Dimry v. Bert Bell/Pete Rozelle NFL Player Retirement Plan

Background

Charles Dimry, a former National Football League player, applied in 2014 for Total and Permanent Disability benefits under the Bert Bell/Pete Rozelle NFL Player Retirement Plan. The Plan provides benefits when a player is substantially prevented from, or substantially unable to, engage in any occupation or employment for pay or profit, and the condition is permanent.

The Retirement Board initially denied the application. In an earlier round of this case, the district court found that the Board had acted improperly and sent the claim back for reconsideration. After the Board denied the claim again, the district court again found that the Board had abused its discretion and had not provided the full and fair review required by the Employee Retirement Income Security Act of 1974 (ERISA). The Ninth Circuit affirmed and sent the case back for the district court to decide whether Mr. Dimry was entitled to benefits. On remand, the court allowed Mr. Dimry to submit additional evidence. Both sides then sought judgment under Federal Rule of Civil Procedure 52.

Why the Court Found the Board’s Decision Improper

The Plan gave the Retirement Board discretion to decide benefit claims, so the court reviewed the decision for abuse of discretion. The court found several problems with the Board’s second denial.

First, the Plan did not require claimants to support pain complaints with objective medical evidence. The court found it unreasonable to reject Mr. Dimry’s reports of pain on that basis. Dr. Jackson, the Board’s Medical Director, had recognized that pain could be real and severe even without certain objective findings, yet relied on the lack of such findings in evaluating Mr. Dimry’s claim. The court therefore found his reasoning unpersuasive, illogical, and implausible.

Second, the Social Security Administration had found Mr. Dimry disabled as of October 1, 2012. Its administrative law judge found that his impairments could reasonably be expected to cause his reported symptoms and that the medical and other evidence supported his statements about the intensity and effects of his pain. The Board was not required to accept that determination, but the court found that it failed to provide an adequate reason for rejecting it.

Third, the Plan did not address Dr. Murphy’s November 2021 opinion disputing Dr. Jackson’s description of certain neurological examinations as normal. The court found that this issue was important because Dr. Jackson had relied on those descriptions in concluding that the objective evidence did not support Mr. Dimry’s complaints.

Finally, the court considered the Board’s overall conduct. It found that the Board had previously adopted the opinions of its selected physicians without adequately resolving conflicting medical evidence, and later failed to meaningfully consider the Social Security Administration’s determination. Because of this history, the court gave little deference to the Board’s decision.

Evidence of Total and Permanent Disability

The court separately determined that the record supported an award of benefits. Mr. Dimry’s treating and examining physicians documented chronic neck, back, and knee pain, along with limitations on standing, sitting, walking, lifting, driving, computer work, and housework. Dr. Murphy concluded that Mr. Dimry could not work because of severe pain and described restrictions that included being able to stand or sit for only limited periods, working for no more than about two hours each day in those positions, and needing several unscheduled breaks.

Dr. Murphy’s later report also considered Mr. Dimry’s spinal injuries, chronic knee pain, chronic kidney disease, and Crohn’s disease. Dr. Murphy found Mr. Dimry’s pain complaints credible and continued to support the earlier functional restrictions. The Board’s neutral examining physicians also documented his pain and functional limitations; one found no evidence that Mr. Dimry was exaggerating his symptoms.

Ruling

The court held that Mr. Dimry’s pain made him substantially unable to engage in any occupation or employment for pay or profit on a permanent basis. Judge Jacqueline Scott Corley granted Mr. Dimry’s motion for judgment under Rule 52 and denied the defendants’ motion. The court ruled that Mr. Dimry was totally and permanently disabled under the Plan and entitled to all withheld “Inactive A Total and Permanent” benefits. The parties were ordered, within 30 days of the order, to meet and confer about the specific amount of benefits due, including interest, and to submit a proposed judgment consistent with the order.