Tyrone Keys, a former professional football player from 1983 to 1989, recently filed a lawsuit in the Middle District of Florida alleging that the Bert Bell/Pete Rozelle NFL Player Retirement Plan and the NFL Player Disability and Neurocognitive Benefit Plan wrongfully stopped his disability payments and, subsequently, refused to reinstate the payouts. Keys v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, et al., 8:18-cv-02098 (M.D. Fla. Aug. 22, 2018).

Under the plans, Keys had been receiving benefits for permanent injuries to his back, knees and one of his shoulders that he sustained while playing in the NFL.

Keys received the benefits until 2011, at which time the Disability Initial Claims Committee, or DICC, deadlocked on whether or not to continue the payments. Under the plans, deadlocks are considered to be a denial of benefits. While Keys appealed, he received benefits under his plan on a revised status.

Those payments continued until the retirement board, the last available route for appeal, ultimately voted to deny the ongoing benefits in 2018. Having exhausted all of his administrative remedies, Keys has now filed suit under Section 1132(a) of the Employment Retirement Income Security Act, or ERISA, to reinstate his benefits and recover damages.

Under Section 1132(a), beneficiaries of retirement plans such as Keys’ plan can bring forth a civil action to either (1) seek relief under the statute or (2) recover benefits due under the terms of the plan, enforce rights under the plan or clarify rights to future benefits.

In his suit, Keys is alleging three claims arising under ERISA: First, a declaration of his rights under the terms of his previous plan; second, a claim for benefits based on his previous plan; and, third, an estoppel on the retirement board from collecting alleged overpayments to Keys.

The first count in the complaint also deals with the alleged overpayments. Per the board’s decision in 2018, Keys is required to reimburse both plans as a result of overpayments made to him. The board seeks to offset future benefits to make up for this indebtedness.

Keys alleges that there is no basis to do so because he never supplied the board with any false information that would have led them to granting the benefits originally.

When the board and the DICC granted Keys benefits, they did so with a plethora of medical information supplied by Keys. In those documents, Keys’ doctor provided an extensive report about the disabilities endured by Keys as a result of his injuries.

Keys argues that if all the information he supplied was originally correct and he was still awarded benefits, then Keys has a valid claim with regard to the alleged overpayments. If the original decision to grant benefits was based on the information provided at the time, it is hard to see what argument the board can make that they were improper as a result of Keys’ actions.

The second claim pertains to the benefits denied to Keys as a result of the board’s decision. In that decision, the board specifically denied the payment of certain benefits from 2011 to 2013 while Keys appealed through administrative channels.

Additionally, Keys alleges that the board abused its discretion when it terminated certain benefits from August 2017 onward. Administrative decisions can be reversed through judicial review if the court finds an abuse of discretion. Shahandeh-Peh v. I.N.S., 831 F. 2d 1384 (7th Cir. 1987). Keys argues that he provided accurate medical records of his injuries, and therefore, the decision to overturn a previous grant was an abuse of discretion.

The issue here is whether or not the injuries that entitled Keys to the benefits originally were exclusively the result of his NFL career. Notably, Keys was also in a serious car accident in 2002. Keys claims the accident merely exacerbated his pre-existing injuries sustained during his NFL career.

The board sees this as evidence that it is not responsible for the entirety of Keys’ disability, and therefore it has overpaid him.

An important piece of evidence for Keys’ argument in this matter is his Social Security disability payments. Keys received Social Security disability benefits for the first time in May 2011. When he advised the plans at issue of these payments, he continued to receive benefits from both plans.

Importantly, the Social Security payments are based on Keys’ injuries that are supposedly from his NFL career, and not the 2002 car accident. Keys can point to this as evidence that the accident did not change the nature of his disabilities.

This is vital for Keys, as the critical piece of the board’s argument is that the information he supplied to them was not accurate. The board does not merely allege that Keys claimed the accident had no part in his disability. Rather, the board claims that there were no details about the accident at all in his application for benefits in 2003. Keys does not deny this allegation.

The first two counts will turn, then, on whether or not the car accident needed to be included in the 2003 application. If the accident contributed to the severity of his disability, and by extension, the amount of benefit payments, then the court may find that Keys should have included the information.

In that scenario, Keys may not win the argument that the decision to stop benefit payments and seek collection on overpayments was erroneous.

The final count in Keys’ complaint could provide the answer to this issue. Keys alleges that because the board is being dishonest about what was known when the benefits were granted in 2003, it should be estopped from affecting his benefit payments. As trustees for the plans, the board has a fiduciary responsibility to ensure all relevant information has been gathered for assessing the plan.

According to the complaint, despite being aware of the accident, the board did not seek additional information before granting the benefits. If this holds, it could render the controversy about the lack of details regarding the 2002 car accident moot.

Ultimately, this case will turn on the 2002 car accident and the level of detail provided in the 2003 application. If Keys’ assertion that the board chose not to inquire further about the accident because it was satisfied with the determination that Keys’ injuries stemmed from his NFL career, he has a successful argument for the reinstatement of his benefits.

If the information in the 2003 application was not sufficient to cause the board to inquire for more details, then the board will have to show that its prior decisions were not the fault of the plans’ administrators.

Outside of the specific ruling that may come in this case should the parties not settle, the Keys case provides some useful insight into the inner-workings of the current NFL disability claims process.