In Darren Mickell v. Bert Bell/Pete Rozelle NFL Players Retirement Plan (Plan), Mickell spent nine years in the NFL as a defensive end. He was repeatedly subjected to high speed contact hits which caused multiple orthopedic injuries to his “back, ribs, shoulders, arms, hands, knees, hips, legs, and feet.” He had multiple orthopedic surgeries. Mickell also sustained multiple blows to his head that affected his cognitive functioning. His injuries eventually caused him to leave the NFL.
In September 2013, Mickell applied to the Plan for disability benefits based on injuries to his knees, hips, back, and shoulders. The Plan provides disability benefits to eligible NFL players. Claims for benefits are initially determined by a Committee. If the Committee denies the claim, the player can appeal to a six-member Board for review. The Board may refer the player for evaluation by one or more physicians who are selected by the Plan and referred to by the Plan as “Plan Neutral Physicians.”
Mickell submitted his medical records and documentation from his treating physicians to the Committee. The records and physician statements supported his claim that he was unable to work due to his injuries and cognitive impairment.
The Plan had seven of its Plan Neutral Physicians review Mickell’s medical records. Some also examined him, including an orthopedist, neurologist, neuropsychologist, and a psychiatrist. All opined that Mickell was not disabled and one psychiatrist opined that Mickell could do “some kind of employment.”
The Committed denied the application, Mickell appealed to the Board, who upheld the Committee’s denial based on the opinions of the Plan Neutral Physicians. The Board acknowledged “the presence of potentially conflicting evidence in the record” but, according to the Court of Appeals, the Board “discounted that evidence in light of the absolute discretion given to it by the Plan to weigh the evidence.” The Board also noted that while Mickell’s treating physicians found he had impairments, they did not “directly address whether [he is] totally and permanently disabled.”
Mickell appealed the administrative denial of his claim by filing an ERISA lawsuit in the U.S. District Court for the Southern District of Florida. The District Court upheld the Plan’s denial, so Mickell appealed that decision to the United States Court of Appeals for the Seventh Circuit.
The Circuit Court reversed the ruling of the District Court and remanded the case with instructions to the District Court to “consider all the evidence of Mr. Mickell’s conditions together, including any evidence of Mr. Mickell’s functional capacity, to determine whether the combined effects of his impairments render him disabled.”
The Circuit Court noted that “Even though we review the Board’s determination under a deferential standard, the standard does not render us a mere stamp of approval. On the contrary, we review the decision for whether the Board ‘entirely failed to consider an important aspect of the problem.’”
The Board Abused its Discretion When It Ignored Relevant Evidence Submitted by Mickell
The Appeals Court began its review by clarifying that when reviewing an ERISA claim under an abuse of discretion standard, the role of the court is to “determine if there was a reasonable basis for the decision, based on the facts known by the administrator at the time the decision was made.” Simply giving more weight to some experts than others is not an abuse of secretion. The Court upholds a “Plan’s determination ‘if it has a reasonable factual basis, even if the record contains contrary information.’”
Even under this deferential standard, this Court agreed with Mickell that the Board relied on seven of its own experts, three of whom indicated that Mickell was “employable” but it totally disregarded the evidence of Mickell’s “MRI reports, x-ray reports, hospital records, injury reports, and treating physician’s records.”
The Board stated that it reviewed Mickell’s “entire file,” but the Court found that statement was “belied by the record.” The Board’s denial letter did not “discuss any evidence Mr. Mickell had presented to the Committee.”
Ultimately, the Court held that “When it failed to review relevant medical evidence that supported Mr. Mickell’s claim, the Board abused its discretion.”
The Board Abused its Discretion by Failing to Consider the Cumulative Effects of Mickell’s Impairments
In this case, the burden of proof was not on Mickell to prove he was disabled. According to the Plan Documents, the burden rested with the Board or the Committee to find “that he has become totally disabled.”
The Board should have had Mickell submit to an examination “by a vocational expert, who could have provided an opinion about whether Mickell’s specific impairments – when considered together – prevented his gainful employment.”
Instead of doing this, the Board relied on the opinions of the Plan Neutral Physicians who properly limited their “conclusions to areas within their expertise.” The Board and the District Court particularly relied on the opinion of a psychiatrist who found that “Mickell’s psychological difficulties did not rise to a level that precludes some kind of employment like assisting in sports programs for youths.”
The Board ignored the evidence submitted by Mickell which included the report of a psychologist and Licensed Mental Health Counselor who both concluded he was unable to work due to his “cognitive and emotional impairments.”
Appellate Court Remanded to the District Court for Further Proceedings Consistent with This Opinion
The Appellate Court held that, “Because the Board abused its discretion by failing to consider (1) Mr. Mickell’s medical records and reports from his treating physicians, and (2) the cumulative effect of Mickell’s impairments, we reverse the District Court’s order granting summary judgment to the Plan. We Remand to this case to the District Court for further proceedings consistent with this opinion.”
This case was not handled by our firm, but we believe it can be instructive to those who suffer from several different medical conditions that may have a cumulative affect rendering them disabled. If you have questions about this case, or questions about your own claim for disability, contact any of our disability attorneys at Dell & Schaefer for a free consultation.
We have clients all over the country since all work and client conferences are by phone. Call us at (800) 632-8331.