HELPING PEOPLE LIKE YOU WITH THEIR DISABILITY, LIFE AND LONG-TERM CARE BENEFIT CLAIMS

On October 15th, the U.S. Court of Appeals for the 11th Circuit ruled in favor of our client, Darren Mickell, in the case, Mickell v. Bell/Pete Rozelle NFL Players Retirement Plan, holding that the NFL abused its discretion when it denied disability benefits to Mickell under the NFL Player’s Retirement Plan (The Plan) and remanded the case back to the lower court with instructions regarding the proper way to review Mickell’s claim for disability benefits.

Disabling conditions

Mickell played as the defensive end on several NFL football teams over a period of nine years.  He sustained a number of severe orthopedic injuries as well as numerous head blows which caused psychological problems and cognitive deficiencies.

In 2013, Mickell applied for disability benefits under the NFL Player’s Retirement Plan because his injuries prevented him from working in any gainful occupation. His medical records confirmed that due to significant orthopedic problems, he experienced chronic pain and could not handle sustained physical activity of any kind. Additionally, his doctors diagnosed him with severe mood impairment, cognitive disorder from “multiple concussive injuries,” anxiety and depression.

Multiple treating physicians opined that Mickell could not work. His neuropsychologist wrote that the combination of cognitive decline, mood and behavior problems as well as physical impairments made it very unlikely that Mickell could consistently go to work or finish work tasks. His rehabilitation and physical medicine doctor said that Mickell could not work four consecutive hours, and that his disabilities are permanent and will worsen.

As part of its claim review, The Plan sent Mickell to seven neutral (plan-selected) doctors for evaluation. Each physician considered only the particular area of injury in which they specialize and not the impact the combination of those injuries would have on Mickell’s overall functionality.  Each doctor stated that the particular injury/body part they assessed did not impair him to the point that he could not work in any capacity.  Based almost solely on the opinions of their seven physicians, The Plan denied Mr. Mickell’s claim.  The review board indicated that it could discount Mickell’s evidence because The Plan had “absolute discretion” to weigh conflicting evidence.

After exhausting all of his administrative appeals, we filed a lawsuit on behalf of Mickell with the District Court to review the denial under the Employment Income Security Act of 1974 (ERISA).  The District Court upheld the Plan’s denial of benefits and we appealed to the 11th Circuit Court of Appeals.   The 11th Circuit reviewed the evidence and allowed both sides to present their case in oral argument.  After careful review, the 11th Circuit Court of Appeals reversed the District Court’s order and sent Mickell’s case back to the District Court to review his claim in accordance with its findings.

The Plan abused its discretion by ignoring our client’s medical evidence

The 11th Circuit Court of Appeals held that the plan improperly ignored the medical evidence submitted by Mickell and gave weight only to the opinions of its own hired physician consultants. By reflexively deferring to the opinions of its own doctors without considering the other medical evidence and physician opinions, The Plan abused its discretion and acted arbitrarily and capriciously.  While The Plan had discretion to weigh the relative strength of conflicting evidence, it was an abuse of that discretion to completely ignore claimant’s medical evidence. In fact, the board did not even review important medical records our client submitted.

Failure to consider the combined impact of all impairments on ability to work was another abuse of discretion

The 11th Circuit also agreed with our argument that it was unreasonable for the plan not to consider the cumulative effect of Mickell’s physical, mental and emotional impairments in order to fully understand their combined impact on his ability to work in any job. The Plan ignored the results of a Functional Capacity Evaluation, performed by one of Mickell’s treating physicians, which objectively measured Mickell’s overall ability to function reliably in a work setting.  The FCE findings indicated that Mickell is unable to maintain gainful employment due to the effect of his numerous medical conditions.  While The Plan’s neutral doctors only analyzed impairments that were within their specialties, the Court noted that the plan could easily have had a vocational expert assess the overall effect Mickell’s numerous impairments would have on his ability to be gainfully employed.

Employability looks at the whole person, not an isolated injury or illness. The court found that because the board “ignored an important consideration in the question of whether he was disabled,” it again abused its discretion.

The 11th Circuit sent the case back to the trial court for reconsideration in line with these findings.

(The text of the 11th Circuit decision in Mickell v. Bell/Pete Rozelle NFL Players Retirement Plan is available on Westlaw at 2020 WL 6074329.)

If you or someone you know has questions about their own disability claim or if you are in the process of appealing a denial of benefits, please contact our firm for a free consultation at (888) 644-2644 or through our website www.DiLawGroup.com

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