2008 D e c i sion s O p inion s of the U nit e d S t at e s C our t of Appe al s for the Third C ir c uit 2-11-2008 

# P a cconi v . T ru s tees United Mine P re c e de nt i al or N on-P re c e de nt i al : N on-P re c e de nt i al D ocke t N o . 06-4799

F o llow thi s and a dd it ion al works at : http://d i git alc ommon s .l a w . vi ll anova . e du/thirdc irc uit_2008

Thi s de c i sion i s brou ght t o you for f re e and ope n a c c e s s b y the O p inion s of the U nit e d S t at e s C our t of Appe al s for the Third C irc uit at V i ll anova U nive r sity S choo l of L a

w Di git al Reposit ory

. It h as be e n a c c ept e d for inclusion in 2008 D e c i sion s by an authori z e d a dmini s tr at or of V i ll anova U nive r sity S choo l of L a

w Di git al Reposit ory

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____________ N o. 06- 4799

____________ J O S E P H F . P A C C O N I, J R ., A ppel l ant v. T RU S T E E S OF T HE UNI T E D M I NE WORKE RS OF AM E RI CA , HE AL T H AND R E T I R E ME N T F U N D O F 1 9 7 4 ; MI C H A E L H . H O L L A N D ; MI C H A E L W.

BU CK NER ; STEVEN F. SCHA AB ; B. V. HY LE

__________ O n A p p ea l from the U n it ed S tat es D istri ct C o u rt f o r th e W e ste rn D istric t o f P e n n sy lv a n ia ( N o. 05- cv- 01488) D istri ct Ju d g e: H o n o rab le T erren ce F . M cV erry Subm i t t ed U nderT hi r d C i r cui tL A R 34. 1( a)

J anuary15, 2008 B e f o re : B A R R Y , C H A G A R E S a n d R O T H , C irc u it Judg es.

____________ ( Fi l ed: February11, 2008)

____________ OPI NI ON O F THE COURT

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C H A G A R E S, C i r cui tJ udge. J os eph Pacc oni appea l s the D i s tr i ctC our t ’ s adver s e gr antof s um m aryj udgm enton h i s c l a i m f

o rd i s a b i l i tyr e t i r e me n tb e n e f i t s u n d e rth e Em p l o yme n tRe t i r e me n tI n c o me Secur i tyA ctof 1974 ( E R I SA ) . A s the trus t ees admi ni s t er i ng the bene fi tpl an ( the T rustee s, an d , the P lan, resp ec ti v ely ) did n o t arbitraril yo r ca p ri ciou slyd en yP ac co n i’ s c la im , w e w ill a f

f ir m th e D is tr ic t C o u rt ’s e n tr yo f s u m m a ry ju d g m e n t. I. A s w e w rite m a in lyf

o r th e p a rties , w e o n lyb rie f lyre c ite th e f

a c ts. A f ter ro u g h ly 30 y ear s of coa l m i ne empl oym ent , J os eph Pacc oni appl i ed fora di s abi l i typens i on fr om the U ni t ed M i ne W or ker s of A m er i ca ( U M W A ) on J une 20, 2003. Pacconi had s uffe r ed num er ous w or k- r el at ed i nj ur i es , and cl ai m ed ent i t l ementt o benef i t s bas ed on di s abl i ng back a nd neck c ondi t i ons , bi l at er al pl ant arfi br os i s , bi l at er al footpai n, part i al t earof the le f t b ic e p , ri g h t u ln a r n e u ri tis , ri g h t h a n d c a rp a l tu n n e l s yn d ro m e , a n d c h ro n ic a n k le p a in . O n Sept ember16, 2004, the Trus t ees deni ed Pacc oni ’ s cl ai m , concl udi ng thatnone of Pacc oni ’ s m edi cal condi t i ons m etthe cr i t er i a forqual i fi cat i on underthe Pl an. T he T ru s te e s s u b s e q u e n tly re a f f ir m e d th e ird e n ia l o f

