United States District Court, E.D. Missouri, Eastern Division
MEMORANDUM AND ORDER
CATHERINE D. PERRY, UNITED STATES DISTRICT JUDGE.
22, 2015, plaintiff Robert D. Worlitz sustained an injury on
his employer's premises. After the injury, Worlitz
requested medical and disability benefits from the defendants
in this case, the Board of Trustees of District #9,
International Association of Machinists and Aerospace Workers
Pension and Welfare Trust. The Trust denied his request.
Consequently, Worlitz filed this lawsuit seeking a
declaratory judgment of his entitlement to past and future
benefits under the Employee Retirement Income Security Act
(ERISA), 29 U.S.C. § 1132(a) et seq. Pending
before me is the Trust's motion for summary judgment on
Worlitz' claims. The undisputed evidence shows that (1)
the injury Worlitz sustained is not covered by the governing
rules of the Trust's welfare plan, and (2) Worlitz is no
longer a covered employee under the welfare plan, and so he
has no entitlement to future benefits. I will grant the
defendants' motion for summary judgment.
judgment must be granted when the pleadings and proffer of
evidence demonstrate that there is no genuine issue of
material fact and that the moving party is entitled to
judgment as a matter of law. Fed.R.Civ.P. 56(a); Celotex
Corp. v. Catrett, 477 U.S. 317, 322-23 (1986);
Torgerson v. City of Rochester, 643 F.3d 1031, 1042
(8th Cir. 2011) (en banc). I must view the evidence in the
light most favorable to the nonmoving party and accord him
the benefit of all reasonable inferences. Scott v.
Harris, 550 U.S. 372, 379 (2007). The movant bears the
initial burden of demonstrating the absence of an issue for
trial. Celotex, 477 U.S. at 323. Once a motion is
properly made and supported, the nonmoving party may not rest
upon the allegations in his pleadings but must, by affidavit
or other evidence, set forth specific facts showing that
there is a genuine issue of material fact. Id. at
324; Torgerson, 643 F.3d at 1042. A factual dispute
is “genuine” for summary judgment purposes only
when there is “sufficient evidence favoring the
nonmoving party for a jury to return a verdict for that
party.” Anderson v. Liberty Lobby, Inc., 477
U.S. 242, 249 (1986).
first step in evaluating a denial of benefits claim under
ERISA is determining the appropriate standard of review.
Goewert v. Hartford Life & Acc. Ins. Co., 442
F.Supp.2d 724, 727 (E.D. Mo. 2006). De novo review is
appropriate unless the plan grants its administrator
discretionary authority to determine benefit eligibility or
construe the terms of the plan. Janssen v. Minneapolis
Auto Dealers Ben. Fund, 447 F.3d 1109, 1113 (8th Cir.
2006) (citing Firestone Tire & Rubber Co. v.
Bruch, 489 U.S. 101, 115 (1989)). If a plan gives
discretionary authority to a plan administrator, the plan
administrator's decision is reviewed under a deferential
abuse of discretion standard. Id.
Trust's welfare plan is governed by the policies and
procedures set forth in the Trusts' Plan Document and
Summary Plan Description (SPD). ECF 18-2 at pg. 2; Aff. of
Debbie Watson, ECF 18-1. The SPD grants the plan
administrator discretionary authority to both determine
eligibility for benefits and interpret the provisions of the
The individuals and entities charged with reviewing appeals
shall have discretionary authority to rule on all appeals and
their decisions shall be final and binding on all parties . .
. . Benefits will be paid only if the reviewing party
determines in their discretion that the applicant is entitled
to them. The reviewing party shall have discretion to make
determinations of fact, interpret all documents and other
matters pertaining to the appeal; to determine eligibility
for benefits, and to exercise such authority as set forth in
this Summary Plan Description.
ECF 18-2 at pg. 68. Accordingly, a deferential abuse of
discretion standard governs my evaluation of the Trust's
determinations concerning both Worlitz' eligibility and
the Trust's denial of his benefits claim.
before the Court on the Motion
following undisputed facts are drawn from the parties'
pleadings, affidavits, and attachments to those affidavits.
sustained an injury to his knees on June 22, 2015. Aff. of
Robert Worlitz, ECF 20-29. At the time of injury, he was
employed as a mechanic by Seeger Toyota, a car dealership
located in St. Louis, Missouri. Id. Worlitz explains
the injury as follows: “I stepped into a
depression/hole in the pavement of Seeger Toyota, while
pushing a car, thereby directly and proximately causing
injuries to my right knee primarily, and also to my left
knee.” Id. On July 28, 2015, Worlitz underwent
surgery on his right knee. Id. The surgery was
ultimately unsuccessful; on January 27, 2016, Worlitz filed a
workers' compensation claim in connection with the knee
injury with the Missouri Department of Labor and Industrial
Relations. Worlitz Workers' Compensation Claim, ECF 20-7.
March 5, 2016, Worlitz quit his position at Seeger Toyota,
and on April 1, 2016, he began working as a mechanic for John
Bommarito Oldsmobile-Cadillac-VW, a car dealership located in
St. Peters, Missouri. ECF 20-29 at pg. 2. In or after April
2016, Worlitz informed the Trust that he had a pending
workers' compensation claim for the knee injury.
Id. SPD § 8.F.26 permits the Trust to advance
medical expenses for a covered employee's work-related
injuries if the employee has a pending workers'
compensation claim. Pursuant to § 8.F.26, the Trust
advanced medical expenses to Worlitz after the parties agreed
to execute a lien on his workers' compensation
settlement. Def.'s Statement of Uncontroverted Material
Facts, ECF 18 at pg. 3.
September 9, 2016, Worlitz and Seeger Toyota settled his
workers' compensation claim, and Worlitz reimbursed the
Trust in full for the funds it had previously advanced. ECF
20-29 at pg. 5. On September 29, 2016, Worlitz filed a
separate lawsuit against several third party contractors
alleging “defective construction on the premises of
[Worlitz'] employer, Seeger Toyota at the time of his
initial injury on 6/22/2015.” Pltf.'s Second
Amended Petition, ECF 12 at pg. 3. That lawsuit, Worlitz
v. Diestelkamp LLC, Lamke ...