Youboty v. NFL Player Disab ( 2021 )

Case: 20-40613 Document: 00515825217 Page: 1 Date Filed: 04/16/2021
United States Court of Appeals
for the Fifth Circuit United States Court of Appeals
Fifth Circuit
FILED
April 16, 2021
No. 20-40613
Summary Calendar Lyle W. Cayce
Clerk
Ashton Youboty,
Plaintiff—Appellant,
versus
NFL Player Disability ; Neurocognitive Benefit Plan,
Defendant—Appellee.
Appeal from the United States District Court
for the Southern District of Texas
USDC No. 4:19-CV-2306
Before Higginbotham, Jones, and Costa, Circuit Judges.
Per Curiam:*
In this disability benefits case, the issue is whether a benefits review
board (“Board”) properly exercised its discretionary authority to interpret a
benefit plan. Under the Employee Retirement Income Security Act
*
Pursuant to 5th Circuit Rule 47.5, the court has determined that this
opinion should not be published and is not precedent except under the limited
circumstances set forth in 5th Circuit Rule 47.5.4.
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No. 20-40613
(“ERISA”) and the facts of this case, it did, and the judgment of the district
court is AFFIRMED.
The facts of this case are largely undisputed. Ashton Youboty played
six seasons in the National Football League (NFL), suffered various injuries
while playing, and eventually retired. As part of his job, Youboty had a
benefit plan subject to ERISA which “covers partial disabilities and is called
“line of duty” (LOD) benefits.” Youboty v. NFL Player Disability &
Neurocognitive Benefit Plan, No. 4:19-CV-2306, 2020 WL 5628020, at *1
(S.D. Tex. Aug. 17, 2020). “Each eligible player … must apply for benefits
within 48 months after retirement. In this case, Youboty's application
deadline was August 25, 2018. He submitted his application in May of 2018.
On that application he indicated Youboty was not expecting any additional
surgeries in the next year and was not planning on submitting additional
documentation. While his application appears to have been based upon
multiple conditions, the only one that is pertinent in this case concerns his
LOD application based upon orthopedic impairments.” Id.When a player applies for LOD orthopedic benefits he is examined by
one of the Board’s neutral physicians. See id. These neutral physicians are
chosen and approved by both sides of the Board, which includes three
members appointed by NFL Players Association and three members
appointed by NFL management. Id. The player must have a substantial
disability to qualify for these benefits. Id. The physician reviews the player’s
medical history and the player, and he scores the player’s injuries or
conditions on a point system. Id. If a player accumulates 10 points based
upon this examination, he qualifies for LOD benefits. Id. A neutral physician
(and then a second neutral physician after an appeal) reviewed Youboty and
scored Youboty’s orthopedic impairments at eight, two short of what
Youboty needed to receive LOD benefits.
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The dispute is whether the Board should have awarded points based
on a 2019 knee surgery Youboty underwent after he had already filed his
application and the deadline to file his application had passed. Had the Board
awarded points based on the 2019 surgery, Youboty would have qualified for
LOD benefits.
Youboty’s claims were first reviewed and rejected by the Disability
Initial Claims Committee. Youboty then appealed to the six-member
Disability Board that has discretion to decide appeals of those who are denied
benefits. The Board unanimously denied his appeal. Youboty then brought
suit in federal district court. He alleged that “under the authority of
29 U.S.C. § 1132(a)(1)(B) of ERISA,” the Board’s decision “not to count his
left knee surgery as an orthopedic impairment under the Plan’s orthopedic
point system because it occurred after his deadline for submitting his LOD
application was contradicted by the Plan’s plain language.” Therefore, “the
Board’s interpretation of the Plan was an abuse of discretion.” The district
court affirmed the Board’s decision, finding that the Board did not abuse its
discretion in its interpretation of the benefits plan.
Since the Board was vested with discretionary authority to interpret
the benefits plan and whether Youboty qualified, the district court was
correct to review the Board’s decision under an abuse of discretion standard.
