Employee Benefits

Dist. Ct. did not err in remanding claimant’s denied application for Social Security disability benefits to ALJ for supplemental findings regarding MRI results, as well as resolution of ultimate question as to whether claimant’s pain was sufficiently debilitating. While claimant argued that he was entitled to outright award of benefits without any remand, where: (1) two treating physicians gave consistent opinions supporting his claim of persistent pain; (2) his long medical history included surgery and several unsuccessful procedures to alleviate said pain; and (3) claimant has had to endure two prior remands over 9-year period to obtain more factual findings, Ct. found that remand was appropriate since record contained some evidence that could be read to undermine claimant’s claim for benefits.

Record failed to contain sufficient evidence to support ALJ’s denial of claimant’s application for Social Security disability benefits, where said denial was based on ALJ’s assessment at Step 2 of 5-step disability analysis that claimant’s schizophrenia diagnosis was not severe impediment. Diagnosis of schizophrenia, standing alone, is sufficient to satisfy severe impairment requirement at Step 2, and ALJ improperly conflated Steps 2,4 and 5 in denying instant application. Moreover, ALJ fundamentally misunderstood claimant’s symptoms of schizophrenia, which led him to mistakenly conclude that claimant’s mental condition was “essentially normal.” ALJ also improperly rejected opinion of claimant’s treating physician and improperly ignored evidence that claimant needed help to accomplish activities in daily living.

Record failed to support ALJ’s denial of claimant’s application for Social Security disability benefits based on her degenerative disc disease, asthma and obesity. While ALJ did not err in declining to give treating physician’s 4-hour shift restriction conclusive weight on question of claimant’s disability since there was other medical evidence that cast doubt on validity of said restriction, ALJ erred in finding that claimant was not credible with respect to her subjective accounts of pain, where said finding was based upon her ability to perform daily life chores and/or her statement to her treating physician that she was looking for work. As such, claimant was entitled to remand for reconsideration of her claim.

Record contained sufficient evidence to support ALJ’s denial of claimant’s application to renew his disability benefits based on his severe learning disability. While ALJ acknowledged that claimant could not do many jobs that required interaction with public or that demanded that claimant receive only oral instructions from his supervisor, ALJ could properly find that claimant’s medical condition had sufficiently improved so that he could do simple jobs that did not require interaction with public and allowed supervisor to demonstrate task before it was assigned to him. Moreover, ALJ was not required to accept contrary opinion from claimant’s expert who was hired by claimant’s counsel to bolster claimant’s claim for benefits, where expert did not treat claimant, and where expert’s most recent opinion was inconsistent with his prior opinions and opinions of other doctors. ALJ also properly noted that claimant lived by himself while pursuing college degree and performed delivery services for flower shop, which supported finding that claimant could perform jobs such as car washer or kitchen helper.

Dist. Ct. erred in dismissing for failure to state valid cause of action plaintiffs' ERISA action alleging that defendant-as trustee of plaintiffs’ employee stock ownership plan (ESOP) breached its fiduciary duty and engaged in prohibited transactions by purchasing privately-held company stock for ESOP at inflated price and financing said purchase under circumstances where plaintiffs incurred substantial losses arising out of said transactions. Although Dist. Ct. found that plaintiffs failed to sufficiently plead breach of duty by asserting special circumstances surrounding instant purchase and financing of said stock, record showed that instant purchase and financing were prohibited transactions under section 406(a) of ERISA, and as such, plaintiffs were not required to allege absence of adequate consideration or unreasonableness of interest rate on loan. Moreover, plaintiffs were not required to plead absence of any section 408 exemptions to instant prohibited transactions, since such exemptions are essentially affirmative defenses that must be pleaded by defendant. Also, plaintiffs alleged viable breach of fiduciary action, where they asserted that defendant either failed to conduct adequate inquiry into proper valuation of stock or by intentionally facilitating improper transaction.

