Atkins v. Bert Bell/Pete Rozelle NFL Player Retirement Plan

694 F.3d 557, 54 Employee Benefits Cas. (BNA) 1190, 2012 WL 3931010, 2012 U.S. App. LEXIS 19049
CourtCourt of Appeals for the Fifth Circuit
DecidedSeptember 11, 2012
Docket11-51202
StatusPublished
Cited by23 cases

This text of 694 F.3d 557 (Atkins v. Bert Bell/Pete Rozelle NFL Player Retirement Plan) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Atkins v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, 694 F.3d 557, 54 Employee Benefits Cas. (BNA) 1190, 2012 WL 3931010, 2012 U.S. App. LEXIS 19049 (5th Cir. 2012).

Opinion

EDITH BROWN CLEMENT, Circuit Judge:

Gene Atkins, a former player for the New Orleans Saints and Miami Dolphins National Football League (“NFL”) teams, filed suit seeking more generous disability benefits under the Bert Bell/Pete Rozelle NFL Player Retirement Plan (the “Plan”). The district court granted summary judgment in favor of the Plan, affirming its benefits determinations that Atkins is only eligible for “Inactive” player disability benefits instead of the more generous “Football Degenerative” disability benefits he *560 seeks. Atkins challenges the standard of review employed by the district court and the substantive merits of the benefits determinations. We AFFIRM.

FACTS AND PROCEEDINGS

1. The Bert Bell/Pete Rozelle NFL Player Retirement Plan

The Plan is an employee, multi-employer welfare benefit plan governed by the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1002(3)(2)(A), 1002(37)(A), and the Labor Management Relations Act (“LMRA”), 29 U.S.C. §§ 141 et seq., also known as the “Taft-Hartley Act.” As required by statute, the Plan is jointly administered by employee (NFL players) and employer (NFL club owners) representatives. 29 U.S.C. § 186(c)(5)(B). Three player representatives are appointed by the NFL Players Association (“NFLPA”) and three club ownership representatives are appointed by the NFL Management Committee (“NFLMC”) (collectively the “Retirement Board” or the “Board”). The Retirement Board, which meets quarterly, is the “named fiduciary” of the Plan and is responsible for administering the Plan. The Plan grants the Board “full and absolute discretion, authority and power” to interpret the Plan and decide claims for benefits. The Plan also provides that, in exercising its discretionary powers, the Retirement Board “will have the broadest discretion permissible under ERISA and any other applicable laws.”

The Plan provides monthly total and permanent (“T&P”) disability benefits to eligible NFL players. Retired players such as Atkins may be eligible for benefits categorized as either “Football Degenerative” or “Inactive.” A player may qualify for “Football Degenerative” T&P benefits if his disability “arises out of League football activities.” A player may qualify for “Inactive” T&P benefits if his disability “arises from other than League football activities.” Football Degenerative benefits are significantly greater than Inactive benefits. After an initial benefits determination, a player’s benefit category may be altered only upon a showing of “changed circumstances” based on “clear and convincing” evidence.

A player’s claim for T&P disability benefits is first reviewed by the Disability Initial Claims Committee (“DICC”). The DICC is composed of two members, one appointed by the NFLPA and one by the NFLMC. If the two members of the DICC are deadlocked, the claim is deemed denied. Decisions of the DICC are appealable to the Retirement Board. If the members of the Retirement Board are deadlocked, they may vote to submit the matter to a Medical Advisory Physician (“MAP”) for a determination regarding medical issues. In the event of a deadlock concerning eligibility or entitlement to benefits, the Retirement Board may vote to refer the dispute for final and binding arbitration.

2. Atkins’ Initial Claim for Disability Benefits

Gene Atkins played professional football from 1987 until 1996, spending the majority of his time playing with the New Orleans Saints and the last several years with the Miami Dolphins. During his career he was well-recognized for his aggressive, hard-hitting play as a defensive back and he sustained a number of injuries resulting from on-field collisions.

In December 2004, Atkins submitted an application for disability benefits to the Plan administrators, claiming T&P disability as a result of three conditions stemming from his football career. The conditions Atkins listed were: (1) right shoulder ailments, including movement limitations *561 and chronic pain; (2) chronic constant pain in his neck that radiated through his arms and hands, affecting his ability to drive, sense of touch, and ability to hold objects; and (3) depression and mood issues that limited his ability to function, due in part to his constant physical pain and inability to work. Atkins reported that he worked at a Target store for five months but had to stop because of pain, headaches, and difficulties in dealing with people.

Following receipt of his disability application, Plan administrators sent Atkins to two neutral physicians for evaluation, Keith Kesler (“Kesler”), a psychiatrist, and Tarek Souryal (“Souryal”), an orthopedist. Kesler reported that Atkins suffered from poor cognitive function, which he stated “cannot be determined” as to whether it resulted from football. Kesler also reported that Atkins had chronic pain and headaches, as well as possible neurologic defects, all of which were the result of-.football. Kesler found Atkins totally disabled as a result of his impairments. In contrast, Souryal reported that Atkins suffered from neck and shoulder impairments which were the result of football, but the impairments did not render him totally disabled.

Atkins’ application and Kesler’s and Souryal’s reports were reviewed by the DICC on June 7, 2005. The two members deadlocked and the claim was deemed denied. Atkins appealed the decision to the Retirement Board as provided for under the Plan. The Retirement Board scheduled Atkins for two additional examinations by neutral physicians, orthopedist J. Bryan Williamson (“Williamson”) and neurologist Raymond Martin (“Martin”).

Williamson concluded that Atkins suffered from long-term neck and right shoulder impairments due to football-related injuries. However, Williamson also concluded Atkins was not totally disabled. Martin found that Atkins was totally disabled due to a combination of problems. He concluded Atkins’ physical impairments were a result of football, but his memory problems were of an unknown source. He suggested that formal neuropsychological testing would have to be done to determine the etiology of Atkins’ problems with intellect, memory, and mental status.

With the benefit of Williamson’s and Martin’s reports, the. Retirement Board considered Atkins’ claim at its next scheduled quarterly meeting held on October 20, 2005. The Retirement Board deadlocked and referred the matter to a MAP. The Plan defines a MAP as a board-certified orthopedic physician or a physician in another medical discipline as designated by the NFLPA and NFLMC. A MAP has the authority to decide only those medical issues submitted by the Retirement Board. Atkins was referred - to Thomas Boll (“Boll”),'a Ph.D. clinical neuropsycholtigist, for an examination. The referral states that Boll was to evaluate the impaired body parts identified by Atkins, specifically his “head ache, numbness, shoulders, neck [and] hands.”

Boll concluded that Atkins suffered from illiteracy and borderline mental ability, neither of which resulted from football.

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Bluebook (online)
694 F.3d 557, 54 Employee Benefits Cas. (BNA) 1190, 2012 WL 3931010, 2012 U.S. App. LEXIS 19049, Counsel Stack Legal Research, https://law.counselstack.com/opinion/atkins-v-bert-bellpete-rozelle-nfl-player-retirement-plan-ca5-2012.