William J. Welsh, Appellee/cross-Appellant v. Burlington Northern, Inc., Employee Benefits Plan, Appellant/cross-Appellee

54 F.3d 1331, 1995 U.S. App. LEXIS 9964, 1995 WL 256749
CourtCourt of Appeals for the Eighth Circuit
DecidedMay 4, 1995
Docket94-1767, 94-2822
StatusPublished
Cited by35 cases

This text of 54 F.3d 1331 (William J. Welsh, Appellee/cross-Appellant v. Burlington Northern, Inc., Employee Benefits Plan, Appellant/cross-Appellee) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
William J. Welsh, Appellee/cross-Appellant v. Burlington Northern, Inc., Employee Benefits Plan, Appellant/cross-Appellee, 54 F.3d 1331, 1995 U.S. App. LEXIS 9964, 1995 WL 256749 (8th Cir. 1995).

Opinions

MORRIS SHEPPARD ARNOLD, Circuit Judge.

In 1977, William Welsh injured his lower back at work. As a result, he was unable to continue his previous job with his employer, a railroad, but moved to another position with the company, making less money. He sued the railroad in state court in 1980 for damages resulting from that injury; the suit was based on the Federal Employers’ Liability Act (FELA), see 45 U.S.C. §§ 51-60. In late 1984, a jury awarded him $500,000 on a general verdict. That award was affirmed on appeal. See Welsh v. Burlington Northern Railroad Co., 719 S.W.2d 793 (Mo.Ct.App.1986).

In late 1985, just before he turned 39 years old, Mr. Welsh became totally disabled from arachnoiditis (inflammation of membranes within the brain and spine), apparently caused by Pantopaque, a dye that was injected into his spine for diagnostic purposes at least three times after he injured his back. Arachnoiditis may cause “headache, epileptic seizures, blindness, or slowly progressive spastic paralysis (difficulties with movements due to increased muscle tension) affecting both legs or all four limbs.” American Medical Association, Encyclopedia of Medicine at 128 (C. dayman ed. 1989). One of the symptoms that Mr. Welsh suffers is bowel incontinence, necessitating the use of an adult diaper. He also suffers from “intractable pain,” according to an evaluation performed in 1991. There is “no effective treatment” for arach-noiditis. American Medical Association, Encyclopedia at 128.

[1335]*1335The railroad’s health insurance plan paid Mr. Welsh disability benefits based on the arachnoiditis until mid-1987. At that time, the railroad paid the amount of the FELA award; the health insurance plan then informed Mr. Welsh that no further disability payments would be made. The basis for that decision was the health insurance plan’s contention that under the terms of the disability benefits contract, the health insurance plan was entitled to use the FELA award received by Mr. Welsh to offset the amounts due to him under the disability benefits contract. (The briefs do not say so explicitly, but we infer that the total amount of disability benefits that could ever be due to Mr. Welsh— based on his projected entitlement to them until age 66 — is less than the amount of the FELA award.)

In late 1992, Mr. Welsh sued the health insurance plan in federal district court, alleging that it was improper for the health insurance plan to use the FELA award as a setoff to the disability benefits that he was entitled to receive. On cross-motions for summary judgment, the district court granted summary judgment to Mr. Welsh in late 1993, holding that the arachnoiditis “was an independent cause of [Mr. Welsh’s] disability”— in other words, that Mr. Welsh’s back injury was not the cause of his disability — and therefore that the health insurance plan was not entitled to use the FELA award as a setoff to the amounts due to Mr. Welsh under the disability benefits contract. In early 1994, the district court entered judgment for Mr. Welsh but declined to award attorney’s fees to him.

A few months later, the district court amended the judgment to allow certain retirement benefits to be deducted from the disability payments due to Mr. Welsh. The district court calculated the amount of past disability benefits due and, in addition, declared that Mr. Welsh was “entitled to receive disability benefits so long as he is disabled or until he reaches the age of 65, whichever occurs first.”

The health insurance plan appeals the grant of summary judgment to Mr. Welsh, arguing that genuine issues of material fact exist that preclude summary judgment for Mr. Welsh, see Fed.R.Civ.P. 56(c), and that the law requires summary judgment for the health insurance plan instead. The health insurance plan also asserts that the district court should not have calculated the disability payments due, for either the past or the future, but should have left those determinations to the health insurance plan. Mr. Welsh cross-appeals the district court’s calculation of the disability payments due, arguing that too much was deducted for the retirement benefits. We affirm the district court with respect to all of those issues. Mr. Welsh also cross-appeals the district court’s refusal to grant him attorney’s fees. We reverse and remand for proceedings consistent with this opinion with respect to the question of attorney’s fees.

I.

The disability benefits contract in this case is subject to the provisions of the Employee Retirement Income Security Act (ERISA), see 29 U.S.C. §§ 1001-1461. The district court held that the disability benefits contract did not give the health insurance plan the discretion to construe the terms of the contract and therefore that judicial review had to be de novo with respect to the health insurance plan’s determination that under the setoff provision of that contract, the FELA award could be used to reduce the disability payments due. See, e.g., Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 956, 103 L.Ed.2d 80 (1989). The health insurance plan does not appear seriously to challenge that holding by the district court, and, indeed, we believe that that holding is correct.

The contract for the short-term total disability plan provides that the benefits paid for short-term disability “will be decreased by ... [a]ny disability benefit paid or payable under any Workmen’s Compensation or Occupational Disease Act or the Federal Employer’s Liability Act.” The contract for the long-term total disability plan provides, in the section dealing with monthly income benefits, that the benefits paid “shall be reduced by ... any amount paid or payable ... under any Worker’s Compensation or Occupational or Non-Occupational Disease or Dis[1336]*1336ability Act or similar law (including, but not limited to, loss of income payments under the Federal Employers Liability Act).” In this opinion, we refer to the two contracts collectively as the disability benefits contract (since both compensate for total disability).

The general essence of the health insurance plan’s argument is that the disability benefits contract allows a setoff for any amount awarded to Mr. Welsh as a result of the FELA lawsuit, regardless of whether the injury at issue in the FELA lawsuit is the same as that for which Mr. Welsh receives the benefits under the long-term disability plan. The health insurance plan also argues, nonetheless, that the FELA lawsuit included claims for the arachnoiditis that Mr. Welsh now suffers and which entitles him to draw benefits under the long-term disability plan.

Specifically, the health insurance plan first contends that a genuine issue of material fact exists with respect to what caused Mr. Welsh’s arachnoiditis. In light of the health insurance plan’s insistence that Mr. Welsh’s arachnoiditis was included in the injuries for which he received compensation in the FELA lawsuit, we do not quite understand the relevance of that argument.

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Cite This Page — Counsel Stack

Bluebook (online)
54 F.3d 1331, 1995 U.S. App. LEXIS 9964, 1995 WL 256749, Counsel Stack Legal Research, https://law.counselstack.com/opinion/william-j-welsh-appelleecross-appellant-v-burlington-northern-inc-ca8-1995.