Jeffrey Dahl NFL and ERISA

114 Journal of Consumer & Commercial Law

Disabled Players Thrown for Another Loss

By Jeffrey Dahl*

THE NFL AND ERISA

Journal of Consumer & Commercial Law 115

INTRODUCTION Retiredprofessionalfootballplay-ers face a daunting challenge whentryingtoobtainfootball-relateddisabilitybenefitsfromtheNFL,evenwhenthegreaterweightoftheevidencesupportstheirclaim.ThisisduetotheEmployeeRetire-ment IncomeSecurityActof1974(knownbytheacro-nymERISA)andthefederalcourtdecisionsof the last35yearsthathaveinterpretedit,combinedwithdisabil-ityplantermsthatgiveadvantagetothosedenyingtheclaimandthewillingnessofdecision-makerstoexploitthe leverageERISAhasofferedthem. AlthoughotheremployeesintheprivatesectorfacethesamehazardsandhurdlesofERISA,claimsofformerNFLplayershelphighlightthesignificantshortcomingsofthelaw.

THE NFL, CONCUSSIONS, AND ERISAThe long-term health effects of concussions suffered by NFLplayershasrecentlygarneredsignificantattention. Consideringthatconcussionsarecommoninmanycontactsports,andhaveoccurred intheNFLsince its formationin1920,seriousstudyandpublicdiscussionoftheirpotentialtocauseseriouslong-terminjuryhavebeen longoverdue. Intheolddays, theywere justcalled“dingers”or“havingyourbellrung”andusuallynothingmorewassaidaboutit.Theconsumerdemandforanentertain-mentproductthatincludedbone-crunchinghitsandtacklesandtheneedtohavethebestplayersonthefieldcausedthosethatownedandmanagedtheNFL,themostprofitablesportsbusinessintheworld,toavoidseriousstudyanddiscussionsofthelong-termeffectsofheadtrauma.Thewarriormentalityoftheplayersenabledthelongsilence,asmostlearnedatanearlyagetoequatecomplainingwithweakness.Beingthebestoftenrequiredhavingahighpainthresholdandkeepingquietabouttemporaryblurredvisionandfuzzy-headedness. Thereisadifferentbutintertwinedharmtoplayerswhosubmit a claim for disability benefits to the NFL, a subtle butsignificantharmthatdoesnotgrabanyheadlines.TheNFLdis-abilityplan(containedintwodocuments,theNFLRetirementPlanandasupplementaldisabilityplan) isanERISAplanthatprovidestheNFLRetirementBoarddiscretiontomakedisabilitybenefitdecisions. Thismeans:1)thatthescalesof justiceare

tiltedinfavoroftheNFL,i.e.acourtisrequiredtodefertoadis-abilitydecisionmadebytheNFLRetirementBoardandcanonlyreversetheNFLBoard’sdecision’sifitisfoundtobeanabuseofthatdiscretion,and2)thereisnolegalremedybeyondgettingthebenefitsthataredue,meaningthereislittleornodownsideinde-layinganddenyingvalidfootball-relateddisabilitybenefitclaims.

GENE ATKINS ThingsusedtobedifferentforGeneAtkins.Bythetimehewas eight years old, hebelievedhewouldbecome aprofes-sionalfootballplayer.GenegrewuponOrangeAvenue,intheSouthCityareaofTallahassee,Florida.HisfathersoldfurnitureataretailstoreinTallahasseeandhismotherstayedathomeandlookedaftertheirninechildren.Gene,thesecondyoungest,at-tendedRickardsHighSchoolinTallahassee,atoughschoolwheremanyofthekidsraningangs.AtRickardsGeneplayedfootball,baseball,andrantrack.Althoughdyslexic,Genepersevered.Hewouldnotonlygraduatefromhighschoolbutcollegeaswell. Atkins received a number of scholarship offers andelectedtoplayfootballatFloridaA&MinTallahassee,wherehebecameacollegeAll-American.In1987,afterhisjunioryear,hewasdraftedinthe7throundbytheNewOrleansSaints.Hewasthe179thdraftpickoverall. Sixfootoneinchand200pounds,Geneplayedregu-larlyfortheSaintsasadefensivebackandkick-returnerin1987


and1988.Althoughjust21andoneoftheelitefewwhomakeittotheNFL,hereturnedtoFloridaA&Mduringhisfirstoff-seasontocompletehiscollegedegree. In1989hebecameastarterandstartedinalmosteverygame in thedefensivebackfield for theremainderofhiscareer.HeplayedsixyearswiththeSaintsandthreeyearswiththeMiamiDolphins, endinghis career in 1995. Hewas known as hard-hitter,especiallyinNewOrleans,whichatthetimehadoneofthebestdefensesintheleague.GenedislocatedhisrightshoulderfourtimeswhileplayingforNewOrleans,andrepeatedlyhadhis“bellrung”fromhighspeedcollisionsinvolvinghishelmet.At-kinsoftenresortedtohittingandtacklingopposingplayerswithhisheadbecausehewasunabletowrapthemupwithhisarmsduetotherepeatedinjuriestohisrightshoulder. SinceAtkinswasinthedefensivebackfield,eachgameinwhichheplayedoverhisten-yearcareerwasaseriesofhigh-speedcollisions,manyofwhichinvolvedtheuseofhisheadtohitopposingplayers. Unfortunately, Atkins doesn’t remember much of hisprofessional football career. His claims against the NFL havegivenhimreasontoretrieveoldgametapesoutofhisgarageandwatchsomeof them. Manytimes,he says, it’s likewatchingastrangerplayfootball. After football, Atkins tried the construction businessandthencoaching,buthisneckpain,headaches,andcognitiveproblemsgrewmoresevere.Frustratedandwantingtohelppro-videforhisfamily,hegotajobataTargetstoreneartheirapart-mentinRoundRock,Texas,hangingsignsinthemorningbeforethe store opened. HiswifePatricia remembers him repeatedlycallinghome,askingheraboutsimpleworktasksthathewastoldtoperform.Duetohiscontinuousneckandshoulderpain,head-aches,cognitiveimpairment,andfingertipsthatfeltliketheywerecoveredinplastic,Genehadtoquithis jobafewmonthsafterbeinghired. Atkinshasovercomesomeincrediblehurdles.Evenso,hispriorsuccesscouldnotadequatelypreparehimforthestrugglewhichhecontinuestofaceintryingtoobtainfootball-relateddis-abilitybenefitsfromtheNFL.

Atkins Applies for Benefits InDecemberof2004Atkinsappliedforfootball-relateddisability benefits under the Bert Bell/Pete Rozelle NFL PlayerRetirement Plan, which, along with a supplemental disabilityplan,providesmonthlyincomebenefitsincaseoftotalandper-manentdisability. Withinhisapplication,whichhecompletedwith the help of his ex-wife Sandra Atkins, he described threeconditionswhichcausedhimtobedisabled,allofwhichheat-tributedtohistenyearsplayingNFLfootball:

“1)Unabletoliftrightshoulderormovearmtofunc-tionalpositions cannot reachupormore than90degreestoeitherside.Hadseveraldislocatedshoulder

injuriesandeventuallyhadapininsertedtokeepshoul-derinplace.Thepinwasremovedin1996becauseofchronicpaininthearea.Ihavetroubledrivingbecauseitsdifficulttoturnthesteeringwheel;

2)Chronicconstantpainatthebaseofheadandneck.Pain sometimes radiates through arms and my hands,feels likeplastic. EverythingItouchfeelsnumbandIdropobjects I try andpickup.Unbearablepainmostdays.IhadseveralstingerswhileplayingbutdidnotfeelanyaffectsuntilIturned38yearsold;

3) Mood swings-because of my inability to functionwithout constant pain, my mood has been effected.Depressionoverthephysicalconditionofmybodyandnotbeingabletowork.”

