{"id":7441,"date":"2020-04-06T21:24:17","date_gmt":"2020-04-07T02:24:17","guid":{"rendered":"https:\/\/www.nickortizlaw.com\/?p=7441"},"modified":"2024-01-04T17:38:54","modified_gmt":"2024-01-04T22:38:54","slug":"hounihan-v-aetna-court-rules-claimant-isnt-totally-disabled","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/hounihan-v-aetna-court-rules-claimant-isnt-totally-disabled\/","title":{"rendered":"Hounihan v. Aetna – Court Rules Claimant Isn’t Totally Disabled"},"content":{"rendered":"
Charlie Craig Hounihan (\u201cHounihan\u201d) was a technician who was employed by Proctor and Gamble (\u201cP&G\u201d) on the Bounty paper towel line at a plant in Cape Girardeau, Missouri. Through his employment with P&G, Hounihan was covered under both short term and long term disability<\/a> benefit plans with Aetna<\/a>. The Proctor & Gamble Disability Committee (\u201cDisability Committee\u201d) is the fiduciary of the plan and has the final say for reviewing and making appeal decisions related to claims made under the plan. The plan\u2019s requirements include the possibility of having to participate in an independent medical examination<\/a>\u00a0and\/or a functional capacity evaluation.<\/p>\n The plan further states that the claimant has the burden of proving he is disabled. If there is a period during which the claimant does not submit sufficient proof of disability, he will not be paid for that time period. Additionally, \u201cpartial disability\u201d and \u201ctotal disability\u201d must also be supported by\u00a0objective evidence. The plan itself defines the following:<\/p>\n \u201c\u2018Total Disability\u2019 means a mental or physical condition resulting from an illness or injury which is generally considered totally disabling by the medical profession and for which the participant is receiving regular recognizable 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.\u201d<\/p><\/blockquote>\n The plan goes on to explain:<\/p>\n \u201c\u2018Partial Disability\u2019 means 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 job, but can perform other roles at the same site or 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.\u201d<\/p><\/blockquote>\n Partial disability is further limited to a maximum of 52 weeks under the plan\u2019s provisions.<\/p>\n During 2012, Hounihan started to develop severe pain in his hip and knee. Soon after, Robert Tipton, M.D., prevented Hounihan from returning to work. On September 19, 2012, Hounihan began to receive total disability benefits. Jimmy Bowen, M.D., began treating Hounihan for pain radiating in the right hip, lower back, and buttocks. By January 2013, Dr. Bowen allowed Hounihan to return to work with light work restrictions. However, the department that Hounihan was employed in did not have work that could accommodate his restrictions. This led to the receipt of partial disability payments starting on January 10, 2013. By February 2013, Hounihan was classified as totally disabled.<\/p>\n The following May, David King, M.D., diagnosed Hounihan with a labral tear with parent label cyst and a femoral acetabular impingement. Hounihan then had an acetabulosplasty for impingement with labral tear repair and a right hip arthroscopic femoroplasty. On June 22, he was brought to the hospital with a right hip infection. This required Kurt Merkel, M.D. to perform an emergency irrigation and debridement of the right hip. After this surgery, Hounihan still had pain in his right hip area. He then had aspirations of the hip and additional irrigation and debridement procedures.<\/p>\n In April of 2015, Hounihan had a total hip replacement<\/a> and began seeing Christopher Mudd, M.D. Dr. Mudd believed that the original hip surgery\u2019s infection had never been resolved and that Hounihan would need to have his hip implant taken out. On May 6, he had this implant removed and had further irrigation and debridement. By December, Hounihan had another total right hip replacement done. The final count for procedures on his hip was 17 over the period of 2013 to 2016.<\/p>\n