Hammond v. Procter & Gamble Health and Long Term Disability Plan

          MEMORANDUM AND ORDER ON DEFENDANT'S MOTION FOR SUMMARY JUDGMENT

          RICHARD G. STEARNS UNITED STATES DISTRICT JUDGE

         Pro se plaintiff Donald Hammond brought this action under section 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1132, seeking review of defendant Proctor & Gamble Health and Long Term Disability Plan's (P&G Health) denial of benefits under a long-term disability insurance plan sponsored by his former employer, the Proctor & Gamble Company (P&G Company). Hammond claims that P&G Health arbitrarily and capriciously determined that he was only partially, and not totally, disabled within the meaning of the plan and was therefore ineligible to receive disability income benefits beyond the fifty-two-week lifetime limit set for partial disability. Because there is substantial evidence in the administrative record (A.R.) to support its ineligibility determination, P&G Health's motion for summary judgment will be allowed.

         BACKGROUND

         Hammond began his employment with the P&G Company on April 23, 1979, as a production mechanic for the Gillette Company^[1] working 12-hour shifts alternating between three or four days per week. In the relevant time frame, Hammond participated in employee short term disability (STD) and long-term disability (LTD) plans provided by P&G Company. Effective beginning on July 1, 2014, the P&G Disability Benefit Plan and the P&G Health and Long-Term Disability Plan provided STD and LTD benefits respectively. On April 1, 2017, P&G Company consolidated the two 2014 plans into the P&G Health and Long-Term Disability Plan (collectively with the 2014 plans, Benefit Plans).

         Plan Terms and Conditions

         Under the Benefit Plans, a participant may receive STD benefits of two-thirds pay up to 52 weeks for “disability due to qualifying off-the-job illness, injury, pregnancy, or childbirth.” A.R. (Dkt # 26) at 737. For disabilities beyond 52 weeks, LTD provides half-pay and “may be paid until age 65.” Id.

         In addition, the Benefit Plans set a 52-week maximum lifetime benefit for a participant determined to be “Partially Disabled.” A Partial Disability is

a mental or physical condition resulting from an illness or injury because of which the participant is receiving medical treatment and cannot perform the regular duties of his or her current job but can perform other useful roles at the same Company site or at other jobs outside the Company. Thus, a partially disabled participant is not necessarily prevented from performing useful tasks, utilizing public or private transportation, or taking part in social or business activities outside the home.

Id. at 303. In contrast, no lifetime limit applies to a “Totally Disabled” participant. Total Disability is defined

as a mental or physical condition resulting from an illness or injury that is generally considered totally disabling by the medical profession and for which the participant is receiving regular recognized treatment by a qualified medical professional. Usually, total disability involves a condition of such severity as to require care in a hospital or restriction to the immediate confines of the home.

Id.

         Hammond's Medical and Claims History

         Hammond suffers from a history of plantar fasciitis and peroneal tendinitis of the right foot, which were first diagnosed in 2012 and 2014, respectively. In April of 2015, Hammond's physician, Dr. Michael Tremblay, diagnosed a calcaneal spur and plantar facial fibromatosis of the right foot. Hammond's condition caused him to take a brief leave of absence, followed by a period of part-time work in May of 2015, before he returned to his regular work schedule on June 1, 2015. On May 5, 2015, Hammond applied for and received STD pay. In September of 2015, he suffered a relapse and returned to working part-time shifts, again with STD pay. P&G Health made no determination as to Hammond's disability status at this time.

         Hammond met with his treating podiatrist, Dr. Timothy Curran, seven times for diagnosis and treatment between his relapse in September of 2015 and June of 2016. Following each of the seven appointments, Dr. Curran diagnosed Hammond with either plantar fasciitis or peroneal tendinitis of the right foot and recommended that Hammond restrict his work to six or eight hours per day.^[2] Hammond also received a second opinion from an orthopedic surgeon, Dr. Eric Bluman, in May and June of 2016. He diagnosed Hammond with peroneal tendinitis, placed him first in a “tall ...