Atkinssubmittedaletterwithhisapplicationineffortstofurtherexplainhiscondition.Thelastparagraphreadsasfol-lows:

“Isufferfromdepression,andprobablyhaveforseveralyears,butwasindenial.Ihavenotsoughtanymedicalattention,becauseofmylackof insurancecoverage. Ihavenotbeenabletowork,thereforeIamnotcoveredbyanyinsurance.IamnowseekingdisabilityincometorecoverandhopefullygetbettertowhereIcanfunc-tionandtakecareofmychildren. IamingreatneedofimmediatemedicalattentionandwouldwelcometheopportunitybeseenbyyourphysicianinordertoreceivethehelpIneed.”

The NFL retirement plan and supplemental disabilityplanarebothERISAplans. Theseplansarefundedbyatrust,which is funded by contributions from the NFL teams. Thegreaterthenumberofplayerswhoareapprovedfordisabilityben-efits,thegreaterthecontributionsrequired(assumingthereisnooffsettingdecreaseincontributionrequirements). Ifaplayeriffoundtototallyandpermanentlydisabledby the NFL while under contract with an NFL team, the dis-abilityisclassifiedaseitherfootball-related(acategorycalledAc-tiveFootball)orunrelatedtofootball(ActiveNonfootball).1Ifadisabilityisfoundtohavearisenaftertheplayer’sNFLcareerisoverbutbeforethelaterofage45or12yearsaftertheendoftheplayer’slastcreditedseason,theplayercanreceiveeitherFootballDegenerativebenefits(foradisabilityarisingoutofNFLfootballactivities)orInactivebenefits(fordisabilitiesfoundtobeunre-latedtofootball).Thefocushereisonthelattertwocategoriesofbenefits,bothofwhichareavailablefordisabilitiesarisingafteraplayer’sNFLcareerisover. PlayersarepaidarelativelysmallmonthlyamountiftheyareapprovedforInactivebenefits.Monthlybenefitsareen-

InDecemberof2004Atkinsappliedforfootball-relateddisabilitybenefitsundertheBertBell/PeteRozelleNFLPlayerRetirementPlan.


hanceddramatically(andthesupplementaldisabilityplanistrig-gered)iftheplayerisapprovedforFootballDegenerativebenefits.Becausethedisabilitybenefitsarepaidforlife,incontrasttomostotherdisabilityplanswheremonthlypaymentsstopatornearage65,ifarelativelyyoungplayerisfoundtobedisabledfromplay-ingfootball,thelong-termpayoutcanbesignificant.OfcourseitisaflyspeckwhencontrastedwiththecombinedannualrevenueoftheNFLanditsfranchises,whichwasreportedtobeapproxi-mately8.5billiondollarsin2009.2

Atkins,whocommandedasalaryofclosetoamilliondol-lars a year in the latter stages of his career, receives $2,650.50permonthfromtheNFLfordisabilitybenefits.HisbenefitsareclassifiedasInactivebenefits,whichmeanstheNFLRetirementBoard has found his disability to be unrelated to playing NFLfootball. Pursuant to a divorcedecree, half of his benefit goestohisex-wifeSandra. Mostdisabilityplanspayapproximately60%ofone’spre-disability salary,usuallyuntil theageof65 ifoneremainsdisabled. Atkinsreceivesapproximately3%ofhispre-disabilityearnings.

Dancing the Seven Physician Tango...Plus One Dr. Isern-Psychiatrist After receiptofhis claim for football-relateddisabilitybenefits,theNFLsentAtkinstoapsychiatristinBeaumont,RaulIsern,Jr.,M.D.AtkinssawDr.IsernonJanuary4,2005.Dr.IsernneverturnedinareporttotheNFLsubsequenttohisex-aminationofAtkins.

Dr. Souryal-Orthopedic Specialist TheNFLthenhadAtkinsexaminedbyanorthopedicspecialist in Dallas. The orthopedic specialist, Tarek Souryal,thoughtAtkins couldperformmany tasks thatdidnot involveheavy lifting, but noted that “headaches and arm/hand numb-nessmaysignifynon-orthopedicproblem.Shouldhaveaneuro-logiceval.”OntheNFLformthathewasaskedtocomplete,Dr.SouryalwrotethathefeltAtkinscouldworkbutthathehadim-pairmentstohisneckandshoulder,andthattheseimpairmentswerecausedbyplayingNFLfootball.

Dr. Kesler-Psychiatrist ThenextphysiciantheNFLselectedtoexamineAtkinswasKeithKesler,M.D.apsychiatristinAustin.Afterconduct-ing two examinationsofAtkins,Dr.Kesler concluded thatAt-kinswastotallydisabledasaresultofthefollowingimpairments:poorcognitive functioning,chronicpainwithdepressedmood,chronicheadaches, andpossibleneurologicdeficits. Dr.Keslerfound that Atkins’ chronic pain with depressed mood, chronicheadaches, and possible neurologic deficits were all related toplaying football. Like theorthopedic specialist Souryal,KeslerrecommendedthatAtkinsbeexaminedbyaneurologistandalsorecommendedthatAtkinsseeapainspecialist.

The First of Three Deadlocks: Atkins’ Claim is Denied After theNFLobtained the reportsofDr.Kesler andDr. Souryal, the Disability Initial Claims Committee (“Com-mittee”),whichistheinitialdecision-makerfordisabilitybenefitclaimsbroughtundertheNFLretirementplan,deadlockedinitsdecisionwhetherAtkinswasdisabled (TheCommitteehas two

members:oneappointedbytheplayer’sassociationandoneap-pointedbymanagement). Atkinswasadvised thatbecause theCommitteehaddeadlocked,hisapplicationfordisabilitybenefitswasdeniedbyvirtuetheplan’sprovisionthatrendersaclaimau-tomaticallydeniedwhentheCommitteedeadlocks.

Atkins’ Appeal

ERISAhasastructuredclaimsprocedure,formulatedbytheU.S.DepartmentofLaborandplacedwithintheU.S.CodeofFederalRegulations,whichbothdecision-makers andclaim-ants are supposed to follow. One of ERISA’s well-establishedrulesisthatallgroupbenefitplansmustgiveaclaimanttherighttoappeal adeniedclaim. This appeal is sometimes referred toasa“fullandfairreview”oftheclaim,thephrase“fullandfairreview”comingdirectlyfromtheERISAstatutethatrequiresit.Simplyput,theclaimantcanwritealettersayingthathewantsareviewofthedenial,andhehastheopportunitytosubmitmoredocumentationinsupportofhisclaim.Atthisreviewingstage,whentheoriginaldocumentationaswellasnewdocumentationisrequiredtobereviewed,thepartiesarenotviewedadversaries.Infact,ERISAlawrequiresthatthepersonorpersonsconductingthereviewofthedeniedclaimactastheclaimant’sfiduciary.Be-ingafiduciarymeansactingfairly,honestly,andimpartiallywhenreviewingtheclaim.