Dist. Ct. did not err in granting defendant-pension fund’s motion for summary judgment in plaintiff’s ERISA action alleging that defendant improperly failed to include $2,500 quarterly payments plaintiff received for his duties on union’s Executive Board when calculating his pension benefits. Record showed that plaintiff obtained regular weekly salary as business representative of union, and terms of pension fund excluded from definition of “compensation,” “non-wage” payments even if such payments are considered income for tax purposes. Moreover, plan administrator found that plaintiff’s payments for his Executive Board duties were more akin to “stipend” that was not wage payment, and Ct. of Appeals found under standard of deference owed to plan administrator, that administrator’s interpretation of plan’s language was not arbitrary or capricious, especially where payments for plaintiff’s Executive Board duties were not included in his weekly wage payments and were given different payment code.

Ct. of Appeals vacated ALJ’s denial of claimant’s 2004 application for Social Security disability benefits, where: (1) Ct. of Appeals had invalidated original 2006 denial of said application, after finding, in light of claimant’s several physical impairments that would limit her to only sedentary work, that ALJ had failed to ask vocational expert (with respect to claimant’s depression) to assess how claimant’s employment prospects would be affected by her moderate limitation on concentration, persistence and pace, and had improperly ignored psychologist’s opinion that claimant faced moderate limitation on her ability to accept instruction from supervisors. Instead of making said supplemental inquiries, another ALJ, in similarly denying instant application for benefits, found that claimant’s depression was not severe impairment. Ct. of Appeals, though, concluded that said finding was inconsistent with overwhelming medical evidence from treating doctor, who diagnosed claimant with “major depression, recurrent severe,” as well as opinions of other treating doctors, who consistently gave claimant GAF scores of between 50 to 55 based upon her depression. As such, remand was required for determination as to what limitations are caused by claimant’s major depression condition, and what effect said condition has on claimant’s employment prospects.

Record failed to contain sufficient evidence to support ALJ’s denial of social security disability benefits, where claimant alleged that conditions in his arm and groin, as well as certain gastrointestinal conditions, caused him pain that precluded him from obtaining work. ALJ improperly believed that claimant was malingerer, where claimant had significant work history both before and after his first injury to his arm/elbow, and further failed to provide reasoned basis to ignore consulting physician’s opinion that claimant could not stand or sit for significant periods of time, and that claimant’s condition was unlikely to improve.

Dist. Ct. did not err in finding that defendant was liable to plaintiffs-employee participants in ESOP created by defendant, where defendant had breached his fiduciary duty to plaintiffs by orchestrating purchase of company stock (that had been controlled by defendant) at inflated prices with ESOP funds under circumstances that resulted in said stock becoming subsequently worthless. Ct. rejected defendant’s claim that Dist. Ct. violated ERISA by directing him to indemnify other defendants who played minor role in said purchase, since, under Free, 732 F.2d 1331, Dist. Ct.’s remedial authority under ERISA includes indemnification and contribution. Moreover, said order was proper, even though defendant was not named trustee of relevant ESOP, since defendant exercised control over trustees of ESOP and functionally acted in fiduciary capacity. Ct. also held that defendant could properly be required to pay $7,803,534 to subclass of plaintiffs, which represented loss of value of their ESOP accounts, as well as $6,473,850.32 to main class of plaintiffs, which represented amount plaintiffs’ ESOP overpaid for company stock, minus percentage representing interests that subclass had already received.

Record failed to support ALJ’s denial of claimant’s application for SSI benefits on ground that she was intellectually disabled from full-time gainful employment. Record showed that claimant had 75 IQ score, which was within relevant intellectual disability range, that claimant finished high school at 4^th and 5^th grade levels and needed help with bathing, dressing and taking medications while living with her mother. Moreover, one psychologist testified that claimant had significant learning disability and had markedly diminished working memory. Fact that another psychologist concluded that plaintiff could carry out simple tasks did not provide meaningful support for instant denial, where said psychologist, who did not interview claimant, did not explain basis for said opinion. Also, fact that claimant could play video games did not support ALJ’s conjecture that claimant, who had never held job, could learn new job-related tasks, and vocational expert failed to explain source of her opinion that claimant could work as cleaner or factory worker.