Keys v. Bert Bell/Pete Rozelle NFL Player Ret. Plan
Docket: Case No: 8:18-cv-2098-T-36JSS
Court: District Court, M.D. Florida; May 28, 2019; Federal District Court
Defendants filed a Motion to Dismiss Counts I and III of Plaintiff Tyrone Keys' Complaint under the Employee Retirement Income Security Act (ERISA), arguing that the Complaint should only proceed with Count II, as the other counts seek non-existent relief under ERISA. United States District Judge Charlene Edwards Honeywell reviewed the parties' submissions and partially granted the motion.
Tyrone Keys, a former NFL defensive lineman who played from 1983 to 1989, retired due to significant injuries. He subsequently filed a disability claim with the Bert Bell/Pete Rozelle NFL Player Retirement Plan, which offers various classifications of disability benefits: Line of Duty Benefits for substantial disablement, Football Degenerative Total and Permanent benefits for total disability, and Inactive T&P Benefits for unrelated total disabilities.
The Plan's claims administrators include the Disability Initial Claims Committee (DICC) and the Retirement Board. In 1991, Keys applied for Line of Duty benefits, leading to an evaluation by orthopedic physician Dr. Hugh Unger, who identified multiple NFL-related injuries and predicted further degeneration of Keys' conditions.
Dr. Unger assessed Keys' NFL-related impairments, reporting a 50-59% loss of use of his back, a 30-49% loss of use of his shoulder, and a 60-79% loss of use of both knees due to his NFL career. In his 1991 report, he noted multiple extremity issues, including arthritis of the right shoulder, chondromalacia of both knees, and a medial meniscus tear, predicting further degeneration in these areas over time. Following Dr. Unger's findings, the Board awarded Keys Line of Duty benefits for the maximum five-year period, which he received until December 1, 1997. Keys had requested a reclassification of his benefits to T&P Football Degenerative disability benefits, but this was denied in 1997.
On May 7, 2002, Keys was involved in a minor car accident that exacerbated his pre-existing football injuries but did not affect his permanent NFL-related injuries. In September 2003, he reapplied for Football Degenerative T&P disability benefits, citing impairments linked to his NFL career, including cervical spondylosis, lumbar spondylosis, degenerative joint disease, and chondromalacia patella in both knees. Keys described severe limitations in his ability to sit and stand due to pain. The Plan's administrators referred him to Dr. Harold Selesnick, who conducted a thorough physical examination. Dr. Selesnick concluded that Keys was disabled due to his NFL injuries, indicating that his chronic conditions were permanent and likely to worsen, potentially requiring future surgeries such as knee and shoulder replacements.
On March 3, 2004, the Board granted Keys Inactive T&P disability benefits retroactively effective January 1, 2004. Keys appealed, asserting medical evidence of total and permanent disability from his NFL career. Following a review and Dr. Selesnick's report, the DICC approved his claim for Football Degenerative T&P benefits on April 7, 2004, leading to Keys repaying the Inactive T&P benefits he received. The Plan mandates ongoing proof of total disability, resulting in multiple examinations by medical experts who consistently found Keys totally disabled due to his NFL career.
In April 2011, the DICC deadlocked on the continuation of Keys' benefits based on his 2009 tax return, but benefits were maintained during his appeal. Keys informed the Board of his Social Security (SS) disability approval, although he had not yet received the official decision. Under the Plan, SS disability approval generally qualifies a player for Plan disability benefits unless fraud is determined by the Board. In August 2011, the classification of "Football Degenerative" T&P benefits changed to "Inactive A," while "Inactive B" replaced the previous "Inactive" designation. Keys received Inactive A benefits during the pending appeal in late 2011.
In November 2011, the Board upheld the termination of benefits, citing incompatibility between Keys' 2009 tax return earnings and T&P disability benefits, along with a lack of evidence for SS disability approval. Following a February 2012 reapplication with his SS decision, the DICC denied his claim in March 2012, asserting that submitted documents indicated he was still working. Keys appealed, clarifying his limited charity work and inability for full-time employment due to NFL-related conditions, supported by tax returns showing no full-time work.
At a November 2012 meeting, the Board awarded Keys Inactive B benefits effective December 2011 based on his reapplication and SS award. Keys contested this classification, seeking Inactive A benefits instead. The Board rejected his appeal in May 2013 but later reconsidered and awarded Inactive A benefits effective December 2013, contingent on Keys providing authorizations for accessing his SS disability files and tax returns, as well as a list of any employment since January 2004. During this process, Keys continued to receive Inactive B benefits.
In February 2015, the Board terminated Keys' Inactive B benefits, claiming he did not provide requested information. After Keys' counsel submitted the information, his Inactive A benefits were reinstated retroactively to December 2013. However, Keys contested that these benefits should have been retroactive to December 2011 and sought the difference between Inactive A and Inactive B benefits from December 2011 to November 2013, as Inactive A benefits are higher. In August 2017, the Plan administrators informed Keys that his claim for additional benefits for the period from December 2011 to November 2013 was denied, and his Inactive A benefits were terminated. The Board concluded that Keys was never entitled to Inactive A benefits and calculated an overpayment of $831,488.28, which would be deducted from his monthly Inactive B benefits. The Board alleged that it had not previously received a full medical report from Dr. Chet Janecki regarding a car accident Keys had in May 2002, which it claimed was the proximate cause of his impairments, rather than his NFL career. Keys appealed, asserting that his impairments stemmed from his time in the NFL and that the Board had prior knowledge of the car accident when awarding benefits in 2004. The Board denied his appeal on February 26, 2018, stating that he had exhausted his administrative remedies and could only file a lawsuit under ERISA section 1132(a). The legal standard for the complaint requires it to contain a "short and plain statement" that shows entitlement to relief, with sufficient factual matter to support a plausible claim.
