Gonzales v. Truck Drivers and Helpers Local 355 Retirement Pension Fund

Filing 21

MEMORANDUM AND ORDER Granting Gonzales' 11 Motion as to the Remand; Denying the Fund's Cross-Motion for Summary Judgment; Remanding case to the fund for further administrative proceedings. Signed by Judge George Levi Russell, III on 3/27/13. (dass, Deputy Clerk)

UNITED STATES DISTRICT COURT
DISTRICT OF MARYLAND
Chambers of
George L. Russell, III
United States District Judge

101 West Lombard Street
Baltimore, Maryland 21201
410-962-4055

March 27, 2013
MEMORANDUM TO COUNSEL RE:

Lawrence B. Gonzales v. Truck Drivers and Helpers
Local 355 Retirement Pension Fund
Civil Action No. GLR-12-1694

Dear Counsel:
Currently pending before the Court is Plaintiff Lawrence B. Gonzales’ Motion for Summary
Judgment or, in the Alternative, Motion to Remand (ECF No. 11), and Defendant Truck Drivers and
Helpers Local 355 Retirement Pension Fund’s (the “Fund”) Cross-Motion for Summary Judgment
(ECF No. 18). The Court, having reviewed the pleadings and supporting documents, finds no
hearing necessary. See Local Rule 105.6 (D.Md. 2011). For the reasons below, Gonzales’ Motion
to Remand will be granted because Gonzales was denied a full and fair review of his claim, and
notice of the reasons behind the decision to deny his claim. The Fund’s Cross-Motion will be
denied for the same reasons.
The Fund is a multi-employer employee retirement benefit plan that exists for the purpose of
providing post-employment income to participants and designated beneficiaries. At all times
relevant to this action, Gonzales was a participant in the Fund’s pension plan (the “Plan”) by virtue
of his employment with Airborne Express and DHL. On December 31, 1997, Gonzales tripped
over a hand cart while lifting boxes, causing him to jerk awkwardly while trying to catch himself
before hitting the ground (the “1997 work injury”). On January 8, 1998, Gonzales visited Dr. John
M. Langlois of the Total Health Chiropractic Center complaining of lower back pain. Dr. Langlois
treated Gonzales until July 29, 1998, when his symptoms were reduced to a mild level, but
Gonzales reported residual weakness in his lower back. With the exception of January and
February, Gonzales continued to work at least 150 hours per month during this treatment period.
On November 4, 2003, Gonzales returned to Dr. Langlois complaining that the pain in his
back again reached a moderate level. Prior to Gonzales’ return, a February 27, 2003 MRI
evaluation revealed mild degenerative changes in the lumbar spine and disk bulging. According to
Dr. Langlois, after receiving treatment subsequent to his November 2003 complaints, Gonzales
attempted to return to work on January 5, 2004, but was again taken off work on January 22, 2004,
because his work activity caused severe discomfort. Gonzales’ work records show, however, that
he worked at least 150 hours per month through December 2004. Thereafter, the records indicate
sporadic work activity at a rate of one to two months per year from 2005 through January 2008.
From January 2004 through March 2009, Gonzales continued treatment with Dr. Langlois
and consulted various specialists. In 2006, Gonzales underwent surgery, which resulted in pain

