Keys v. Bert Bell/Pete Rozelle NFL Player Ret. Plan
| Decision Date | 02 October 2020 |
| Docket Number | Case No. 8:18-cv-2098-T-36JSS |
| Citation | 493 F.Supp.3d 1147 |
| Parties | Tyrone KEYS, Plaintiff, v. BERT BELL/PETE ROZELLE NFL PLAYER RETIREMENT PLAN and NFL Player Disability and Neurocognitive Benefit Plan, Defendants. |
| Court | U.S. District Court — Middle District of Florida |
Jeffrey E. Dahl, Pro Hac Vice, Law Office of Jeffrey Dahl, San Antonio, TX, Lansing C. Scriven, Lanse Scriven Law, Tampa, FL, for Plaintiff.
Brian Douglas Equi, Goldberg Segalla LLP, Orlando, FL, Katherine Burgess Kohn, Pro Hac Vice, Michael L. Junk, Pro Hac Vice, Groom Law Group, Chartered, Washington, DC, for Defendants.
The matter comes before the Court upon the parties’ cross motions for summary judgment. In this action, retired professional football player, Tyrone Keys, seeks reinstatement of his NFL-related benefits under the Bert Bell/Pete Rozelle NFL Player Retirement Plan and the NFL Player Disability & Neurocognitive Benefit Plan ("the Plans"), and declaratory relief to prevent the administrators of the Plans from clawing back benefits that were paid to him. (Doc. 35). The Plans have filed counterclaims to recover alleged overpayments of certain benefits to Keys that Keys wrongfully obtained through misrepresentations and omissions to the Plans. (Doc. 39).
Keys has filed a motion for summary judgment, arguing that he did not present any false information to the Board; did not receive an incorrect classification of benefits; should receive reinstatement of those benefits; and is not liable for any overpayment. (Doc. 57). In response, the Plans contend that the decision to terminate Keys’ benefits was reasonable considering Keys’ history of false, incomplete, and contradictory statements, and incorporated the arguments in their motion for summary judgment. (Doc. 60). In their motion for summary judgment, the Plans argue that the decision to reduce and terminate Keys’ disability benefits was reasonable because Keys repeatedly failed to provide complete and accurate information to the Plans—including hiding a 2002 car accident—in order to shore up a higher disability award than he was truly entitled to. (Doc. 58). Keys responds in opposition, asserting that there was nothing in the administrative record1 supporting the claim that he was rendered disabled by the car accident, and not NFL football. (Doc. 61). Keys also lists various reasons why the decision to reduce and terminate his benefits was not reasonable, including that he provided medical records regarding the 2002 accident to the Plans’ experts prior to their independent medical examination, and those experts had significant experience examining former NFL players and opined that his disability resulted from professional football. See id. Having considered the motions, responses, and replies,2 and having heard oral argument, the Court will deny Defendants’ motion and grant in part Keys’ motion.
Keys played football in the NFL for several seasons, as a defensive lineman for the Chicago Bears, Tampa Bay Buccaneers, and the San Diego Chargers. AR at 1228, 1034. In 1989, injuries to his back, knees, and shoulders apparently forced him to retire from the sport. Id. at 1034. About two years later, in 1991, he submitted a claim for disability benefits to the administrators of the Plans. Id. at 457. In his application, he sought "Line of Duty Disability" benefits4 ("LOD") and "Total and Permanent Disability" benefits5 ("T&P"). Id. The nature and cause of the disability was listed as football and Keys also indicated that there was a workers’ compensation claim pending. Id.
