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Worlitz v. Board of Trustees

United States District Court, E.D. Missouri, Eastern Division

November 20, 2019




         On June 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.

         Legal Standard

         Summary 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).

         The 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.

         The 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 SPD:

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.

         Evidence before the Court on the Motion

         The following undisputed facts are drawn from the parties' pleadings, affidavits, and attachments to those affidavits.

         A. Worlitz' Claims

         Worlitz 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.

         On 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.[1] 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.

         On 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 ...

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