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Kaiser Beats Doctor in|Long-Term Benefits Case

SAN FRANCISCO (CN) - A former Kaiser doctor waived his right to long-term medical benefits during arbitration of a wrongful-termination lawsuit, a federal judge ruled.

Thomas Gonda, a retired cardiothoracic surgeon, was hit by a car in 2003 while riding a Segway. His head injury caused double vision, headaches, memory loss and difficulty focusing on tasks.

Despite surgery to evacuate subdural hematomas, Gonda continued to have episodes of confusion for several years. The head injury intensified his alcohol and drug use, according to U.S. District Judge Samuel Conti's summary of the case in his Feb. 17 ruling.

Gonda completed a substance abuse treatment program in 2007, but Kaiser refused to allow him to return to work and fired him.

Gonda filed wrongful termination lawsuits against Kaiser in state court, which were consolidated and arbitrated.

Gonda also applied for benefits under the Employee Retirement Income Security Act (ERISA) and received them from 2008 to October 2010, when he was notified they would be cut off.

Gonda sued the Permanente Medical Group and its plan, the Long Term Disability Plan for Physicians in March 2011, seeking benefits and damages for breach of fiduciary duty.

Kaiser sought summary judgment, claiming Gonda had waived his right to benefits under ERISA in the previous settlement agreement.

Judge Conti allowed Kaiser leave to amend its answer, which was filed on Feb. 10.

In response, Gonda claimed that the settlement agreement had been "superseded by agreements that are later in time and more specific than the release contained in the settlement agreement. LINA's [Life Insurance Company of North America] willingness to consider [his] appeals constituted a superseding agreement that his ERISA claims had not been released," Gonda said.

Conti said that doesn't matter - that Kaiser retained the right to use the settlement agreement as an affirmative answer to the complaint.

"LINA's decision not to use the settlement agreement as a basis for denying benefits during Dr. Gonda's administrative appeals does not preclude assertion of the settlement agreement as an affirmative defense in this action," Conti wrote in a 26-page order. "It is unclear how LINA's willingness to hear Dr. Gonda's internal appeals could affect TPMG [The Permanente Medical Group] or the TPMG Plan's contractual rights under the settlement agreement. LINA is not a party to this lawsuit, and it was not a party to the settlement agreement. Dr. Gonda cites no authority for the proposition that a non-party (or even a party, for that matter) to a contract can waive another party's rights."

The judge added that even if the medical group, instead of LINA, had agreed to let Gonda appeal, it would not have served as a waiver of his release in the original agreement.

Conti shot down several of Gonda's other arguments, including his arguments for judicial estoppel, governing law, application of the TPMG Plan and that Kaiser's motion for summary judgment was premature.

"Dr. Gonda has failed to show that the facts he seeks, if they exist, would prevent summary judgment," Conti wrote.

Gonda also argued that he did not knowingly voluntarily waive his ERISA benefits, a claim Conti rejected.

"In this case, the plaintiff is highly educated," Conti wrote. "In fact, Dr. Gonda was represented by counsel who fully explained the settlement agreement to him, and Dr. Gonda acknowledged his understanding of the agreement and its implications. Additionally, the parties agreed that the consideration paid to Dr. Gonda was 'compensation for alleged losses, injuries, legal and medical expenses," and Dr. Gonda 'acknowledged and agreed that he would not be entitled to receive the settlement sum if he did not make the promises that he is making in this agreement.'"

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