Fourth Circuit Prevents Arbitrary and Baseless Denial of Benefits
Solomon v. Bert Bell/Pete Rozelle NFL Retirement Plan, No. 16-1730, 2017 WL 2695191 (4th Cir. June 23, 2017).
Recently, the 4th Circuit determined that the Bert Bell/Pete Rozelle NFL Retirement Plan and the NFL Player Supplemental Disability Plan abused its discretion when it denied ex-NFL player Jesse Solomon a certain category of long-term disability benefits, because it completely ignored relevant evidence that supported an award of those benefits. Under the plan, NFL players who later become disabled due to their football careers receive benefits if eligible by the plans terms. One provision of the plan provided for graduated payments of disability: if a player became disabled within 15 years of retiring from the NFL, they would receive a higher benefit amount each month. Solomon retired from the NFL in 1995. He originally applied for benefits in 2009 claiming that he was disabled due to orthopedic ailments. After being denied, Solomon applied once again in 2010, however this time he argued that he had cognitive disabilities, and submitted a large amount of new medical information that supported this contention. Eventually the plan granted Solomon benefits, however it determined that he did not qualify for the higher benefit amount, since he was approved based on the 2010 application, which was past the 15 year cut off. Solomon argued that the medical evidence in his 2010 application clearly showed he suffered from cognitive issues that rendered him totally disabled, and that these conditions dated back to 2008. Furthermore the 2009 denial did not address any cognitive disability whatsoever, and only pertained to his physical conditions. The insurance company stated that it did not need to look at the evidence in his second application because the 2009 denial meant Solomon was not totally disabled as of that date. The insurance company also argued that Solomon did not submit contemporaneous medical evidence showing that he was disabled before the 15 year deadline.
The 4th Circuit held that Solomon was not required to submit evidence and prove his disability before the deadline, as the plan only required that he become disabled before the deadline to receive the higher tier of benefits. The Court also took issue with the plan completely ignoring the relevant medical information in Solomon’s 2010 application. The 2010 application contained multiple expert reports that showed Solomon had a cognitive disability before the cutoff date imposed by the plan, and the insurance company completely failed to even acknowledge their existence. Since a fiduciary may only deny benefits based on substantial evidence, it was an abuse of discretion to ignore “relevant evidence supporting an award of benefits,” and fail to “cite any affirmative evidence relevant to brain injuries on which the Board relied,” when denying Solomon’s claim.