In a 1980 pre-season game Mr. Boyd took a serious hit and suffered a concussion. It ended his career and continues to have a very big and bad impact on his life.
Fortunately for Mr. Boyd, the NFL Players Association, when they struck their Collective Bargaining Agreement with the NFL, included a disability plan so that players who became disabled would have some protection against the resulting loss of income.
That hasn’t worked out so well:
Former NFL player Ben Lynch, who once played for the Cal Golden Bears, said he has also been disabled by recurrent head trauma and added that the NFL also did not cover his care.
"When you're playing football, the union tells you there is a safety net waiting to catch you if you fall," Lynch said. "It's not until you smack the ground that you realize that the safety net they told you about doesn't exist."
Mr. Boyd, however, figured he had legal rights, and he went to court to recover his wrongfully-denied disability benefits.
Whereupon he ran into the legal equivalent of the Fearsome Foursome, the Purple People Eaters, and the Steel Curtain all rolled into one: ERISA.
First, the Ninth Circuit observed that, since under ERISA we pretend insurance companies and plan administrators are Oliver Wendell Holmes, and that their motives are pure and pristine, we treat their decisions as if they were edicts from an Oracle on high:
The NFL Plan was established pursuant to collective bargaining and grants to the Retirement Board the full discretion to adjudicate claims and interpret the Plan. We review the Board's decision to deny Boyd's football degenerative disability benefits for an abuse of discretion.
In fact, as the Ninth Circuit added later in the same opinion, denial decisions under ERISA are so bulletproof that “even decisions directly contrary to evidence in the record do not necessarily amount to an abuse of discretion."
The outcome of Mr. Boyd’s suit for disability benefits was as preordained as if the Green Bay Packers were going to play my woefully bad high school football team: “The Retirement Board did not abuse its discretion in concluding that Boyd's disability did not arise from his League football activities.”
An issue often not understood by potential consumers is what disability insurance to purchase. A lot of employees think that they are covered by employer provided disability which is governed by ERISA laws. One should realize that in almost all cases, a policy governed by ERISA is not worth the piece of paper it is written on.
ReplyDeleteFor example, see this http://illnessandinsurancehell.blogspot.com/2009/10/erisa-schmerisa-or-lessons-i-have.html
and
http://hartford-disability-denial.blogspot.com/2010/12/what-goes-on-in-erisa-litigation.html.
Also ABC news coverage at http://www.dilawgroup.com/
However, my hope is that laws should be changed to it mandatory for the employer and disability insurance company to provide the employee a CLEAR understanding of
a)what is the percentage of claims that the disability insurance company has approved and continued with
b) what is the course to redressal of her grievances and again, what are the chances of success.
This empowers the consumer to make an informed choice of purchasing insurance through employer or on her own.
This may be a useful topic to cover in your blog. I can assist with information if needed