United States District Court, D. Massachusetts
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 ...