Joseph Reinwand v. National Electrical Benefit Fund

United States Court of Appeals
For the Seventh Circuit
Chicago, Illinois 60604
Submitted March 13, 2019 *
Decided March 14, 2019
Before
MICHAEL B. BRENNAN, Circuit Judge
MICHAEL Y. SCUDDER, Circuit Judge
AMY J. ST. EVE, Circuit Judge
No. 18‐2601
JOSEPH REINWAND,
Plaintiff‐Appellant,
v.
NATIONAL ELECTRICAL BENEFIT
FUND,
Defendant‐Appellee.
Appeal from the United States District
Court for the Western District of Wisconsin.
No. 17‐cv‐538‐bbc
Barbara B. Crabb,
Judge.
O R D E R
Joseph Reinwand, a Wisconsin inmate, challenges the entry of summary
judgment on his suit under the Employee Retirement Income Security Act, 29 U.S.C.
§ 1132, asserting claims against the pension fund of his former employer. The National
Electrical Benefit Fund (the “fund”) had suspended Reinwand’s benefits upon learning
that his social security benefits had been terminated when he was incarcerated. The
district court concluded that the fund’s determination was reasonably supported by the
* We have agreed to decide the case without oral argument because the briefs and
record adequately present the facts and legal arguments, and oral argument would not
significantly aid the court. FED. R. A PP. P. 34(a)(2)(C).
NONPRECEDENTIAL DISPOSITION
To be cited only in accordance with Fed. R. App. P. 32.1

-- 1 of 4 --

No. 18‐2601 Page 2
record. Because the district court’s decision was neither arbitrary nor capricious, we
affirm.
Reinwand, formerly an electrical worker, received monthly disability benefits
from the fund between the mid‐1990s and 2012 (he is a vested fund participant). He
qualified for and received a pension because he was entitled to federal disability
benefits from the Social Security Administration (a Social Security award was sufficient
proof of total disability under the fund’s plan). In 2012, the fund cut off Reinwand’s
pension benefits after learning that his social security benefits had been terminated
upon his incarceration. See 42 U.S.C. § 402(x).
Reinwand has since applied several times to submit proof of his disability to
have his benefits reinstated, without success. The first time, in 2012, he submitted a
single‐page medical form that the fund rejected. The second time, in 2014, he submitted
the same form, filled out by a different physician; the fund rejected that submission as
well.
In late 2014, Reinwand sued the fund for reinstatement of benefits. The district
court denied his request, but found that the fund had denied his claim without
explanation, and so it remanded his claim to the fund administrator.
In 2016 Reinwand submitted his third application, attaching the same medical
form, filled out by a different physician, that listed his diagnoses as post‐traumatic
stress disorder, sleep problems, and alcohol abuse, and stated that he ʺremains unable
to work.ʺ This time, the fund sought outside medical experts to evaluate Reinwandʹs
application. Shawn Clausen, M.D., concluded that Reinwand ʺwas able to work at the
electrical trade.ʺ And an independent psychiatrist, Dr. William Holmes (employed by a
third party medical reviewer, the Medical Review Institute of America, Inc.), opined
that no evidence supported Reinwandʹs claim of “total disability.” A determination of
total disability required “detailed evidence of the ways in which the patient’s symptoms
interfere with the patient’s daily functioning to the extent that the patient would be
unable to work,” Holmes explained, and Reinwand had not presented evidence to show
how his psychiatric condition prevented him from working. The fund denied
Reinwand’s application.
Reinwand then sued the fund again, but this time the district court upheld the
fund administratorʹs decision. The court concluded that the fund’s decision to deny
benefits was reasonable and adequately justified. As the court noted, Reinwand’s

-- 2 of 4 --

No. 18‐2601 Page 3
evidence was “meager” (just a single “conclusory” opinion from his treating physician
listing his diagnoses and a couple of symptoms, unsupported by medical records or
treatment history), and the fund reasonably relied on Dr. Holmes’s opinion and the lack
of objective medical evidence to conclude that Reinwand’s condition did not meet the
fund’s definition of total disability.
On appeal Reinwand first challenges the district courtʹs characterization of his
medical reports as “conclusory.” But the medical form filled out by his treating
physician was the same form that the fund had twice rejected as insufficient and
unsupported, and the fund had advised him that he would need to submit medical
proof of his disability. The fund reasonably based its denial of his application on the
opinion of outside medical experts, two of whom concluded the medical reports did not
demonstrate disability.
Reinwand also argues that the language used by Dr. Holmes to define total
disability 1 conflicts with the fund’s own definition, 2 and by adopting the doctor’s
opinion, the fund orally modified his benefits plan. But this reading is not correct. The
fund quoted Dr. Holmes’s language only to flesh out the basis for his opinion; the test
that the fund in fact applied was its longstanding definition of disability:
After reviewing the entire record here, including the aforementioned Medical
Reports and [Dr. Holmes’s] written opinion, we have determined that you have
not met the definition of disability set forth above since at least March 2012.
(emphasis added).
NEBF Denial Letter, March 21, 2017. The reference to “above” can refer only to the
fund’s previously quoted definition. The fund’s decision to deny benefits was
adequately supported by the record and was neither arbitrary nor capricious. See
Jackman Fin. Corp. v. Humana Ins. Co., 641 F.3d 860, 864 (7th Cir. 2011).
1 “A determination of total disability would require detailed evidence of the
ways in which the patient’s symptoms interfere with the patient’s daily functioning to
the extent that the patient would be unable to work.”
2 “Specifically, the evidence must show that the participant is “unable to engage
in substantial gainful activity by reason of any medically determinable physical or
mental impairment which can be expected … to last for a continuous period of not less
than twelve (12) months ….”

-- 3 of 4 --

No. 18‐2601 Page 4
We have considered Reinwand’s remaining arguments, and none has merit. We
AFFIRM.

-- 4 of 4 --