Cloud vs. NFL Player Retirement Plan – Appeals Court Reverses Pro-Plaintiff USDC Decision

A former NFL running back won at the district court level but lost on appeal after the Fifth Circuit found he failed to show “changed circumstances” sufficient to justify reclassifying his long-term disability (LTD) benefits to the highest tier. Despite the district court’s sharp criticism of the NFL Retirement Plan’s rubber-stamp review process, the appellate court reversed and entered judgment in favor of the Plan.

The dispute between Michael Cloud and the Bert Bell/Pete Rozelle NFL Player Retirement Plan centered on Cloud’s eligibility for the highest level of disability benefits because of injuries sustained during his NFL career, including multiple concussions. Cloud initially received lower-tier benefits, but sought an upgrade based on further evaluations of his condition.

Key legal arguments and court analysis:

• Disability and Benefit Tiers: The NFL Retirement Plan distinguishes between different levels of disability benefits, focusing primarily on whether a disability occurred “in the line of duty” (LOD) or was “totally and permanently” (T&P) disabling. The Plan also divides T&P benefits into “active” and “inactive” categories, with the former providing significantly greater financial support. Cloud was initially placed in the lower “Inactive A” tier and sought reclassification to “Active Football,” which promised greater benefits.
• Initial and Subsequent Claims: After being found disabled by the Social Security Administration (SSA) in 2014, Cloud reapplied to the NFL Plan for an upgrade from LOD to T&P benefits, which was granted, but not to the “Active Football” level. He did not initially appeal that decision. In 2016, Cloud again sought reclassification to “Active Football,” submitting additional medical evidence and personal testimony to show that his condition had worsened. The Plan denied this request, citing a lack of “changed circumstances” that would warrant an upgrade.
• The Court’s Initial Decision: After reviewing the case, the district court found that the NFL Plan’s review process was flawed, criticizing it for procedural inadequacies and a lack of fair and thorough review of claims. The court was particularly critical of the Plan’s “rubber stamp” approach and its systematic denial of benefits to severely injured players. As a result, the court ruled in favor of Cloud and ordered the Plan to provide him with the highest level of benefits and back pay.
• Court of Appeals Reversal: On appeal, the Fifth Circuit focused on the “changed circumstances” requirement for reclassification to a higher benefit level under the Plan. The appellate court concluded that Cloud failed to demonstrate such changed circumstances between his last successful benefit claim in 2014 and his reclassification attempt in 2016. Therefore, despite acknowledging the district court’s findings of procedural default, the appellate court reversed and entered judgment in favor of the NFL Plan.

This case highlights the complexities and high stakes involved in ERISA disability plan claims, particularly those requiring a showing of “changed circumstances” for reclassification. Courts’ scrutiny of such requirements underscores the need for claimants to document and prove any changes in their condition when seeking reclassification of benefits.

If you are facing challenges with disability claims, especially under plans that require strict proof of changed conditions, it is critical to consult with experienced legal professionals who can help you navigate these complexities and advocate effectively on your behalf. Ensure that all documentation is submitted in a comprehensive and timely manner to strengthen your case and secure the benefits you deserve.

Here are PDF copies of the decisions:

• Cloud v The Bert BellPete Rozelle NFL Player Ret. Plan USDC
• Cloud v The Bert BellPete Rozelle NFL Player Ret. Plan CA