Dr. Williamson-Orthopedic Specialist Exercisinghisrighttoafullandfairreviewofhisclaim,AtkinsappealedtheCommittee’sdecision.Inresponse,theNFLsentAtkinstoanotherorthopedicspecialistandaneurologist.InJuly,2005,AtkinswasexaminedbyJ.BryanWilliamson,M.D.,anorthopedicspecialistinHouston.Dr.WilliamsonexaminedAtkinsforapproximately30minutesandfoundimpairmentstohisneck,rightshoulder,andthumb,allofwhichwerecausedbyfootball,butWilliamsonindicatedthathefeltAtkinswouldbeabletoengageinalightdutyorsedentaryoccupation. WilliamsonsummarizedAtkins’condition:

“Hisrightshoulderwhichgiveshimpainanddiscom-fort and limited range of motion is directly related toplaying football and injuries sustained while playingfootball.Hisneckpainwhichresultsfrommultipleleveldegenerativediseaseisrelatedtohispositiontoplayingsafetyandrepetitivetraumatohisheadandneck.Itisimportanttonotethatpersonsofhisagecanhavede-generativechangesimilartothisonadegenerativebasisonly.ItisfeltthatplayingfootballintheNFLcontrib-utedtothesignificantdegenerativechangeinhisneckandpaininhisneck.”

AboutAtkins’severeheadacheshesaid:“Overall it isexpectedhisneckandsecondarycervical


occipitalheadacheswillcontinuetogivehimproblemsanddifficultiesinthefuture.ItisunclearthatthereisanyrelationshipofMr.Atkins’abilitytoconcentrateorabilitytoworkwithothersisrelatedtohisneckorshoul-derproblems.”

Dr. Martin-Neurologist Then Atkins was also examined by Raymond Martin,aneurologistselectedbytheNFL.Dr.MartindeterminedthatAtkinswasdisabled. He reported that the impairmentswhichcausedAtkins tobedisabledwerebilateralnumbness inhands,frozenrightshoulder,neckpainandlimitedrangeofmotioninthe neck, chronic headaches, and memory problems. On theNFLform,MartinindicatedthatthenumbnessinAtkins’hands,hisfrozenrightshoulder,andhisneckpainallresultedfromplay-ingfootball.MartinwasunabletosaywhetherAtkins’memoryproblemswererelatedtofootball.

THE NFL PLAYER’S FIDUCIARY: THE NFL RETIRE-MENT BOARDThe NFL Retirement Board is the fiduciary that is required toconductthefullandfairreviewofaplayer’sdeniedclaim.Ithassixmembers,threeofwhomareselectedbytheNFLPlayers’As-sociation(“NFLPA”)andthreeofwhomareselectedbytheNFLManagementCouncil.

The Second Deadlock: Atkins’ Claim Referred to a Medical Ad-visory Physician for a Binding Decision

Afterreceiptoftheadditionalmedicalexaminationre-ports,theBoardannouncedthatithaddeadlockedonitsreviewof the claim just as the InitialCommitteehaddeadlocked. Ina letter, Atkins was advised that pursuant to a retirement planprovisionhisclaimwouldbereferredtoaMedicalAdvisoryPhy-sician (“MAP”) for adeterminationofdisability thatwouldbebindingupontheBoard.

TIME OUT: MORE ABOUT ERISA

Because it provides the explanation as to why Atkins’claimwasnotdecidedat thispoint, it isappropriate todiscussERISAingreaterdetail.AccordingtotheU.S.Congress,ERISAwasenactedto:

“protectparticipantsinemployeebenefitplansandtheirbeneficiaries,byrequiringthedisclosureandreportingtoparticipantsandbeneficiariesoffinancialandotherinformationwith respect thereto,byestablishing stan-dards of conduct, responsibility, and obligation of fi-duciaries of employee benefit plans, and by providingappropriateremedies,sanctions,andreadyaccesstothe

Federalcourts.”3

TheguidingprincipleofERISA,accordingtotheU.S.SupremeCourt,isa“carefulbalancingbetweenensuringfairandpromptenforcementof rightsunderaplanandtheencourage-mentofthecreationofsuchplans.”4

ERISA applies to most employee benefits in the pri-vatesector,mostcommonlypensionbenefits,disabilitybenefits,healthinsurancebenefits,andlifeinsurancebenefits.Althoughitsprimaryfocusistheregulationandprotectionofpensionben-efits,includingthecreationofapensionguarantyfund,ERISAgovernsotherbenefits,includingdisabilitybenefits,andregulateshowclaimsaretobehandled.Oneofitsstatedpurposesistopro-tectaclaimant’srighttoseekredressatthecourthouse,butitalsotrumps,inlegalnomenclature“preempts,”allstatelaw,sothataclaimantmustexclusivelyrelyuponERISAlawwhenseekingalegalremedy.Theestablishedcase lawonERISAbenefitclaimshascreatedadifficultinclineforcurrentandfutureclaimants.5

No Live Testimony, No Cross-Examination, No Jury Trial

BecausetheirdisabilityclaimsaregovernedbyERISA,NFLplayershavenorighttoajurytrial.IndecidingwhethertheNFLBoardabuseditsdiscretionindenyingaplayer’sclaim,thetrialislimitedtoafederaljudge’sreviewoftheclaimfile.Oncethedisputeisincourt(whichgenerallymeansonceacomplainthas been filed at the federal courthouse) players have no righttosubpoenadocumentsconcerningthebackgroundorqualifica-tionsofthephysicianswhotheNFLhasaskedthemtosee.Theplayershavenorighttotestifyorelicitlivetestimonyfromtheirspouses,formerteammates,ortreatingphysicians.Theyhavenorighttocross-examinephysiciansoradversewitnessesattrial.

A Player Must Prove that the NFL Board Abused its Discretion

ManyoftherightsdeniedaclaimpursuanttoERISAareoftenconsideredfundamental.Forexample,arighttoajurytrial to resolve a civildisputeover20dollars is supposed tobeguaranteedbytheSeventhAmendment.6However,thereisevenagreaterlossthanthelossofajuryandtherighttolivetestimo-ny.BecausetheNFLretirementplanandsupplementaldisabilityplangrant theNFLBoard the right tobeking, i.e. fulldiscre-tiontodecideplayerbenefitclaims,establishedERISAcaselawrequiresthatareviewingcourtdefertotheNFLBoard’sdecision.TheBoard’sdecisionwillnotbetamperedwithunlessthecourtfinds that itabused itsdiscretion. What thismeans is that theplayermustcometocourtwithmorethana“preponderanceoftheevidence”inhisfavor,whichistheburdenofproofrequiredforthevastmajorityofcivilclaims.Towinincourt,theplayermustprovethattheNFLBoardactedarbitrarilyandcapriciouslyindenyinghisclaim.Thedistancebetweenthesetwoburdensofproofisconsiderable.ERISAdeference,therequirementthata

TheguidingprincipleofERISA,accordingtotheU.S.SupremeCourt,isa“carefulbalancingbetweenensur-ingfairandpromptenforcementofrightsunderaplanandtheencouragementofthecreationofsuchplans.


claimantproveat trial that thefinaldecision-makeractedarbi-trarilyandcapriciously,isahighhurdle,andisoftenthelynchpinoffederalcourtdecisionsthatareadversetoanERISAclaimant.

Onerous Plan Terms: A Clear and Convincing Evidence Stan-dard

Although some details of ERISA plans are regulated(ERISAisprimarilydevotedtotheregulationofpensionplans),mostdetailsofanon-pensionplancanbefreelywritten(suchasthedefinitionofdisability).Plantermsthatseeminnocuousortooesoterictomattercanhaveareal impactonbenefitclaims.AnNFLplayerwhohasalreadybeenfounddisabledbutwhoisreceivingInactivebenefits,i.e.hehasbeenfounddisabledbytheNFLBoardbuthisdisability is found tobeunrelated to foot-ball,hasamuchmoredifficulttimeupgradingtofootball-relatedbenefitsthananewclaimantaskingforthesamething.ThisisbecausetheNFLplansrequirethatadisabledclaimantprovebyclear and convincing evidence, rather than a preponderance oftheevidence,thathisdisabilityshouldbereclassifiedasafootball-relateddisability. A typical civil trial is a contestbetweendisputantsonalevelplayingfield.InatypicalERISAtrial,theclaimantstartswithinaholeonhissideofthefieldbecausehemustprovethatthe claimsdecisionwas an abuse of discretion. DisabledNFLplayers, deemed by the Board to be disabled for reasons otherthanpro football, start inaholewithin thebroaderhole. Thebroaderholeistheabuseofdiscretionstandardwhereallplayersfindthemselves,theblackerholewithinistheplanrequirementthataplayer,alreadydisabled,provetotheNFLBoardbyclearandconvincingevidencethatheshouldbeupgradedtofootball-relatedbenefits.

