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Wilce v. Proctor & Gamble Disability Benefit Plan

September 11, 2008

WENDY WILCE, PLAINTIFF,
v.
THE PROCTOR & GAMBLE DISABILITY BENEFIT PLAN, DEFENDANT.



The opinion of the court was delivered by: Judge Caputo

MEMORANDUM

Presently before the Court are the motions for summary judgment of Plaintiff Wendy Wilce (Doc. 11) and of Defendant The Proctor & Gamble Disability Benefit Plan ("The Plan") (Doc. 14). Because there is no question of material fact that the Defendant did not act arbitrarily and capriciously when terminating Plaintiff's long-term disability benefits, the Court grants Defendant's motion for summary judgment and denies Plaintiff's motion for summary judgment. The Court has jurisdiction over this matter pursuant to 28 U.S.C. § 1331 ("federal question jurisdiction").

BACKGROUND

Plaintiff Wendy Wilce initiated this action on April 24, 2007 under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §1001 et. seq., to challenge the September 21, 2005 termination of her total disability benefits by the Defendant, The Proctor & Gamble ("P&G") Disability Benefit Plan. In her complaint, the Plaintiff alleged that the Defendant "acted arbitrarily and capriciously in denying Plaintiff's total disability benefits," that the Defendant's role as both insurer and Administrator created a conflict of interest sufficient to rescind their discretionary authority, and that Defendant breached its fiduciary duties by delaying resolution of Plaintiff's administrative appeals and by failing to consider the opinions of Plaintiff's physicians. (Pl.'s Complaint, Doc. 1, ¶¶ 15-18.)

On November 30, 2007, Plaintiff filed her Motion for Summary Judgment (Doc. 11) along with a corresponding brief (Doc. 13) and statements of fact (Doc. 12).On December 3, 2007, the Defendant filed its own Motion for Summary Judgment (Doc. 14) with supporting brief (Doc. 17) and statements of fact (Doc. 15).*fn1 On December 18, 2007, Defendant filed its Brief in Opposition to Plaintiff's Motion for Summary Judgment (Doc. 20) along with Defendant's Reply to Plaintiff's Statement of Material Facts (Doc. 19). While these motions were under consideration by the Court, The United States Supreme Court decided Metropolitan Life Insurance Co. v. Glenn, 128 S.Ct. 2343 (2008). Since Glenn bears on the questions before the Court, both parties were permitted to file supplemental briefs addressing the decision's applicability in the current case and they did so on July 31, 2008. Since the parties' summary judgment motions have now been fully briefed, the motions are now ripe for disposition.

I. The P&G Disability Benefit Plan

The P&G Disability Plan ("the Plan") provides benefits for both partially and totally disabled participants for up to fifty-two (52) weeks. (Def.'s Statement of Material Facts ["Def.'s Statement"] ¶ 3.) These benefits are funded by employee contributions and are administered by a four person Board of Trustees. (Id.) Two members of the Board are appointed by P&G, one member is appointed by a Reviewing Board, and the fourth member is appointed by the other Trustees. (Id.; The Proctor & Gamble Disability Benefit Plan ["Plan Document"], Doc. 18, Ex. B, at P&G/WILCE 000202-09.) During this initial fifty-two week period disabled Plan participants are entitled to sixty-six and two-thirds percent (66 2/3%) of their weekly salary at the time they ceased working. (Pl.'s Brief in Support of Motion for Summary Judgment ["Pl.'s Brief in Support"], Doc. 13, at 1-2.) Plan participants who are partially disabled, but not totally disabled, are limited to this fifty-two week period for the receipt of benefits. (Def.'s Statement ¶ 4; Plan Document, at P&G/WILCE 000206.)

Participants who continue to be totally disabled at the end of the fifty-two week period become entitled to benefits paid through the Proctor & Gamble Long-Term Disability Allowance Policy ("LTD Plan"). (Def.'s Statement ¶ 4; Plan Document, at P&G/WILCE 000211; 2006 Summary Plan Description ["LTD Plan Description"], Doc. 18, Ex. D, at P&G/WILCE 000250.) Participants qualifying for continuation of payments beyond the initial fifty-two week period are entitled to payments of fifty percent (50%) of their weekly salary at the time they ceased working. (Pl.'s Brief in Support, at 2.) The LTD Plan benefits are paid through a Trust that is funded by P&G. (Def.'s Statement ¶ 5; Plan Document, at P&G/WILCE 000208; LTD Plan Description, at P&G/WILCE 000261-262.) Two P&G appointed Trustees are responsible for administration of the LTD Plan. (Def.'s Statement ¶ 5; LTD Plan Description, at P&G/WILCE 000261-262.)