alleviation for approximately one to two months, but was deemed a clinical failure by at least one
specialist. (See A.R. 39).1
On March 19, 2009, the Social Security Administration (“SSA”) held a hearing to determine
whether Gonzales was eligible for disability benefits. On April 1, 2009, Administrative Law Judge
William F. Clark determined that Gonzales was disabled as of January 14, 2004, and listed his
disability as “[d]egenerative disc disease lumbar spine status post fusion with radiculopathy,
dysthymic disorder.” (A.R. 54). Gonzales thereafter filed an application for disability retirement
benefits, which the Fund denied on April 7, 2009 (“initial denial letter”). In that letter, the Fund
articulated the Plan guidelines and then stated “[y]our Social Security Award list[s] your disability
as [d]egenerative disc disease lumbar spine status post fusion with radiculopathy, dysthymic
disorder . . . . You have not met the qualifications for a benefit based on Disability Guidelines.”
(A.R. 12-13). On April 20, 2009, Gonzales filed an appeal of the denial. (A.R. 10). In that appeal
letter, Gonzales averred that his disability was due to the 1997 work injury, not degenerative disk
disease, and attached various reports from his medical specialists. The Fund denied Gonzales’
appeal on August 17, 2009, stating the evidence Gonzales provided illustrated that his “disability
was the result of illness or disease.” (A.R. 8-9).
On June 8, 2012, Gonzales filed a Complaint in this Court against the Fund seeking the
disability benefits allegedly owed to him from January 14, 2004, through the present. (See ECF No.
1). Gonzales filed the pending Motion for Summary Judgment or, in the Alternative, Motion to
Remand on January 14, 2013, and the Fund filed its Cross-Motion for Summary Judgment on
February 1, 2013. In his Motion, Gonzales avers that the Fund violated ERISA’s appeal and notice
requirements, and that the Fund’s denial of his request for disability benefits is an abuse of
discretion. The Court will not address Gonzales’ abuse of discretion argument, however, because
the case will be remanded on procedural grounds.
ERISA requires plan administrators to “provide adequate notice in writing to any participant
or beneficiary whose claim for benefits . . . has been denied, setting forth the specific reasons for
such denial.” 29 U.S.C. § 1133 (2012). Moreover, plan administrators must “afford a reasonable
opportunity to any participant whose claim for benefits has been denied, a full and fair review by
the appropriate named fiduciary of the decision denying the claim.” Id. The proper remedy for a
procedural violation of ERISA is to remand the case to the Fund for a full and fair review. See
Gagliano v. Reliance Standard Life Ins. Co., 547 F.3d 230, 239-41 (4th Cir. 2008). While “remand
should be used sparingly, . . . [it] is most appropriate where the plan itself commits the trustees to
consider relevant information which they failed to consider or where [the] decision involves records
that were readily available and records that trustees had agreed that they would verify.” Elliott v.
Sara Lee Corp., 190 F.3d 601, 609 (4th Cir. 1999) (citation and internal quotation marks omitted).
Gonzales avers that the Fund’s initial denial letter failed to comport with ERISA’s appeal
and notice requirements because it does not include the contents specified in 29 C.F.R. § 2560-5031(g) (West 2013). The Fund counters that the letter complies with ERISA’s procedural
requirements because it clearly stated that the SSA determination was the basis for the denial and,
therefore, there was no way for Gonzales to perfect his claim. Moreover, the Fund avers that
remand is unnecessary because the SSA determination will remain unchanged and, since there is no
1

All record citations correspond with the bates number listed in the administrative record
(“A.R.”).
2

dispute that Gonzales worked approximately five and a half years following the 1997 work injury,
there is no additional evidence the Fund could consider that would affect its determination.
Under ERISA, written notifications of adverse benefit determinations must adhere to the
following:
The notification shall set forth, in a manner calculated to be understood by the
claimant – (i) The specific reason or reasons for the adverse determination; (ii)
Reference to the specific plan provisions on which the determination is based;
(iii) A description of any additional material or information necessary for the
claimant to perfect the claim and an explanation of why such material or
information is necessary; (iv) A description of the plan’s review procedures and
the time limits applicable to such procedures . . . .
29 C.F.R. § 2560.503-1(g)(1).
Gonzales avers that the Fund’s initial denial letter, issued April 7, 2009, failed to address
parts (i) and (iii) of the regulation. In its initial denial letter, the Fund articulated the Plan guidelines
and then stated “Your Social Security Award list[s] your disability as [d]egenerative disc disease
lumbar spine status post fusion with radiculopathy, dysthymic disorder . . . . You have not met the
qualifications for a benefit based on Disability Guidelines.” (A.R. 12-13). The administrative
record, however, shows that the SSA determination was not the only factor the Fund considered.
To the contrary, the May 22, 2009 e-mail of Employer Trustee, David Granek, states that he was
“uncomfortable” with the timing of Gonzales’ injury and his work record after the SSA disability
date. (A.R. 70). Moreover, the Fund’s May 13, 2009 meeting minutes also note that Gonzales
continued to work well after his SSA disability determination date. (A.R. 71). The length of time
between the 1997 work injury and Gonzales’ disability date, as well as his continued work hours
thereafter, appear to have contributed to the Fund’s decision. The initial denial letter, however,
states that the sole reason for the denial is the SSA determination. This letter contravenes the
procedural mandates of ERISA because Gonzales should have been afforded an opportunity to
address specifically the timing issue on appeal. Furthermore, the briefing in this case raises a
related issue of causation—namely, whether the 1997 work injury caused the degenerative disk
disease—that the Fund did not previously consider. The Fund’s alleged reliance upon the SSA
determination does not absolve it of its duty to ensure that participants are afforded a full and fair
review of their claims. Accordingly, Gonzales’ Motion (ECF No. 11) is GRANTED, as to the
motion to remand, the Fund’s Cross-Motion for Summary Judgment (ECF No. 18) is DENIED, and
this case will be REMANDED to the Fund for further administrative proceedings.
Despite the informal nature of this memorandum, it shall constitute an Order of the Court,
and the Clerk is directed to docket it accordingly.
Very truly yours,
_________/s/_____________
George L. Russell, III
United States District Judge

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