Connecticut Gen. Life Ins. Co. v. Humble Surgical Hosp., L.L.C., 878 F.3d 478,
483 (5th Cir. 2017) (quoting Vega v. Nat'l Life Ins. Servs., Inc., 188 F.3d 287,
295 (5th Cir. 1999) (en banc), overruled on other grounds by Metro. Life Ins. Co.
v. Glenn, 554 U.S. 105, 128 S. Ct. 2343, 171 L.Ed.2d 299 (2008)) (“[W]hen
an administrator has discretionary authority with respect to the decision at
issue, the standard of review should be one of abuse of discretion.”). The
district court found that the Board did not abuse its discretion in refusing to
award points for the 2019 knee surgery.
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After carefully considering the briefs, we affirm the district court for
essentially the same reasons.
In a case involving a plan administrator’s (here, the Board)
interpretation of a benefits plan, we first consider whether the
administrator’s interpretation is legally correct. If it is not legally correct, we
must consider whether the administrator abused its discretion. In
determining legal correctness, we examine: “(1) whether the administrator
has given the plan a uniform construction, (2) whether the interpretation is
consistent with a fair reading of the plan, and (3) any unanticipated costs
resulting from different interpretations of the plan.” Wildbur v. ARCO
Chem. Co., 974 F.2d 631, 637 (5th Cir. 1992) (citing Jordan v. Cameron Iron
Works, Inc., 900 F.2d 53, 56 (5th Cir. 1990)). In determining whether the
plan administrator abused its discretion, we consider three additional factors:
“(1) the internal consistency of the plan under the administrator's
interpretation, (2) any relevant regulations formulated by the appropriate
administrative agencies, and (3) the factual background of the determination
and any inferences of lack of good faith.” Id. (citing Batchelor v. Int’l
Brotherhood of Elec. Workers Local 861 Pension & Ret. Fund, 877 F.2d 441, 445-
48 (5th Cir.1989)).
Here, the Board’s interpretation is legally correct. There is no
evidence on the record that the plan was not applied uniformly. 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.
The plan’s requirement that the Board “take into account all
information” (whether or not that information was available to the Board
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during its first review) is a broad statement that does not specifically require
the Board to award points based on surgeries that occurred after the
application deadline. For example, it is imaginable that a surgery that
happened well before the application deadline was inadvertently not included
in the application, and that the Board should consider that. But even if it
meant that post-application surgeries must be considered, the plan does not
say those surgeries must be awarded points. The Board did consider the 2019
surgery, but it did not ultimately decide to award points because the surgery
occurred after the application deadline.
Allowing players to submit claims even after the application deadline
would significantly increase costs for the plan, both in amount of payout and
in administrative costs, because appeals could be stretched out or brought
some time later after a new surgery. Also, allowing post-application events
to influence the claims furnishes no guideline for how long the process could
be strung out, or what limitation must be placed on such events.
Even if we disagreed with the Board’s interpretation, we cannot say it
is an abuse of discretion to decide that surgeries occurring after the
application deadline do not count toward the determination. There is
nothing internally inconsistent about the Board’s interpretation that
surgeries must happen before the application date to be counted, but it would
arguably be inconsistent to interpret the plan the other way since the plan
does specify an application deadline. Further, there is no bad faith or conflict
apparent; indeed, the Board’s decision was unanimous, which means all the
NFL player appointed members agreed. Finally, ERISA’s requirement “that
the claims administrator who is responsible for the initial decision advise the
claimant what ‘additional material and information’ can be provided in order
for the claimant to perfect the claim” means that the Board needed to give
Youboty an opportunity to submit something if there was a way for him to
perfect his claim. See 29 CFR § 2560.503-1(g)(1)(iii)); It would be
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unreasonable to read this as Youboty suggests – that ERISA requires a plan
to allow him to submit information and have additional surgeries until he gets
a desired result.
For the foregoing reasons, the judgment of the district court is
AFFIRMED.
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