A California court finds former NFL Player is disabled due to chronic pain and awards total and permanent disability benefits under the NFL Player Retirement Plan (the “Plan”).
Mr. Dimry is a former player in the National Football League. Following a lengthy playing career, Mr. Dimry developed chronic pain. This pain made it impossible for him to work in a full-time occupation. So, he filed for total and permanent disability benefits under the Plan.
Despite evidence of disabling pain, the Plan denied Mr. Dimry’s claim based on a medical review completed by its medical director, Dr. Jackson. So, he filed a lawsuit in federal court and asked the court to award his benefits. Based on a thorough review of the record, the court ultimately ruled that the Plan’s decision to deny benefits was wrong and awarded Mr. Dimry his benefits.
The Court’s Decision
The court ruled that the denial of benefits based solely on Dr. Jackson’s opinion was wrong and unreasonable for five reasons.
- It was wrong to suggest that objective medical evidence was needed to support Mr. Dimry’s claim as the policy language did not require objective evidence.
- Dr. Jackson’s opinion that Mr. Dimry’s pain could be real and severe without certain objective evidence and then conclude that the pain is not severe because of a lack of objective evidence was “illogical” and “implausible.”
- It was wrong for the Plan to ignore the Social Security Administration’s award of disability benefits and its finding that Mr. Dimry’s impairments could be reasonably expected to cause his pain.
- It was wrong for the Plan to ignore Mr. Dimry’s treating physician’s conclusions that he was disabled.
- The Plan’s action suggested that it intended to deny Mr. Dimry’s benefits regardless of the evidence.
For these reasons, the court ordered that the Plan award Mr. Dimry his benefits.
This case highlights a common theme we see in NFL Disability Cases. The Plan will ignore credible and objective evidence of disability in favor of their own reviewing doctor’s opinions.
As experienced disability insurance attorneys, we have successfully represented former NFL players as it relates to their total and permanent and line of duty disability claims. 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.
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