Ryan v. The Procter & Gamble Company

UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF OHIO

WESTERN DIVISION

ROBERT RYAN,

Plaintiff,

Case No. 1:20-cv-556

v. JUDGE DOUGLAS R. COLE

THE PROCTER & GAMBLE

U.S. BUSINESS SERVICES

COMPANY,

Defendant.

OPINION AND ORDER

In recent years, Robert Ryan had wrist and knee injuries—and resulting

surgeries. His employer-sponsored health plan from Procter & Gamble offered him

only limited partial disability benefits, so he administratively appealed—and

eventually sued—seeking more. In Ryan’s view, he is Totally Disabled under the

benefit plan’s definition of that term. Unfortunately for him, several doctors and the

plan’s administrator disagree. In this suit, he asks the Court to reject the doctors’

view and find him Totally Disabled. Both parties now move for Judgment on the

Administrative Record. (See Docs. 16, 17). For the reasons discussed below, the Court

GRANTS the Defendant’s Motion (Doc. 16) and DENIES Ryan’s Motion (Doc. 17).

BACKGROUND

Ryan used to work for Procter & Gamble. (Doc. 6, #17). There, he participated

in The Procter & Gamble Health & Long-Term Disability Plan (“Plan”). (Id.). The

Plan provides several benefits to company employees, including short and long-term

disability benefits, total disability benefits, and partial disability benefits. (See

generally Doc. 14-1).

As one might imagine, many relevant terms in the Plan have complex

definitions. Relevant today, “Total Disability” is

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. at #164). And perhaps not surprisingly, “Totally Disabled” means “a person who

has a Total Disability.” (Id.). The Plan explicitly requires the claimant to establish

that they are disabled. (Id.). That obligation is continuous, with physician

certifications normally needed each month. (Id.).

Procter & Gamble itself does not run the Plan. That responsibility instead falls

to the plan administrator. (Id. at #154). Here, that administrator is The Procter &

Gamble U.S. Business Services Company, the Defendant (“P&G”). (Id.). The plan

administrator has all “the power, responsibility, and discretionary authority

necessary to carry out the administration” of the Plan. (Id. at #114).

All this matters because, in late 2015, Ryan fell while working in his yard and

injured his left wrist. (Id. at #285). The fall left him in significant pain and reduced

his range of motion to the point that, a few weeks later, he still complained of pain

that made it hard for him to move multiple fingers. (Id. at #283). He began receiving

disability benefits in early November. (Doc. 6, #18). That next March, he had wrist

fusion surgery. (Doc. 14-1, #345). Then, in June, Dr. Nathan Schroeder cleared him

to work full-time performing work in the “Sedentary Physical Demand Category.” (Id.

at #239). In the following months, Dr. Samir Mahesh Patel noted improvement in

Ryan’s wrist multiple times. By October 2016, Patel cleared Ryan to lift up to fifteen

pounds and work eight hours per day but noted that Ryan still had some pain a couple

of months later. (Id. at #268–72).

In March 2017, Ryan had a second surgery, this time to remove hardware from

the previous surgery. (Id. at #476). In September, Ryan saw Dr. Peter J. Stern. Ryan

still complained of some pain then, so Dr. Stern assigned him a twenty-five-pound

lifting restriction. (Id. at #303–04). Dr. Stern also noted that Ryan had “not been told

that he may not be able to return to work.” (Id. at #304).

Against that backdrop, Ryan applied for Total Disability benefits. On

September 26, 2017, the Lima Review Board, a local board with authority to review

and decide both initial and continuing claims under the Plan, notified Ryan that it

had determined him to be Partially Disabled rather than Totally Disabled. (Id. at

#433). The Lima Review Board noted that Ryan’s “treating physician indicated that

[he] could return to work” with some restrictions. (Id. at #434). Based on that

determination, Ryan began receiving Partial Disability benefits for the fifty-two-week

period the Plan specified. That meant his benefits would last him until September

18, 2018. (Id. at #430). Ryan appealed this decision; more on that later.

In mid-to-late 2018, Ryan also started having knee pain and sought treatment.

(Id. at #214). On August 8, 2018, Dr. Salim Hanna noted that Ryan’s wrist “has been

his biggest problem” but that he now had knee pain from “catching clicking and

grinding.” (Id.). Ryan could not identify any event that could have caused his

newfound knee issues. (Id. at #207). At the end of October, Ryan had surgery to fix

his knee trouble. (Id. at #200). After that, Dr. Joseph R. Misson remarked that the

goal would be to “get [Ryan] back to work with some sort of light duty.” (Id. at #198).

Dr. Misson approved him for light duty with restrictions in late November. (Id. at

#196).

On December 14, 2018, Ryan appealed the Lima Review Board’s decision to

award him only partially disabled status. (Id. at #315). As part of that appeal, Dr.

Elliot Ames reviewed all available records. Dr. Ames concluded that “the objective

medical information does not support” Total Disability and that Ryan could return to

work “in any capacity” with the listed restrictions. (Id. at #555). He did not, however,

examine Ryan at any time. Based on Dr. Ames’s conclusions, the Disability

Committee denied Ryan’s appeal. (Id. at #563).

After losing his appeal, Ryan sued in this Court. Both parties believe they are

entitled to judgment on the administrative record and have moved accordingly. (See

Docs. 16, 17).

