Pro football players have a disability plan provided by the NFL. Like all private sector employer-provided disability benefit plans, the Employee Retirement Income Security Act, also known as ERISA, is the governing law.
In the recent case of Giles v. Bert Bell/Peter Rozelle NFL Player Retirement Plan, the Maryland federal court took the NFL disability benefits plan for denying benefits to a former player. ERISA does not make it easy for a disabled worker to obtain disability benefits because, most times, a court does not do its own review of the facts. Rather, ERISA requires a court to defer to some extent the decision of the plan. In Giles, the Maryland federal court described the court’s standard of review as follows:
The standard of review in the ERISA context “equates to reasonableness: [A court] will not disturb an ERISA administrator’s discretionary decision if it is reasonable.” Evans v. Eaton Corp. Long Term Disability Plan, 514 F.3d 315, 322 (4th Cir. 2008) (citations omitted). “At its immovable core,” the standard requires that a court “not reverse merely because it would have come to a different result in the first instance.” Id. Thus, a reviewing court may not overturn a benefit decision that results from a “‘deliberate, principled reasoning process’” and that “is supported by ‘substantial evidence,’” even if the court “would reach a different decision independently.” Helton, 709 F.3d at 351 (citation omitted).
The NFL disability benefits plan denied Giles, in part, because the finding of the Social Security Administration that he was totally disabled did not include a determination that the disability was caused by injuries sustained when an active NFL player. The Court rejected this basis for the Plan’s denial with some harsh language:
The Plan’s latest rationale for denying Football Degenerative benefits to Giles amounts to a “Hail Mary” pass. In Giles I, I concluded that the Plan, having contractually agreed to adopt the Social Security Awards standard for benefits, improperly sought to curtail that provision by adding a requirement—proof of a total inability to work—that was contrary to the Plan’s plain language. See ECF 49 at 37. The Plan has now conceded that Giles’s work limitation resulted from his NFL football activities, and not from an illness, injury, or other cause. Despite that acknowledgment, the Plan has sought to salvage its denial by adding a requirement that Giles’s disabled status under the SSA criteria must have “arise[n] out of League football activities.” The Retirement Board has denied Football Degenerative benefits because Giles, although physically limited to sedentary work due to injuries sustained during his NFL career, qualified for Social Security disability benefits based in part on his age. Because that limitation is contrary to the Plan, reversal is warranted.
The Giles case illustrates how hard a disability benefits plan may make it for a disabled worker to collect what his due to him or her under the plan terms. It is important that a disabled worker consult with knowledgeable attorneys when fighting for disabled benefits. Lebau & Neuworth attorneys have decades experience advocating for the disabled. We welcome your call.
