A California Court ruled in favor of a former NFL player seeking total and permanent (T&P) disability benefits. The court found that the NFL Plan unreasonably ignored medical evidence of disability in favor of examinations performed by plan-selected doctors.
Mr. Dimry’s Application for T&P Disability Benefits
Mr. Dimry played in the NFL for 12 seasons. His career left him with many physical injuries. Physical impairments have prevented him from working since 2012.
In 2014, Mr. Dimry applied for T&P disability benefits. He claimed he could no longer stand or lift and couldn’t concentrate due to exhaustion and ongoing pain. With his application Mr. Dimry submitted a lot of medical evidence supporting disability. This included a residual functional capacity evaluation which found he had no capacity for meaningful work. The evidence submitted made it clear Mr. Dimry’s doctors felt he was disabled.
The NFL Plan’s Denial of Mr. Dimry’s Application
As part of its review the NFL Plan required Mr. Dimry to submit to a medical examination by a plan-selected doctor. This doctor concluded Mr. Dimry could perform light work. Thus, the NFL Plan denied Mr. Dimry’s application.
Mr. Dimry appealed the NFL Plan’s decision to deny his application. He again pointed to medical evidence of disability and critiqued the evaluation conducted by the plan-selected doctor.
As part of its appeal review, the NFL Plan required Mr. Dimry attend another medical examination. This time the plan-selected doctor found he was capable of working a desk job. Thus, the NFL Plan denied Mr. Dimry’s appeal. In its appeal denial letter, the NFL Plan recognized conflicting medical opinions between the plan-selected doctors and Mr. Dimry’s doctors. Still, the NFL Plan asserted that that it credited the findings of the plan-selected doctors over all other medical evidence. It reasoned that neutral evaluation are uniformly accepted and relied upon.
The Court Rules in Favor of Mr. Dimry
Following the denial of his appeal, Mr. Dimry filed a lawsuit against the NFL. He claimed the doctors selected by the NFL Plan had a financial conflict of interest. He provided evidence that the NFL Plan paid the first examining doctor about $188,683 over the span of one year. The court agreed that the financial conflict added suspicion of bias.
The court ultimately found that the NFL Plan denied benefits based upon an unreasonable bias in favor of plan-selected physicians. The court noted that although the NFL Plan noticed conflicting medical evidence, it simply adopted the opinions of the plan-selected physicians. The court found this action wrong. It also found that the Plan was not entitled to decide a benefits claim by mere default to plan-selected physicians.
Dabdoub Law Firm Can Help
Our firm has represented many former NFL players. We understand how the NFL Plan operates. You should not take on the NFL Plan on your own. Give us a call to speak with one of our experienced NFL disability lawyers.