In furtherance of his claim for benefits, Keys was examined by Dr. Hugh S. Unger, a neutral physician appointed by the Plans,6 on December 9, 1991. Id. at 448-449. In his report, Dr. Unger described the nature of the disability as "[r]restriction of back motion and patellofemoral compression, on the right." Id. at 448. He opined that Keys would never be able to return to professional football, but may engage in occupations which preclude bending, lifting, climbing and like physical activities. Id. He also indicated that Keys suffered a 50-59% loss of the use of his back, 30-49% loss of the use of his shoulder, and a 60-79% loss of use of his knees. Id. at 449. Additionally, Dr. Unger opined that Keys had "multiple extremity involvements, with arthritis
of the right shoulder, chondromalacia of both knees, and tear of the medial meniscus" and he "anticipated that further degeneration in the right shoulder may develop in time and [that Keys] may develop early arthritic changes in the knees." Id. at 449.7
Approval for LOD benefits
By correspondence dated January 23, 1992, Keys was notified that he was approved for LOD benefits. Id. at 506. The first payment, retroactive to January 1, 1992, was provided to Keys with correspondence dated March 3, 1992. Id. at 512. In the letter, the Plans indicated that LOD benefits were payable for the duration of the disability, but not to exceed five years. Id. Keys was examined yearly by Dr. Unger for the next four years—on March 4, 1993, March 7, 1994, March 24, 1995, and March 11, 1996—in order to retain his benefits. Id. at 522, 526-531, 534, 536-543, 550, 552-557, 564-565, 567-571. Each time, Dr. Unger opined that Keys was able to work, subject to his limitations. See id. Around the time of his examination by Dr. Unger in 1996, Keys requested reclassification of his disability from LOD to T&P. Id. at 589. That request was denied, and Keys appealed. Id. at 573-574, 618. The appeal was rejected. Id. at 622. Keys was again examined by Dr. Unger in October 1997 and May 1998,8 and his opinion regarding Keys’ ability remained the same as in prior years—Keys’ could work with limitations. Id. at 631-632, 658.
May 2002 car accident
A few years later, in May 2002, Keys was involved in a motor vehicle accident. Id. at 3726. Following the accident, he presented to various medical practitioners with injuries arising from the accident. One such provider was Dr. Chet Janecki, to whom he complained of neck pain, low back pain, and left knee pain, arising from a rear-end collision around May 7, 2002. Id. at 3836. He was seen several times after. Id. at 1023, 1088. He was also seen by his chiropractor Dr. Richard Shaker—whom he had been treating with even as early as January 2000—as well Dr. Howard Hochman. Id. at 3843-3848, 3851-3857.
2003 Application for T&P benefits and benefits award
On or about September 16, 2003, the Plans received an application for Total and Permanent disability benefits from Keys. Id. at 755-760. In that application, Keys indicated that he had previously received a workers’ compensation award in the amount of $39,000. Id. at 760. He also provided a copy of his income tax return January – December 2000 tax year. Id. at 761-792. By correspondence dated November 25, 2003, the Plans acknowledged Keys application and notified him that a neutral physical examination was required. Id. at 793. Subsequently, he was scheduled for the independent medical evaluation with Orthopedist, Dr. Harlan Selesnick. Id. at 794. That examination was conducted on December 18, 2003. Id. at 846. Dr. Selesnick examined Keys’ knees, cervical spine, lumbar spine, and right shoulder. In his report, Dr. Selesnick opined that Keys was totally disabled to the extent that he was substantially unable to engage in any occupation or employment for remuneration or profit and this disability was permanent.
Id. In the letter that accompanied his report, Dr. Selesnick provided more details:
By correspondence dated March 3, 2004, the Plans informed Keys that he was approved for T&P Inactive disability benefits,9 and benefits would be payable for life or until cessation of the total and permanent disablement, subject to periodic examination as required by the Board. Id. at 976. An appeal was filed about a month later, challenging the classification as Inactive. Id. at 1102. In the request for administrative review, Keys argued that he should have been approved for the "Football Degenerative" benefits because "his disabilities all ar[o]se out of NFL football activities." Id. at 1102. Hence, Keys believed he was entitled to gross monthly benefits in an amount no less than $4,000, rather than the $1,207.50 awarded. Id. at 1107. Upon further review, Keys was reclassified to Football Degenerative and found "eligible for benefits under the NFL Player Supplemental Disability Plan in the amount of $5,167.00 per month." Id. at 1107, 1186. Keys was also awarded "a monthly benefit of $3,000" under the Retirement Plan. Id. at 1120-22, 1186.
Keys requests for reclassification of disability status
Later that year, Keys again sought reclassification, this time to Active Football T&P disability status.10 Id. at 1180, 1187-1202. He was examined by Dr. Selesnick who stated that his "orthopaedic opinion [was] essentially unchanged from December 18, 2003." Id. at 1185. In their March 16, 2005 correspondence denying Keys’ request, the Plans indicated that he had not shown any change of circumstances warranting reclassification. Id. at 1246. The Plans further explained that Keys had been examined by Plan neutral physicians in the years following his career, and those physicians consistently opined that Keys was not...
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