The Only Damages Will Be the Benefits that Should Have Been Paid

Finally,ERISAjurisprudencehasstrippedtheplayersoftheleveragethatextra-contractualclaimscanprovide.Nomat-terhowunreasonablytheNFLBoardmayhaverespondedtohisclaim or how much delay occurred as a result of its structuralmalformation(3playersassociationmembersand3managementmembers) and internal dispute resolution deformity (no timeclockonanarbitrationwhentheBoardisdeadlocked),ifaplayeriswildlysuccessfulatthecourthousethemosthewillreceivearethemonthlybenefitsthatshouldhavebeenpaidinthefirstplace.Unlikeclaimsthatcanbebroughtunderstatetortlaworunderstateinsurancecodes,noclaimsforconsequentialdamages,men-talanguishdamages,orpunitivedamagescanbebroughtagainsttheNFLforeitherpurposefuldelayorforrenderinganoutlandishdecision.Unreasonabledelayandunreasonabledecision-makingareguaranteedafreeride(otherthanthepossiblepaymentofat-torney’sfees).

BACK TO ATKINS’ CLAIM

At this point in the process, 10 months after Atkinssubmitted his claim, no decision had been reached. From anorthopedicperspectiveAtkinswasfoundnotdisabled. Butthephysicianspecialistsinneurology(Martin)andpsychiatry(Kes-ler), physicians hand-picked by those that operate and manage

theNFLretirementplanandsupplementaldisabilityplan,deter-minedAtkinstobetotallyandpermanentlydisabledasaresultofplayingprofessionalfootball.IntheabsenceofERISAjurisprudence,thereislittledoubtthatAtkins’ claim for footballdegenerativedisabilitybenefitswouldhavebeenquicklyapprovedatthispoint.TheNFLBoardwouldberecklessindeediftheyweretoletAtkinshaveajurytrialwheretheywouldbe forced toadmit that theydeniedhis claimeventhoughfromapsychiatricandneurologicperspectiveAtkinswasfoundtobetotallyandpermanentlydisabledasaresultofplay-ingprofootball.Therewasnocompetingevidencefromspecial-istsineitherdisciplineindicatingotherwise.Furthermore,thesewere not findings by treating physicians who may have held atreatmentbiasinfavoroftheirpatientbutinsteadwerefindingsbymedicalspecialistsselectedbytheNFL!Alargejuryverdictin favor of Atkins would not be surprising. The NFL Board’sinsistenceuponmoreexaminationswouldprobablybeviewedbyajuryasbadfaith,thatis,shoppingforanopinionthattheNFLBoardwanted,i.e.anopinionofnodisabilityordisabilityunre-latedtofootball,andalsomotivatedbydelay. However,becauseERISAofferstheclaimantnopossi-bilityofamonetaryremedyforunreasonabledelay,Atkinswassenttomorephysicians.

Atkins’ Claim Continues....For Another Four Years!The MAP: Thomas Boll, Ph.D.-Neuropsychologist AtkinswassenttoseeThomasBoll,Ph.D.onDecember29,2005,whoseopinionwouldbreaktheseconddeadlockandbindtheBoard.AlthoughtheNFLretirementplanpromisestheplayersthatonlyaphysicianmaybindtheBoardwhenitdead-locksoveraplayer’smedicalcondition,theNFLBoardassigneditsdecisiononAtkinstoDr.Boll,whoisnotaphysicianbuthasaPh.D. inneuropsychology. He is thePlusOne in theSevenPhysicianTango choreographed by the NFL. Dr. Boll opinedthatAtkinswasdisabledduetotheimpairmentsofilliteracyandborderlinemental ability,majordepression, andpain. He saidAtkins’illiteracyandborderlinementalabilitywerenotrelatedtofootball,thatitcouldnotbedeterminedwhetherhisdepressionwasrelatedtofootball,butindicatedthathisunresolvedpainwascausedbyhisprofootballcareer.

Atkins Approved for Inactive Benefits

By letter dated February 23, 2006, approximately 14months after Atkins applied for benefits, the Board notifiedAtkins thathis claim fordisabilitybenefitshadbeenapproved.However,theNFLBoarddeterminedthathisdisabilitywasun-relatedtofootball,thatis,hewasapprovedforInactivebenefits.TheBoardfoundtheeffectivedateofdisability,i.e.thedatedis-


abilitypaymentswouldcommence,asbeingJune1,2005.TheNFLadvisedAtkinsthathewouldreceive$1,822.50permonth(Inactivebenefitshavesinceincreasedslightly-asofApril,2010,Atkinsisreceiving$2,650.50),tobedividedequallywithhisex-wife,pursuanttoadivorcedecree.Asaresult,Atkinsbeganre-ceiving$911.25permonthfromtheNFLforhisdisability.7 Atkins was relieved to finally receive something fromtheNFLbutdidn’tunderstandwhyhewasonlyentitledtoInac-tivebenefits,sinceDr.Bollfoundsomeofhisimpairmentswerecausedbyplayingprofootball.Heappealedthedecision. Atkinswassenttomoredoctors. Dr. Gilbert-Neurologist AlthoughtheneurologistDr.MartinhadalreadyfoundGenedisabledfromplayingfootball,theNFLsentAtkinstoAt-lantainJune2006toseeanotherneurologist,Dr.RobertGilbert.AccordingtoAtkins,Dr.GilbertconductedaphysicalexamonAtkinsthatlastedapproximatelyfiveminutesandindicatedthatalthoughAtkinswaslimitedbypainfromimpairmentscausedbyfootball,he feltAtkinscouldengage in some typeof sedentarywork. TheNFLBoarddeniedAtkins’appeal, indicatingthathewasonlyentitledtoInactivebenefits. Dr. Robert Cantu-Neurosurgeon WhenAtkins learnedof the suicidedeathofhisNFLcontemporaryAndreWaters,who alsoplayed safety,he soughtmorehelpforhisdepressionandcognitiveproblems.8HewasledtoChrisNowinski,aHarvardgraduatewhosuffersfrompost-concussion syndromeas a resultof abriefprowrestlingcareer,and who subsequently wrote the book Head Games: Football’sConcussion Crisis. Nowinski has been instrumental in creatingthecurrentpublicawarenesssurroundingconcussionsandtheirpotential for long-termdamage. Atkins talkedwithNowinski,whoreferredhimtoaneurosurgeonnamedRobertCantu,M.D.inFebruaryof2007.9Dr.CantupracticesinConcord,Massa-chusetts,andspecializesinpost-concussioninjurytoathletessuchasAtkins.AfterconductinganumberoftestsonAtkins,CantudiagnosedAtkinswithpost-concussionsyndromeandearlytrau-matic encephalopathy. 10 Dr.Cantu indicated thatAtkinswasnotabletoworkduetodementedmentalstatuscausedbyheadtraumafromprofessionalfootballactivitiesandthatthiscondi-tionwaspermanent.ByletterdatedOctober5,2007,theCom-mitteedeniedtherequestforreconsiderationandreclassification,butadvisedAtkinsthathecouldappealthedetermination.

