Jesse Solomon v. Bert Bell/Pete Rozelle NFL Player Retirement
860 F.3d 259
| 4th Cir. | 2017Background
- Jesse Solomon, a former NFL player, retired in 1995 and later sought Plan disability benefits for football-related injuries including cognitive/neurological impairments consistent with CTE and severe orthopedic injuries.
- The Bert Bell/Pete Rozelle NFL Retirement Plan (the Plan) provides two TPD benefit tiers: Football Degenerative (TPD within 15 years of retirement) and Inactive (TPD after 15 years); Football Degenerative pays higher benefits.
- Solomon filed a first Plan claim (Mar. 2009) alleging orthopedic TPD; the Committee denied it (May 2009) and the Board affirmed (Nov. 2009) based on orthopedics.
- He filed a second Plan claim (Dec. 2010) asserting neurological/cognitive TPD, submitting new neuropsychological reports and MRIs; the Plan’s neutral neurologist (Dr. DiDio) concluded Solomon was TPD from progressive postconcussive/possible CTE.
- The Committee deadlocked on the second claim (Mar. 2011) resulting in denial; an ALJ later awarded SSA disability benefits with an onset date of Oct. 29, 2008; the Board accepted SSA disability for Inactive benefits but denied reclassification to Football Degenerative, treating the earlier 2009 denial as dispositive and ignoring the new neurological evidence.
- District court awarded Football Degenerative benefits; Fourth Circuit affirmed, holding the Board abused its discretion by failing to consider and explain rejection of the uncontradicted new medical evidence (including the Plan’s own expert).
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the Board abused its discretion by classifying Solomon as Inactive rather than Football Degenerative | Solomon: Board ignored new, uncontradicted neurological evidence (and Plan’s neutral neurologist) showing TPD before the 15-year cutoff; therefore decision was arbitrary | Plan: The Board’s 2009 denial (orthopedic claim) and lack of contemporaneous medical evidence before Mar. 31, 2010 support classifying him as Inactive | Held: Board abused its discretion—it failed to address or explain rejection of new evidence and improperly relied on the 2009 orthopedic denial to foreclose neurological claims |
| Whether the Plan could require contemporaneous medical evidence dated before the cutoff to prove onset date | Solomon: Plan does not require contemporaneous evidence; later medical records are probative of earlier onset | Plan: Plaintiff must produce contemporaneous medical evidence showing TPD before the cutoff | Held: Rejected Plan’s contemporaneous-evidence requirement; later medical evidence may show earlier onset and the Plan’s prior briefing on this issue was inconsistent with precedent |
| Whether the Board could treat its 2009 orthopedic denial as dispositive of neurological TPD | Solomon: 2009 decision addressed only orthopedics and does not preclude a separate neurological onset determination | Plan: The 2009 denial indicates Solomon was not TPD prior to that decision | Held: Board improperly treated the 2009 orthopedic denial as foreclosing neurological claims; the conditions are distinct and must be assessed on their own record |
| Whether the SSA onset determination binds the Board | Solomon: SSA finding supports early onset (alternative argument) | Plan: SSA determination not binding on Plan for onset date | Held: Court did not decide this question because it affirmed on abuse-of-discretion grounds (note: Plan later amended the Plan to make SSA onset non-binding) |
Key Cases Cited
- Champion v. Black & Decker (U.S.) Inc., 550 F.3d 353 (4th Cir.) (standard of review when plan gives administrator discretion)
- DuPerry v. Life Ins. Co. of N. Am., 632 F.3d 860 (4th Cir.) (reasonableness requires deliberate, principled reasoning and substantial evidence)
- Bernstein v. CapitalCare, Inc., 70 F.3d 783 (4th Cir.) (same standard referenced)
- Booth v. Wal–Mart Stores, Inc. Associates Health & Welfare Plan, 201 F.3d 335 (4th Cir.) (nonexclusive factors for reviewing ERISA fiduciary decisions)
- Weaver v. Phoenix Home Life Mut. Ins. Co., 990 F.2d 154 (4th Cir.) (absence of contemporaneous evidence is not dispositive when other evidence supports onset)
- Jani v. Bell, [citation="209 F. App'x 305"] (4th Cir.) (unpublished) (rejecting contemporaneous-evidence requirement in Plan context)