The Trustees of both the Disability Plan and the LTD Plan have discretion to determine benefits eligibility and interpretation of the respective plans. (Def.'s Statement ¶ 7; Plan Document, at P&G/WILCE 000208; LTD Plan Description, at P&G/WILCE 000259.) Plan participants seeking benefits first submit claims to a Reviewing Board responsible for investigating the claim and making a recommendation to the Board of Trustees. (Def.'s Statement ¶ 8; Plan Document, at P&G/WILCE 000208-209.) The Reviewing Board at the Mehoopany plant where Plaintiff was employed consists of four members. Three of these members are elected by employees participating in the plan and the fourth member is appointed by the Board of Trustees. (Id.)

The P&G Disability Plan defines "partial disability" as: a mental or physical condition resulting from an illness or injury because of which the participant cannot perform regular duties but can perform other useful duties. Thus, a condition of Partial Disability does not necessarily prevent the Participant from performing useful tasks, utilizing public or private transportation or taking part in social or business activities outside the home.

(Plan Document, at P&G/WILCE 000197.) The Disability Plan, likewise, defines "total disability" as: a mental or physical condition resulting from an illness or injury which is generally considered totally disabling by the medical profession. 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. (Plan Document, at P&G/WILCE 000199.)The LTD plan adopts the same definition of total disability. (LTD Plan Description, at P&G/WILCE 000263.)

II. Plaintiff's Employment, Medical & Benefits History

In December 1984, Plaintiff Wendy Wilce began her employment with The Proctor and Gamble Paper Products Company ("P&G") at its Mehoopany, Pennsylvania plant. (Pl.'s Statement of Material Facts ["Pl.'s Statement"], Doc. 12 ¶ 2; Def.'s Reply to Pl.'s Statement of Material Facts ["Def.'s Counterstatement"], Doc. 19 ¶ 2; Def.'s Statement ¶ 1.) During her employment with P&G, Plaintiff was a participant in a long term disability plan sponsored by P&G and maintained by Defendant, The Proctor & Gamble Disability Benefit Plan. (Pl.'s Statement ¶ 3; Def.'s Counterstatement ¶ 3; Def.'s Statement ¶ 2.)

In a letter dated February 13, 2006, Sean McCall, M.D., Plaintiff's physician since 2002, listed the Plaintiff's diagnoses while under his care as:

IGA, Anemia of chronic disease; asthma; hypertension; depression; morbid obesity; lifelong prednisone therapy; rotator cuff syndrome [in] right shoulder; lumbar disc disease; dyslipidemia; pulmonary embolism with unknown cause; severe ankle deformities requiring braces for stability and ambulation; history of CVA; seizure disorder; thoracic disc protrusion; lifelong Coumadin therapy; obstructive sleep apnea; history of DVT; bilateral knee osteoarthritis which most likely will need replacement in the future. (Joint App'x., Doc. 18, Ex. A, at P&G/WILCE 000121.) Dr. McCall further stated that the Plaintiff was "unable to do anything the least bit physically demanding on her job. [...] She is also unable to do any office work with any prolonged effort secondary to back pain." (Id.)

Due to her various medical conditions, Plaintiff received partial disability payments under the plan from January 9, 2003 through February 4, 2003. (Id., at P&G/WILCE 000173.) On April 28, 2004, the Plaintiff ceased active employment with P&G and began receiving benefit payments from the Plan as a totally disabled participant as of April 30, 2004. (Id.) On October 8, 2004, the Plaintiff underwent an Independent Medical Evaluation ("IME") at the request of Defendant and was examined by Michael D. Wolk, M.D.. (Id., at P&G/WILCE 000175-180.) In his evaluation, Dr. Wolk noted that "certainly there would be no reason why [Plaintiff] would not be capable of returning to a sedentary type of position." (Id., at P&G/WILCE 000180.) Based on Dr. Wolk's evaluation, the Mehoopany Disability Review Board recommended that Plaintiff return to partial disability status effective October 8, 2004. (Id., at ...


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