P a c c o n i’ s c la im o n tw o m o re o c c a s io n s . I n a l l th r e e o f

th e s e r e v i e ws o f

P a c c o n i ’ s c o n d i t i o n s , th e e x a mi n e r s d e n i e d th e c l a i ms bas ed on Pacc oni ’ s fai l ur e t o demonstr at e a c aus al l i nk— thata mi ni ng acc i dentcaus ed th e in ju ri e s in q u e s tio n . Fol l ow i ng thes e deni al s , Pacconi fi l ed a c om pl ai ntal l egi ng w r ongful deni al ofD e sp ite th e m yria d o f c o n d iti o n s o n w h ich P a c c o n i b a se d h is c laim , h e lim its th is 1 a p p e a l to h is c h ro n ic a n k le p a in a n d in s ta b ility. 3 d is a b ility p e n s io n b e n e f its a g a in s t th e T ru s te e s u n d e r E R IS A , 2 9 U .S .C . § 1 0 0 1 , et s eq . T he D i s tr i ctC our tgr ant ed the Trus t ees ’ m ot i on fors um m aryj udgm ent , fi ndi ng, among o th e r th in g s, th a t w h ile P a c c o n i h a d n u m e ro u s a n k le s p ra in s, h is d o c to r a ttribu ted h is

1 a n k le c o n d iti o n to “ d e g e n e ra tiv e a rth ritic c h a n g e s, w h ich w o u ld re n d e r th e a n k le condi t i on i nel i gi bl e forcons i der at i on underQ & A 252”— the Trus t ees ’ i nt erpr et i ve

“ q u e s tio n a n d a n s w e r” g u id e lin e th a t d is q u a lif ie s p ro g re s s iv e c o n d itio n s u n d e r t h e P la n . P a c c o n i ap p e a ls th is ju d g m e n t. II. T he mai n thrus tof Pacc oni ’ s appea l i s thatthe D i s tr i ctC our ti m perm i s s i bl yr el i ed on the Trus t ees ’ pos thoc j us t i fi cat i on fordeny i ng hi s cl ai m . E R I SA r equi r es empl oy ee benef i tpl ans “pr ovi de ade quat e not i ce” t o part i ci pant s deni ed bene fi t s undera pl an,

“ s e t t i n g f

o r th th e s p e c i f

i c r e a s o n s f

o rs u c h d e n i a l ” s o t o “ a f f o r d a r e a s o n a b l e o p p o r tu n i ty . . . f o r a f u ll a n d f a irre v ie w ” b yth e p la n a d m in is tr a to rs . 2 9 U .S .C . § 1 1 3 3 ; 2 9 C .F .R . § 2 2 5 6 0 .5 0 3 -1 . T o e n a b le p lan p a rticip a n ts to c o n tes t d e n ials o f th e ir c laim s, a n d to e n a b le ef fe cti v e jud ici al rev iew o f th e p lan a d m inistrators’ d eterm ination s, “a rev iew ing co u rt m u st f o c u s o n th e e v id e n c e a v a ilab le to th e p lan a d m in istra to rs a t th e tim e o f th e ir d ec isi o n an d m ayn o t adm itn ew ev iden ce o r co n side r pos thoc r at i onal es . ” Fl i nder s v. W or kfor ce St abi l i zat i on Pl an, 491 F. 3d 1180, 1190 ( 10th C i r . 2007) ( quot i ng K i ng v.4

H art for d L i fe a nd A cci dentI ns . C o. , 414 F. 3d 994, 999 ( 8th C i r . 2005) ( r efus i ng t o al l ow cl ai m ant s t o “be s andbagge d byaft er - the- fac tpl an i nt erpr et at i ons devi s ed forthe p u rp o s e s o f

litig a tio n ” )) . Pacconi ’ s cont ent i on thatthe D i s tr i ctC our tcons i der ed a pos thoc r at i onal e forthe T ru ste e s’ d e n ial o f