LAW AND ANALYSIS

As noted, the plan administrator denied Ryan’s appeal. When, as here, a plan

administrator had the authority to initially determine a claimant’s eligibility for

benefits, the Court reviews that decision in an appellate posture, “only to determine

if [the determination] was arbitrary and capricious.”1 Marks v. Newcourt Credit Grp.,

Inc., 342 F.3d 444, 456–57 (6th Cir. 2003) (cleaned up).

This standard is “extremely deferential.” McClain v. Eaton Corp. Disability

Plan, 740 F.3d 1059, 1064 (6th Cir. 2014). And it is “the least demanding form of

judicial review.” Lloyd v. Procter & Gamble Disability Benefit Plan, Plan #501, No.

20-4329, 2021 WL 4026683, at *6 (6th Cir. Sept. 3, 2021) (citation omitted). Indeed,

the Court will overturn the plan administrator only if the decision was “not just

clearly incorrect but downright unreasonable.” Kenny v. Gen. Motors Corp., 24 F.

App’x 330, 332 (6th Cir. 2001) (citation omitted).

Ryan contends that P&G’s decision was arbitrary and capricious largely

because the administrator did not adequately assess his subjective complaints. He

also believes that he is totally disabled. P&G, for its part, stands by the decision (and

the resulting appellate process), believing there to be ample evidence that Ryan is not

totally disabled. P&G also believes that Ryan has not offered evidence showing his

total disability.

P&G has the better argument here. The relevant decision was not arbitrary

and capricious. And nothing Ryan put into the record amounts to evidence that the

decision was “downright unreasonable.”

To start, the evidence reflects that no doctor has declared Ryan Totally

Disabled since he was declared only Partially Disabled. Not even his own treating

1 Both the Plan itself and published Sixth Circuit case law confirm this. (See Doc. 14-1, #114

(granting “discretionary authority” to the Plan Administrator to “[i]nterpret the Plan[] and

decide all matters arising under [it]”)); see also Lloyd v. Procter & Gamble Disability Benefit

Plan, Plan #501, No. 20-4329, 2021 WL 4026683, at *15 (6th Cir. Sept. 3, 2021).

physicians consider him Totally Disabled. Cf. Kenny, 24 F. App’x at 331 (upholding a

district court’s affirmance of an administrator as not arbitrary and capricious even

when the plaintiff’s treating physician found a total disability and the administrator

did not).

Ryan complains that “it is of extreme importance to note” that he has struggled

lifting packages and sitting for a long time. (Doc. 17, #596). But that alone does not

evince Total Disability under the Plan’s definition. It may well show Partial

Disability, but it is not hard to imagine gainful work that Ryan could perform that

does not involve lifting heavy packages or sitting for multiple hours on end.

Ryan’s belief that the process did not adequately account for his subjective

complaints is equally meritless. To support this claim, he cites Tanner v. Nationwide

Mut. Ins. Co., 804 F. Supp. 2d 601 (S.D. Ohio 2011), where the district court found

the plan administrator acted in an arbitrary and capricious manner. But the facts

here do not resemble Tanner. There, for example, the plan administrator did not seem

to address a treating physician’s opinion “at all.” See id. at 614. And the plan

administrator in Tanner required the claimant to provide objective evidence

sufficient, in and of itself, to establish the disability. Id. at 612. True, Dr. Ames noted

that he did not believe the objective evidence supported a finding of Total Disability.

But the Court does not read that as meaning that Dr. Ames believed Ryan was

required to establish his claimed disability solely by reference to such evidence. And

here, unlike in Tanner, Dr. Ames reviewed Ryan’s entire file as part of his original

appeal, including statements submitted by several doctors. Admittedly, Dr. Ames did

not see Ryan directly, but that cannot be the end-all, be-all.

No physician who has considered Ryan’s ability to go back to work (or lack

thereof) has found him Totally Disabled. Perhaps Dr. Hanna comes closest. But Dr.

Ames concluded Dr. Hanna’s comments did not even support “lifetime restrictions,”

let alone Total Disability. (Doc. 14-1, #558). While Ryan’s subjective complaints about

his pain are no doubt relevant to the conversation, the Court declines any invitation

to overturn the plan administrator’s findings as arbitrary and capricious, especially

without even one physician, treating or otherwise, opining that it would be

appropriate to do so.

In a final appeal, Ryan stresses that the Plan’s definition of Total Disability

uses adverbs like “injury that is generally considered totally disabling” and “[u]sually,

total disability” requires hospitalization or home care. (See Doc. 19, #613–14

(emphasis original)). Ryan is right that those words serve as qualifiers. And they do

contemplate the possibility that someone could have an injury or condition, for

example, that did not require hospitalization or immediate home confinement but

still amounted to Total Disability. But that is not the case here. Ryan may well

require some restrictions in his future employment. That does not make him Totally

Disabled, though. Nor does it show that the plan administrator’s decision is arbitrary

and capricious, which is all the Court need decide here.

CONCLUSION

The plan administrator’s decision was neither arbitrary nor capricious. So the

Court GRANTS the Defendant’s Motion for Judgment as a Matter of Law on the

Administrative Record (Doc. 16) and DENIES Ryan’s Motion for the same (Doc. 17).

The Court ORDERS the Clerk to enter judgment for the Defendant and

TERMINATE the case on the Court’s docket.

SO ORDERED.

June 26, 2023

DATE DOUGLAS R. COLE

UNITED STATES DISTRICT JUDGE