A claim is considered facially plausible when the plaintiff presents factual content that allows the court to reasonably infer the defendant's liability for the alleged misconduct. However, the court is not obligated to accept legal conclusions framed as factual allegations. Keys' Complaint contains three counts.
Count I seeks a declaration of rights under section 1132(a)(1)(B) of the Plan, arguing that the Defendants' determination that Keys owes the Plan due to overpayment and their right to offset future benefits was an abuse of discretion since Keys did not provide false information.
Count II claims benefits under section 1132(a)(1)(B), alleging the Defendants improperly denied him Inactive A benefits for December 2011 through November 2013 and terminated his benefits starting August 2017. Keys claims he is owed $144,000 for the earlier period and seeks $9,000 per month for the latter period.
Count III alleges "Estoppel Based Upon Silence" under section 1132(a)(1)(B), asserting that the Defendants failed to pursue information about a 2002 automobile accident until recently, which affects Keys’ benefits. He seeks to retain previously paid benefits and requests that the Defendants be estopped from recovering Inactive A benefits.
The Defendants seek dismissal of Count I, arguing that the declaratory relief sought—verifying the truth of Keys' submissions—is not permitted under section 1132(a)(1)(B). Keys contends that ERISA does not restrict claimants to a single claim for separate decisions affecting them and emphasizes that his Count I aims to enforce his rights under the Plan regarding the clawback of overpaid benefits. Section 1132(a)(1)(B) allows a participant to recover benefits, enforce rights, or clarify entitlement to future benefits, offering three remedies: recovery of accrued benefits, a declaratory judgment for entitlement to benefits, and an injunction against improper refusal of future benefits.
The Eleventh Circuit's ruling in Heffner establishes that while most ERISA cases typically involve requests for traditional benefits, there is room for actions aimed at enforcing rights under the plan's terms. In this context, Keys' Count I for declaratory judgment seeks to affirm his rights regarding a plan provision on overpayment recovery, which pertains to benefit payments. The court's determination will clarify Keys' entitlement to benefits and address whether Defendants wrongfully revoked those benefits through reimbursement demands.
Count II, which questions the Defendants' termination of Inactive A benefits from August 2017, is distinct from Count I. The court's potential finding of abuse of discretion in Count II could imply that Keys deserves benefits from 2004 to 2017, while a ruling against him could suggest he is not entitled to those benefits and may have been overpaid. This distinction allows for the issue of overpayment to be addressed separately.
Defendants also seek to dismiss Count III, in which Keys claims retention of benefits based on estoppel. They argue that such a claim is not recognized under section 1132(a)(1)(B) and is inadequately pleaded. While the Eleventh Circuit's Jones case acknowledged a claim for estoppel under ambiguous plan terms, Defendants contend Keys has not demonstrated ambiguity or misrepresentation. Keys differentiates his claim as "defensive equitable estoppel," pointing to the claims administrator's prolonged silence as prejudicial. He asserts that ERISA does not prohibit this form of estoppel, despite ERISA's broad preemption over state law claims, including equitable estoppel.
Keys argues that ERISA does not prohibit the application of equitable estoppel under section 1132(a)(1)(B), yet he fails to cite any federal court cases enforcing this theory beyond the narrow exception established in Jones. He references Glus v. Brooklyn Eastern Dist. Terminal, where the Supreme Court allowed equitable tolling under FELA due to misleading information from an employer about the filing deadline. However, Keys' analogy conflicts with his assertion that his estoppel claim does not involve misrepresentation of plan terms. Furthermore, the Eleventh Circuit has ruled that estoppel cannot alter statutory requirements under ERISA, which mandates that plans be maintained in writing, thus precluding oral modifications of unambiguous plan terms.
Keys' estoppel claim is insufficiently supported as he does not demonstrate the necessary elements, which include showing that another's conduct led him to believe in a certain state of affairs, resulting in a detrimental change in his position. Under Florida law, estoppel by silence requires that the party to be estopped had a duty to act or speak, failed to do so, and that this failure misled the claimant to their detriment. Keys does not prove that his reliance on Defendants' silence was intended or anticipated by them. His claim of prejudice due to silence pertains to the claims process rather than a common law theory, and he does not clarify how an earlier notification would have changed the outcome. Ultimately, Keys does not establish a viable claim for equitable estoppel under ERISA, leading to the conclusion that Defendants' Motion regarding Count III will be granted.
1. Defendants' Motion to Dismiss is partially granted and partially denied.
2. Count III of the Plaintiff's Complaint is dismissed without prejudice, allowing the Plaintiff to file an amended complaint within 14 days.
3. The Defendants' Motion to Dismiss is denied in all other respects.
4. The Court's ruling is based on the allegations in the Plaintiff's Complaint, which must be accepted as true.
5. The Disability Plan, identified as a multi-employer welfare benefit plan, functions similarly to the Plan, with the same individuals on the Disability Board.
6. A deadlock within the DICC is considered a denial under the Plan.
7. In May 2011, Plaintiff Keys was awarded Social Security disability benefits due to orthopedic injuries from his NFL career that resulted in degenerative arthritis in his spine and knees.
8. The Plan includes an overpayment provision stating that if false information leads to an undeserved benefits award, future payments will be reduced accordingly.
