In Youboty v. NFL Player Disability & Neurocognitive Benefit Plan, No. 20-40613, 2021 WL 1533662 (5th Cir. Apr. 16, 2021), Plaintiff-Appellant Ashton Youboty played six seasons in the National Football League (NFL) and suffered various injuries while playing before he retired. Youboty was a participant in the Defendant NFL Player Disability & Neurocognitive Benefit Plan (“the Plan”) which is subject to the Employee Retirement Income Security Act (“ERISA”). The Plan pays for partial disabilities referred to as “line of duty” (LOD) benefits. To be eligible for this benefit, a player must apply for benefits within 48 months of retirement, which Youboty did based on multiple conditions, including orthopedic impairments. On the application he noted that he was not expecting any additional surgeries in the next year and was not planning on submitting additional documentation. Youboty was examined by one of the Disability Board’s (“Board”) neutral physicians. Youboty needed to accumulate 10 points from the examination to qualify for LOD benefits. He scored only eight points. The Disability Initial Claims Committee rejected his claim. He appealed to the six-member Board and argued that he should have been awarded points based on a surgery that he underwent after he filed his application and the 48-month deadline had already passed. Had the Board done so, Youboty would have qualified for LOD benefits. The Board denied his appeal, Youboty filed suit, and the district court ruled in favor of the Plan.
The Fifth Circuit was tasked with deciding whether the Board properly exercised its discretionary authority to interpret the terms of the Plan when it refused to award points for the post-application surgery. In affirming the district court, the Fifth Circuit first considered whether the Board’s interpretation is legally correct. If it is not legally correct, then the court examines whether the Board abused its discretion. The court found that the Board’s interpretation is legally correct because there is no evidence that the Plan was not applied uniformly and the Plan is completely silent on whether surgeries that occur after the application deadline should count toward the LOD determination, but it does note an application deadline. “Interpreting this deadline also to serve as a deadline for surgeries that count toward the LOD determination is a fair reading of the plan.”
Though the Plan requires the Board to “take into account all information,” this broad statement does not require the Board to award points based on surgeries that occurred after the application deadline. The Board considered the surgery, it just did not award points for it which is not inconsistent with the Plan. The court reasoned that allowing players to submit claims after the application deadline would significantly increase Plan costs because appeals could be stretched out without limitation. The court also explained that even if it thought the Board’s interpretation was not correct, it cannot say it was an abuse of discretion. The Board’s interpretation is not internally inconsistent, in fact, considering surgeries after the application date would be inconsistent with the Plan’s application deadline. The court also found that there is no bad faith or apparent conflict since the Board’s decision was unanimous and the Board includes three members appointed by the NFL Players Association. The court rejected Youboty’s argument that ERISA regulation, 29 CFR § 2560.503-1(g)(1)(iii), requires allowing him to submit information about his additional surgeries.
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