Joy v. AGC-Intl Union of Operating Engineers
2012 U.S. Dist. 91921, 91927 (USDC Or. 2012)
Joy, an operating engineer, was tasked with moving earth from a steep slope near the Oregon coast. The cat that he operated was tied to a winch which let the cat go down the slope and then retrieved it in yo-yo fashion. Joy was lap-belted and harnessed in his seat to ensure he did not fall off the cat. Over the course of several days, Joy noticed bruising and other symptoms, including constipation and pain, which caused him to go the hospital. He underwent emergency surgery for a gangrenous bowel caused by constriction from the lap-belt and harness.
Joy never returned to work. The impairment and limitations caused by the bowel damage exacerbated previous health conditions. Joy’s workers’ compensation claim for the bowel condition was accepted, but the aggravated injury to areas of pre-existing conditions were not. It was settled, but the settlement was not enough to provide an adequate means of support. Joy’s social security disability benefits claim was approved, but acted as an offset against any compensation he might be entitled to receive from the disability benefit for which he applied through the union pension plan.
After he applied for disability benefits, the Plan, based in Portland, Oregon, did a cursory review and then denied the benefits. The Plan relied upon a physician review paid for by the Plan. On appeal, the Plan sent records to a psychiatrist who issued an opinion without ever having examined or tested Joy.
As a means of proving his entitlement to benefits, Joy submitted past medical, counseling and psychiatric records, his own Declaration, and a record of encounters with law enforcement. In addition, he submitted a comprehensive psychiatric evaluation based on testing and close clinical observation and a vocational evaluation. The examining psychiatrist and vocational evaluator concluded that Joy was disabled from performing any work.
When the Plan continued to deny Joy’s claim, he filed suit in federal district court, alleging that the Plan had abused its discretion. In reversing the denial of disability benefits, the Court found that the Plan committed numerous procedural and substantive violations of its obligations under ERISA. The Court held that Joy had proved that he was disabled within the meaning of the Plan, by a combination of permanent physical conditions and mental disorders which existed for more than six consecutive months (as required by the Plan) and rendered him incapable of any substantially gainful activity.
The Court ordered the Plan to accept Joy’s claim for benefits and pay all back benefits owed.