect in the Trustees’ position lies in the fact that the word “endemic” does not appear in the Maggard policy statement. Relying upon their own Resolution 92, a statement of pension eligibility in effect prior to the adoption of the 1974 pension plan, the Trustees suggest that the Fund has consistently viewed occupational diseases as limited to certain specific conditions such as pneumoconiosis and silicosis which are peculiar to coal mining.

Unfortunately, the Trustees’ argument proves too much. The Fund’s restrictive view of disability for occupational disease was indeed well established at the time the Maggard settlement was adopted in 1979. In light of that fact, the omission of any “endemic” requirement from the settlement language cannot be presumed to be accidental.

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Related

Golden v. Barnett
N.D. West Virginia, 2018
Spears v. Connors
105 F.3d 659 (Sixth Circuit, 1997)
Pratt v. Connors
857 F.2d 231 (Fourth Circuit, 1988)

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Bluebook (online)
857 F.2d 231, 1988 WL 95446, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pratt-v-connors-ca4-1988.