The Social Security Administration Awards Atkins Benefits, Finding Atkins Severely Impaired by his Frozen Right Shoulder and Post-Concussion Syndrome

AdditionalsupportforAtkins’appealwasprovided,in-

cludinginterviewswithAtkinsandhiswifePatriciaalongwithanoticethatAtkinshadreceivedfromtheSocialSecurityAdmin-istrationawardinghimdisabilitybenefits fromJanuary1,1998forward. The Administrative Law Judge for the Social SecurityAdministration,whodecidedthatAtkinswasdisabledandshouldreceiveSocialSecuritydisabilitybenefits,foundthatAtkinswas“severelyimpaired”bypostconcussionsyndromeandfrozenrightshoulder,andthatAtkinswas“unabletounderstand,remember,andcarryout simple routine instructionsona sustainedbasis.”HebasedhisfindingsontheopinionsofDr.Cantuandthefind-ingsofDr.RonaldDeVere,whohadseenAtkinsinMayof2007at the government’s request. A neurologist, Dr. DeVere foundthatAtkinshadasignificantlyslowedmentalfunctioning. TheNFLadvisedbycorrespondencethatAtkins’claimwould be presented to the NFL Board for decision at its nextquarterlymeetingonApril30,2008.AtkinswasadvisedaftertheBoardmeetingonApril30,2008thattheBoardhadtableditsdecisionofhisappealandwantedAtkinstoseeyetanotherphysi-cianselectedbytheNFL.InJune2008,theNFLsentAtkinstoSeattletoseeneurologistJamesGordon.Dr. Gordon-The Third Neurologist Selected by the NFL Justashehadseventimesbefore,Atkinsreadilycom-plied.HeflewtoSeattleandsawDr.GordononJune25th,2008.Dr.GordonevaluatedAtkinsforthefollowinghealthconditions:concussions,headaches,andmemoryloss.Dr.GordonwasthethirdneurologistandtheeighthphysicianwhoevaluatedAtkinsattherequestoftheadministratorsoftheNFLretirementplan.11

On September 11, 2008, James Gordon delivered hisreporttotheNFL.Dr.GordondeterminedthatGenewastotallydisabledduetocognitivedysfunctionanddepression,indicatingthatbothoftheseimpairmentsaroseinpartasaresultofGene’sNFL career. He also determined that Gene was impaired duechronictensionheadachesandpost-concussiveheadaches,whichhealsoattributedtoGene’sNFLcareer.Gordonsummarizedhisfindingsasfollows: “It is impossible to distinguish the precise extent to

whichheadinjurycauses,ratherthanexacerbates,Mr.Atkins’s headaches, cognitive and behavior problems,given preexisting neuropsychological limitations andpsychiatric predispositions. What is clear, however,is that he suffers disabling chronic headache, depres-sion,andcognitivelimitations,andthatrecurrentheadtraumaresultingfromhisroleasanNFLdefensivebackcontributedsignificantlytohiscurrentcondition,evenifthatcontributioncannotbereliablyquantified.Inhiscurrentcondition,hecannotbegainfullyemployed.”

Dr.CantuindicatedthatAtkinswasnotabletoworkduetodementedmentalstatuscausedbyheadtraumafromprofessionalfootballactivitiesandthatthiscon-ditionwaspermanent.


A Third Deadlock AtkinsreceivedaletterfromtheNFLonNovember20,2008, approximately four years after he had filed his disabilityclaimandoverthreeyearsafteraneurologist(Martin)andpsychi-atrist(Kesler)selectedbytheNFLfoundGenetobedisabledasaresultofplayingprofessionalfootball.TheNFLtoldAtkinsitwasdeadlockedforathirdtime(twodeadlocksbytheNFLBoard,thefinaldecision-maker;onedeadlockby the InitialClaimsCom-mittee),indicatingasfollows:

“At its November 11, 2008 meeting, the RetirementBoardoftheBertBell/PeteRozelleNFLPlayerRetire-mentPlan(“Plan”)consideredyourappealfromitsear-lierdecisiontoawardyouinactivetotalandpermanent(“T&P”) benefits effective June 1, 2005. The Retire-mentBoardwasdeadlockedon theclassification issueraisedbyyourappeal. Pursuant toprovisionsofPlansection8.3(a),theRetirementBoardreferredthatissuetofinalandbindingarbitration.

Pleasenotethatyouarenotapartytothearbitration.ThearbitrationisbetweenthemembersoftheRetirementBoardappointedbytheNFLPlayersAssociationandthemembersoftheRetirementBoardappointedbytheNFLManagementCouncil.....”

The Arbitration Decision

ThearbitrationtosettlethedisputebetweenNFLBoardmembers over Atkins’ claim has taken over 18 months. Bothpartieshavebeenrepresentedbycounsel.12Althoughsodeeplyentrenched that they engaged in a year and a half of litigationagainstoneanother,alloftheBoardmembersweresupposedtoremainAtkins’fiduciaryduringthisperiod,asthislitigationwaspartoftheERISA-requiredfullandfairreviewofhisclaim. TheArbitrator,Mr.RichardKasher,describedtheheartof the dispute between Board members as whether Atkins wasentitled to “football-related total and permanent disability de-generative benefits because, as he claims, he suffers from post-concussionsyndrome.”Thebasisofthatclaimwasthediagnosisofpost-concussionsyndromemadebyDr.Cantu. Mr.KasherdecidedinfavorofthemanagementBoardmembers.Hisdecisionrestedonthe“clearandconvincing”evi-dence standardwritten into theNFLplan, theholewithin thehole,atthebottomofwhichstandsMr.Atkins.Mr.Kashersum-marizesthecompetingevidenceandhisdecisionasfollows:

“Dr.Cantu’sopinionisqualifiedbyhisfindingthatMr.Atkins’ CTE 13 isbasedupona “moreprobable thannot”diagnosis.Suchanopinion,aswell-foundedasitisbyDr.Cantu,ahighlyqualifiedandrespectedmedicalpractitioner,doesnot,inthisArbitrator’sopinion,meetthe“clearandconvincing”standardofproofrequiredtosustainMr.Atkins’claim. ............ .............Therefore,theresolutionoftheissuesinthiscaserequiretheanalysisofthetwoplausiblemedicalopinions/diag-nosesofGeneAtkins’cognitivedysfunction.14InthisArbitrator’sopinion,neithertheopinionsofDr.Cantu,GordonandDeVereontheonehandandDr.Bollon

theother rise to the levelofclearandconvincingevi-dence.And,asnotedabove, thisArbitratorisboundbythatstandardofproof.

Therefore, Mr. Atkins’s claim falls into the realm of“probability”,asbothDoctorsCantuandBollhaveim-plicitlyacknowledged.”

TheNFLPABoardmembershavesubmittedarequestforreconsiderationthatispending.December2009markedthefifthanniversaryofthefilingofAtkins’claimforfootball-relateddisabilitybenefits.Becausethereisarequestforreconsiderationpending, there has been no final Board decision (however, theBoardisboundtofollowthearbitrator’sdecision).Atkins’federalcourtclaim,challengingtheBoard’sdecision(wheneverthatoc-curs),hasn’tevenbegun.