h is c laim s m a yh a v e so m e m e rit. W h ile th e T ru ste e s c o n sis ten tly e x p lain e d th a t P a c c o n i w a s u n a b le to p ro v e th a t a m in e a c c id e n t ca u se d h is in ju rie s, th e ir s peci fi c r eas ons forthi s fi ndi ng ar e more nuance d. I n the Trus t ees ’ var i ous l ett er s of d e n ial, th e sta ted re a so n f o r d isq u a lify in g P a c c o n i’s a n k le c o n d iti o n c laim w a s th a t “it w oul d notbe r eas onabl e t o concl ude thatthe eve ntof J une 11, 1997, caus ed or c o n tr ib u te d to M r. P a c c o n i’ s ri g h t a n k le p a in s ta tu s -p o s t a n k le re c o n s tru c tio n .” A p p . 1 1 7 . T he Trus t ees r eac hed thi s concl us i on byfi ndi ng thatdes pi t e s us t ai ni ng the i nj uryon J une 1 1 , 1 9 9 7 , “[ t]h e re w a s n o e v id e n c e th a t [ P a c c o n i] w a s tre a ted f o r th is c o n d iti o n u n til N o v e m b e r 1 9 9 7 .” A p p . 1 1 7 . M o re o v e r, “[ P a c c o n i] d id n o t m iss a n ytim e d u e to th is acc i dent ” and i ndeed, even a ft era l i gamentr econs truct i on pr ocedur e i n 1999, he “r eturned t o r egul ardutyand cont i nued t o w or k unt i l he w as l ai d off i n J anuary2000. ” A pp. 117. T he deni al of Pacc oni ’ s cl ai m r egar di ng hi s chr oni c ankl e pai n w as di s t i ngui s hed fr om hi s cl ai m s bas ed on dege ner at i ve di s c di s eas e of the l um bars pi ne, r i ghthand ca rpal tunnel s yndr om e, and dege ner at i ve j oi ntdi s eas e of the ce r vi cal s pi ne, w her e the Trus t ees found s uch condi t i ons di d not“r es ul t [] fr om one s peci fi c eve nts uch as a m i ning accident . ” A pp . 11 5-117 . A ccordi ng l y , w hil e the T rust ees di squali fi ed these5

l att ercondi t i ons bas ed on the pr ogr es s i ve ( r atherthan eve nt - s peci fi c) natur e of the condi t i on i n ques t i on, the Trus t ees di s qual i fi ed Pacc oni ’ s ankl e condi t i on bydi s count i ng th e J u n e 1 9 9 7 e v e n t its e lf. E ven i f w e as s um e, how ever , thatthe D i s tr i ctC our tdi d i m perm i s s i bl yr el yon a po s tho c j us t i fi c a t i on , a nd thu s w e do no tde fe rt o thi s j us t i fi c a t i on , s e e G r i t z e rv. CB S, I nc. , 275 F. 3d 291, 296 ( 3d C i r . 2002) , the Trus t ees s t i l l exer ci s ed thei rdi s cr et i on under the Pl an i n deny i ng Pacconi ’ s cl ai m s acc or di ng t o thei rcons i s t ent l ys t at ed r at i onal e: di s count i ng the J une 1997 ac ci dent . W her e an e m pl oy ee be nefi tpl an ves t s the admi ni s tr at or s w i th di s cr et i on t o m ake be nefi tdet erm i nat i ons , w e mustdefe rabs ent arbi tr aryand capr i ci ous conduct . See V i t al e v. L atr obe A r ea H os p. , 420 F. 3d 278, 281- 82 ( 3d C i r . 2005) ( not i ng thatbeca us e of thi s s t andar d, the admi ni s tr at or ’ s deci s i on “w i l l be overturned onl yi f i ti s ‘ cl ear l ynots uppor t ed bythe evi dence i n the r ecor d’ ”) ; M oat s v. U n it ed M ine W o rke rs of A m erica H ea lth an d R et. F u n d s, 9 8 1 F . 2 d 6 8 5 , 6 8 8 (3d C ir . 1 9 9 2 ) (“ [ U ]n d e r th e a rb itrar ya n d c a p ric io u s s tan d a rd , the tru ste e s’ in terp re tatio n sh o u ld b e u p h e ld e v e n if

th e c o u rt d isa g re e s w ith it, so lo n g a s th e in terp re tatio n is ra tio n a lly re la te d to a v a lid p la n p u rp o s e a n d n o t c o n tr a ry to th e p la in la n g u a g e o f th e p la n .” ). A s n o ted a b o v e , ev id e n c e sh o w s th a t d e sp ite P a c c o n i’s J u n e 1 9 9 7 a c c id e n t, he d id n o t re c e iv e m e d ica l trea tm e n t u n til N o v e m b e r. S o to o , h e d id n o t m iss a n ytim e d u e to th e a c c id e n t, an d h e in d e e d re tu rn e d to w o rk a f ter h is a n k le s u rg e rya n d c o n tin u e d u n til the mi nes s hutdow n. A ccor di ngl y , the Trus t ees ’ deni al i s s uppor t ed bythe r ecor d, andw e w ill a f f irm th e ju d g m e n t o f

th e D istric t C o u rt.

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