OTHER PLAYERS WHO HAVE EXPERIENCED ERISA

TheNFL’shandlingofGeneAtkins’ claim is far fromunique.InDecember2005theWallStreetJournalreportedthatonly90outofmore than7,561 formerproplayerscoveredbytheNFLdisabilityplanreceivefootball-relateddisabilitybenefits.15 Drawnout claims and litigationover formerplayers’ claimsareeasytofind. Althoughthepreponderanceoftheevidence,i.e.thegreaterweightoftheevidence,showsplayerstohavevalidfootball-relateddisabilityclaims,underERISAlawthatisoftennotenough,andthereforedeservingplayersoftenlose.Hereareafewexamples. Victor Washington PhysiciansselectedbytheNFLsaidthatVictorWash-ington, a former NFLdefensive back, runningback, andwidereceiver, was disabled from football-related injuries, includingdepressionfromchronicpain. 16 Washingtonfiledhisclaimin1983,seekingfootball-relatedbenefits,and,liketheAtkinscase,the NFL Board deadlocked and after four years it was sent toanarbitrator. In1987 thearbitrator foundWashington tobedisabled but that his disability was not related to football. In1996Washingtonrequestedreclassificationbaseduponaneutralpsychiatrist’sfavorablefindings,andthecasesettledin1998,al-though litigation continued until 2007 over whether the NFLimproperlywithheldinformationpriortothesettlement. Donald Brumm DonaldBrummplayedprofootballbetween1963and1972.17HeappliedfordisabilitybenefitsinNovemberof1984,requestingfootball-relatedbenefits.DespiteanNFLselectedpsy-chiatristwhofoundBrummtobedisabledfromplayingfootball,inJanuary1987,twoyearsafterBrummfiledhisclaim,theNFLBoarddecidedBrummshouldbepaidInactivebenefits.Brumm


challenged the decision at the courthouse and ultimately wonwhenafederalappealscourtdecidedin1993thattheNFLactedarbitrarily and capriciously in denying Brumm football-relatedbenefits. Even though it tookBrummnineyears toobtain thefootball-relatedbenefits that hedeserved (over six years elapsedbetweenthetimethatthepsychiatristselectedbytheNFLdiag-nosedBrummwith a football-relateddisability and the appealscourtfoundinfavorofBrumm)andtheNFLwasfoundtohaveactedarbitrarilyindenyingBrummbenefits,Brummwasentitledtonothingmorethanthebenefitsthatheshouldhavebeenpaidinthefirstplace. Michael Webster IronMikeWebsterisperhapsthemostwell-knownfoot-ballplayertohavebattledtheNFLonadisabilityclaim,althoughhis7yearbattlehadtobefinishedbyhisestatebecauseofhisearlydeath.18WebsterisrememberedasaPittsburghSteeler,whereheearned4SuperBowlrings.Heplayedatotalofsixteenyears(be-tween1974and1991)andsustainingmultipleconcussionsdur-inghisprocareer.Webster’slifedeterioratedafterfootball.Foundina localtrainstationin1996,hewasseenbyapsychiatristtowhomhereportedthathehadbeenlivingoutofhiscarandhotelsthelastthreeandone-halfyears.InNovemberof1998,Websterwasdiagnosedwithdementiacausedbyhisfootball-relatedheadtrauma. Websterappliedforactivefootballbenefits,inthealter-nativedegenerativefootballbenefits,inthespringof1999.Afterrepeateddelays,in2003theNFLgrantedhimdegenerativeben-efitsbutdeniedactivefootballdisabilitybenefits(activefootballbenefitsprovidesmoremonthlybenefitsthandegenerativefoot-ballbenefits),findingtheonsetofhisdisabilitytohaveoccurredafter his pro football career had ended. Litigation ensued andwasnotcompleteduntil2006,whenafederalappealscourt(U.S.Fourth Court of Appeals) concluded that Webster should havereceivedactivefootballdisabilitybenefits.Thecourt,notingthegreatburdenthatWebsterhadtoovercomeinprevailingonthecase,wroteasfollows:

“Whilerecognizingthatthedecisionsofaneutralplanadministrator are entitled to great deference, we areneverthelessconstrainedtofindonthesefactsthattheBoard lacked substantial evidence to justify its denialhere. Inparticular, theBoard ignored theunanimousmedicalevidenceincludingthatofitsownexpert,disre-gardedtheconclusionofitsownappointedinvestigator,andreliedforitsdeterminationonfactorsdisallowedbytheplan.......”

DespitethearbitrarydenialbytheNFLBoard,thecourtcouldawardnothingmorethanthebenefitsthatshouldhavebeenpaidinthefirstplace.

Otis Armstrong TheproceduraldelaysofArmstrong’sclaimmirrorsthedelaysexperiencedbyGeneAtkins.19ArmstrongwasarunningbackfortheDenverBroncos,playingfrom1973until1980.Hewasinjuredwhileplayingin1980anddidnotplayanotherdown.HeappliedforactivefootballdisabilitybenefitsfromtheNFLin1981.LikeAtkins’claim,Armstrong’sclaimwounditswayintoaBoarddeadlock,thethreeplayer’sassociationmemberssidingwith Armstrong and the three management members decidingthat Armstrong was not disabled. Additional physician opin-ionswereobtainedandin1986,fiveyearsafterArmstrong’scasewassubmitted,itwassentintoarbitrationtobreakthedeadlock.Armstrong sought to rescind the arbitration by a federal courtdecisionbutitwasdenied.However,thearbitratorwasorderedto rulewithin30daysof submissionof thebriefs. In recitingthefactsofthecaseinordertodisplaywhathecalleda“six-yearsenselesscontest,”JudgeKane,afederaljudgefromDenver,pro-videdunrestrainedcriticismoftheNFLBoard:

“Thisbriefandnonexhaustivechronologyofplaintiff’sexperiencesincehis1980injuryisrepletewithdelays,confusion, stalemates, and inconstancy in the part oftheboardandthepersonsunderitscontrol.OtisArm-stronghasbeentheunfortunateforgottenvictimofthestrugglebetweenNFLmanagementandplayers.”

AlthoughJudgeKaneiscriticaloftheNFL’sclaimspro-cess, deservedly so since players like Armstrong and Atkins getlost in what can become an epic struggle between the playersand management, to the NFLPA’s credit, they did not fold tomanagement’sdesiretowithholdfootballdisabilitybenefitsfromArmstrong. At the time of Judge Kane’s order, the physicianswerelinedup5to2insupportofanawardoffootballdisabilitybenefits. Daniel Johnson JohnsonplayedNFL football from1982untilhe suf-fered a career-endingback injury. 20 He then fought theNFLregardingtheonsetdateofhisdisabilityandlostinthe8thCircuitCourtofAppeals.AlthoughthephysiciancountisnotedtobetwotooneinfavorofJohnson’sclaim,duetoERISAdeference,Johnsonlost.InrulingagainstJohnson,theCourt,inapassive,hands-offmannerwhichistypicalofERISAcourtdecisions,con-cludes: “Again, the Board has the authority to construe thetermsofthePlan,

wearerequiredtogivedeference to its interpretation,andwereverseonlyifithasabuseditsdiscretion....Giv-enthePlan’s language,wecannotsaythattheBoard’sinterpretationwasunreasonableorconstitutedanabuseofdiscretion...”

Foundinalocaltrainstationin1996,hewasseenbyapsychiatristtowhomhereportedthathehadbeenlivingoutofhiscarandhotelsthelastthreeandone-halfyears.


Lawrence Smith TheNFLprevailedinthe9thCircuitCourtofAppealson Lawrence Smith’s claim regarding the category of disabilitybenefitsthatwerepaidtohim(hewasapprovedfordegenerativefootballbutnotactivefootball)andthedateofonsetofdisability.21AstheCourtnotes,however,ittooktheNFLalmostfouryearstodecidehisclaimonceheapplied forbenefits. AlthoughtheCourt indicates thatSmithwaspartly responsible for thedelaybecauseofhisfailuretosubmitinformation,fouryearsisinexcus-able,cancausefinancialdevastation,andisthekindoflegalde-laythatanotherdepressedindividualwastalkingaboutinhis“tobeornottobe”soliloquy,whenrecitingthereasonsto“quietusmakewithabarebodkin.”22

Anthony Green AnthonyGreenplayedforfouryearsintheNFL,1990until1993.23Hiscareerwascutshortasaresultofinjuriestohishands,knees,andshoulders.GreenappliedfordisabilitybenefitswiththeNFLin1997.Althoughheappliedforactivefootballdisabilitybenefits,forwhichhewaseligibleeventhoughhedidn’thaveenoughseasonstobevestedsothathecouldapplyforfoot-balldegenerativeorinactivebenefits,theNFLBoardsidesteppedthemeritsoftheclaim.Instead,itdeniedGreen’sclaimonthebasisthathewasnotvested.TheCourtsentitbacktotheBoardin1999becauseoftheBoard’savoidanceoftheclaim’smerits.

Brent Boyd Brent Boyd was a MinnesotaViking from 1980 until1987.24HefiledadisabilityclaimwiththeNFLfororthopedicailments in1997andwasdenied. Hefiledanotherclaim, thistimefororganicbraindamageasaresultofheadtrauma,in2000.LikeAtkins,Boydwasawardedinactivedisabilitybenefits.TheNFLdeferredhisclaimforfootballdegenerativebenefits.BoydwassenttoaneurologistselectedbytheNFLwhofoundBoyd’sdisabilitytobefootball-related.AnotherphysicianviewedBoyd’sbrainscanandconcurredwiththeneurologist. BoydwasthensenttoapsychologistpickedbytheNFLwhoalsofoundBoyd’sdisabilitytobefootball-related. Stilldiscontent,theNFLsentBoydtoyetanotherphy-sician.Thisphysician,aneurologist,opinedthatBoyd’sdisabilitywasnotfootball-related,i.e.thathisheadtraumafromplayingintheNFLdidnotcauseorganicbraininjury.TheBoardfollowedtheminorityopinion,determiningthatBoydwasonlyentitledtoInactivedisabilitybenefits. Boydchallengedthedecision incourtbut lost in trialandinhisappeal,primarilyduetothethroneofERISAdeferenceuponwhichtheNFLBoardsits.IndenyingBoyd’sappeal,theNinthCircuitwroteasfollows:

“AnERISAadministrator’sexerciseofitsdiscretiontoadjudicateclaimsisnotamereexerciseinexpertpoll-taking. Weholdthatamere tallyofexperts is insuf-ficient to demonstrate that an ERISA fiduciary hasabuseditsdiscretion,forevenasinglepersuasivemedi-cal opinion may constitute substantial evidence uponwhichaplanadministratormayrelyinadjudicatingaclaim.”

Boyd testifiedbeforeCongress in 2007, claiming thatthe process was corrupt. Well-versed in ERISA as a result ofhislongbattlewiththeNFL,heaskedCongressforachangeto

ERISAsothatfulldiscretioncouldnotbewhathedescribedasagrantof“absolutepower”totheBoard.

CONCLUSIONS FROM THESE CLAIMS

Incredible Delay is Common WhenplacingAtkins’sclaiminamixingbowlwiththesepublishedclaims,someconclusionscanbemade.Oneisthatin-credibledelayisoftenthenorm.Incredibleisafairdescriptionbecauseintheworldofnon-ERISAdisabilityclaims,aninsureroradministratorisrequiredtodecidetheclaimpromptlyorin-curdelaydamages andpenalties. Texas insurance lawbasicallyrequiresclaimstobedecidedwithin60daysoran18%penaltywillattachtoalldamagesforwrongfullyrejectingaclaim.Notsohere.StatelawprotectionsareofnousetoplayerslikeBrentBoyd,OtisArmstrong,orGeneAtkins.Theunderlyingreasonforthedelay,adelaythatmayverywellresultinfinancialdevasta-tiontotheplayerandhisfamily,isthatthelawallowsit.ERISAprovidesnomonetarysanctionagainstprolongeddelayinmakingadecisiononadisabilityclaim.

A Player Does not Prevail Just Because the Evidence Weighs in his Favor

Also,itisclearthattherearethosesittingontheNFLBoardwhoarewillingtoexploitthedeferencethattheyaregivenbythecourts.Evenifthegreaterweightoftheevidenceisinfavoroffootball-relateddisability,decision-makersknowthattheycansidewithaminoritymedicalopinionandgetawaywithitoftenenough.Itisnaivetosuggestthatthiskindofdecision-making,takingadvantageoftheleveragegivenbyERISAdeferenceratherthan focusingonwhere thegreaterweightof the evidence lies,islimitedtotheNFL.Sinceitislegalandfollowsabasicprofitmotive(lessclaimpayments,greaterprofit),thisthinkingiscom-monplacewithERISAinsurersandclaimsadministrators. Ithasspawnedacottageindustryof“expertreport”services,whichare limited to providing expert consulting reports (the medicalconsultant doesn’t see the patient; he or she merely renders anopinion of disability after reviewing the claim file) that can betucked intoanERISAclaimfile,designed to insure that if theclaimistakentothecourthouse,thecourtwillfindthedecisionreasonable,i.e.notarbitraryandcapricious,evenwhentheexpertreportiscontrarytothegreaterweightofthemedicalevidence.

Plan Language Can Derail a Valid Claim Althoughtheaveragepersonmaybelievethatadisabledemployee should receivedisabilitybenefits if thegreaterweightof the evidence supports that decision, the plan language con-trols. The discretionary clause and the “clear and convincing”


evidencestandardputplayersatasignificantdisadvantageiftheywanttocontesttheBoard’sdecisionatthecourthouse.The“clearandconvincing” evidence standard,directedatplayerswhoarealreadydisabled, requiring them to climbahigherhurdle thannon-disabledplayerswhoalsoapplyforfootball-relatedbenefits,isanexampleofaprovisionthatcandeftlyderailavalidfootball-relateddisabilityclaim.

CONCLUSION

It is a good thing that the long-termhealth effects ofconcussions isfinallygettingthestudyandexposurethat ithaslongdeserved.Preventionofpotentialbraininjuryisabsolutelycritical.However,forthosealreadydisabled,whetherbyconcus-sionsorotherwise,manyfaceanotherchallenge,anuphillroadthatoftenremainshiddenfromthelandscapebecauseofitsdrydetail. Althoughesoteric,ERISAisoftendevastating in itsap-plication,allowingadenialofbenefitstobeaffirmedeventhoughthegreaterweightoftheevidencesupportstheclaim.Morepub-licawarenessofthedifficultieswhichdisabledplayersandotherdisabledemployeesthroughouttheprivatesectorcommonlyfaceintryingtoobtaindisabilitybenefitsisneeded.Perhapstheplay-ersmentionedhere,gladiatorslikeGeneAtkinswhowerepaidtophysicallypunishtheopposingplayersgameaftergame,yearafteryear,withnoweaponsorinstrumentstogenerateforceotherthantheirownbodies,canhelpcreatethatpublicawarenessthatmayultimatelyleadtoare-levelingofthescalesinregardstoERISAbenefitclaims.

*Harkins,Latimer&Dahl,P.C.405N.St.Mary’sStreet,Suite242SanAntonio,[email protected]

1. Theplanterm“TotalandPermanent”disabilityistocon-trastitwiththeLineofDutybenefits.LineofDutybenefitsareshorter-termdisabilitybenefits(althoughtheycanlastupto90months)availabletoactiveplayers.TotalandPermanentdisabil-itybenefitsarethelong-termdisabilitybenefits,availablefordis-abilitiesarisingeitherduringaplayer’sNFLcareerorafterwards(butbeforethelaterofage45or12yearsaftertheendofaplayer’slastcreditedseason). Thefocushere inon long-termdisabilitybenefits:totalandpermanentdisability.2. NewYorkTimes,April5,2010.3. Employee Retirement Income Security Act of 1974, 29U.S.C.§1001(b)2000.4. AetnaHealthInc.v.Davila,542U.S.200,215(2004).5. InsurancecarrierstellthestoryofERISAadvantageaswellasanyone.TheauthorreceivedabriefthisweekrequestingthatthefederalcourtinAustinfindthatthedisabilitypolicyatissueinthecaseisanERISApolicy.SeekingtheshelterERISAprovides,counselforMassMutualwritesintheopeningparagraph:

“The Court should, at the outset, resolve thethreshold issue of ERISA’s applicability. If ap-plicable,ERISAwilldramatically impact the re-mainingproceedings.First,ERISAwillpreemptall of Smith’s state law claims, leaving her with

Althoughesoteric,ERISAisoftendevastatinginitsapplication,allowingadenialofbenefitstobeaffirmedeventhoughthegreaterweightoftheevidencesupportstheclaim.

Gene Atkins

ATKINS: A TALLY OF THE EVIDENCE

SinceAtkinsfiledhisdisabilityclaim,hehasseenninephysiciansandoneneuropsychologist.EightofthesespecialistswereselectedbytheNFL.Thechronologyofspecialistsandtheirfindingsareasfollows: 1.Dr.Isern-Psychiatrist-neverturnedinanopinion. 2.Dr.Souryal-Orthopedist-impaired,butnotdisabled; recommendedaneurologistbecauseofheadachesand hand-armnumbness; 3.Dr.Kesler-Psychiatrist-disabled-footballrelated; 4.Dr.Williamson-Orthopedist-impaired,notdisabled; 5.Dr.Martin-Neurologist-disabled-football-related;

6. Dr. Boll-Neuropsychologist-disabled-some impair-mentsfootball-related,somenot;

7.Dr.Gilbert-Neurologist-notdisabled; 8.Dr.Cantu-Neurosurgeon-disabled-football-related; 9.Dr.Gordon-Neurologist-disabled-football-related; and 10.Dr.DeVere-Neurologist-disabled-football-related. ThetwonotselectedbytheNFLwereDr.CantuandDr.DeVere.Althoughthegreaterweightoftheevidenceclearlysupportsafindingoffootball-relateddisability,ERISAdeference,in tandemwith the clear andconvincingevidence requirementinserted into the plan, have thus far caused Atkins to receivemuchlessthanhedeserves.


onlyaclaimforbenefitsunderERISA.Second,Smithwillnotbeentitledtoajurytrial.Third,theCourtwillreviewMassMutual’sfactualdeter-minationsthatSmithwasnotdisabledunderanabuseofdiscretionstandard.Fourth,theCourtmayconsideronlytheevidenceavailabletoMass-Mutual, and the parties cannot supplement therecordwithoraltestimony.(citesomitted).”

6. Infact,oneofthemanycausesoftheAmericanRevolutionwasKingGeorgeIII’sdecreeforbiddingjurytrialsintheAmeri-cancolonies.http://en.wikipedia.org/wiki/SeventhAmendmenttotheUnitedStatesConstitution.7. Atkinspaymentwasreducedby25%duetoanearlywith-drawalofmoneyfromtheretirementplan.8. Waterswasa safety likeAtkinsandplayed in theNFLatthesametimeasAtkins.AnautopsywasdoneonWaters’brainafterhisdeath,fromwhichitwasdeterminedthatWatershadthebrainofan85yearoldman.ThedeteriorationofhisbrainwasattributedtotraumaasaresultofthehardhitshedeliveredwhileintheNFL.9. NowinskiandCantuareco-foundersoftheSportsLegacyInstitute, anon-profitorganization founded in2007,meant toresearch,inform,andhelppreventbraintraumainsports.10.“Encephalopathy”isgeneralizedbraindysfunctionmarkedbyvaryingdegreesofimpairmentofspeech,cognition,orienta-tion,andarousal. Taber’sCyclopedicMedicalDictionary,20thEdition,page698.11.Dr.GordonwasthefourthneurologistthatAtkinshadseenafterfilinghisclaim,asneurologistDr.DeVereexaminedAtkinsattherequestoftheSocialSecurityAdministration.12.AlthoughtheyarefightingoverAtkins’claim,with3man-agementBoardmemberstakingapositionadversetoAtkins’claimforfootball-relatedbenefits,byERISAlaw,allNFLBoardmem-berswererequiredtoremainafiduciarytoAtkinsduringthis“fullandfair”reviewprocess.Thewriterappreciatesandgivesaspecialthanks here to the NFLPA’s counsel, Joseph “Chip”Yablonski,whokeptAtkins’ andhis counsel advisedof theBoard’s adver-sarialdeliberationsinkeepingwiththefiduciaryrequirementsoftheentireNFLBoard.Althoughthemanagementboardmem-bersdidn’t communicatewithAtkinsorhis counselduring thearbitrationprocess,thebriefwhichtheyfiledafterthearbitrationhearingwasconcludedindicatedthattheyreliedheavilyuponthe“clearandconvincing”evidencestandard,andcontinuedtourge

Dr.Boll’sopinionthatAtkins’disablingcognitiveproblemswerenotcausedbyfootballbutwerecausedbyfunctionalilliteracyandbipolardisorderordepressivedisorder.13.CTEischronictraumaticencephalopathy.14. The opinion contrary to Dr. Cantu and Dr. Gordon wasfromDr.Boll, theneuropsychologist,whobelieves thatAtkins’cognitivedysfunctionisnotfrompost-concussionsyndromebutis caused by a combination of functional illiteracy, psychiatricsymptomsconsistentwithdepressivedisorderorbipolardisorder,andpain.15. “AHobbledStarBattlestheNFL”EllenE.Schultz,WallStreetJournal,December3–4,2005.16.FactstakenfromthecaseWashingtonv.BertBell/PeteRozelleNFLRetirementPlan(9thCir.2007).17.FactstakenfromBrummv.BertBellNFLRetirementPlan,995F.2d1433(8thCir.1993).18.FactstakenfromJaniv.Bell,209Fed.Appx.305(4thCir.2006).19. FactstakenfromArmstrongv.BertBellNFLPlayerRetire-ment,646F.Supp.1094(D.Colo.1986).20.FactsandquotetakenfromtheCourt’sopinioninJohnsonv.BertBell/PeteRozelleNFLPlayerRetirementPlan,468F.3d1082(8thCir.2006).21.FactstakenfromSmithv.Bell,125F.3d859(9thCir.1997).22. “....forwhowouldbearthewhipsandscornsoftime,theoppressor’swrong,theproudman’scontumely,thepangsofde-spisedlove,thelaw’sdelay,theinsolenceofofficeandthespurnsthepatientmeritoftheunworthytakes,whenhehimselfmighthisquietusmakewithabarebodkin...”Shakespeare’sHamlet,Act3,Scene1.Obviously,depressedandfinanciallystrappedplayerslikeAtkinsarepoorlyequippedtohandlea4or5yeardelay.23.FactstakenfromGreenv.BertBell/PeteRozelleNFLPlayerRetirementPlan,1999WL417925(N.D.Tex.).24.FactstakenfromBoydv.BertBell/PeteRozelleNFLPlayersRetirementPlan,410F.3d1173(9thCir.2005).

Jeffrey Dahl NFL and ERISA

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