United States Court of Appeals

for the Fifth Circuit

No. 20-40613

Summary Calendar

Ashton Youboty, 

Plaintiff—Appellant,

versus

NFL Player Disability ; Neurocognitive Benefit Plan, 

Defendant—Appellee.

 Appeal from the United States District Court 

for the Southern District of Texas

USDC No. 4:19-CV-2306

Before Higginbotham, Jones, and Costa, Circuit Judges.

Per Curiam:*

In this disability benefits case, the issue is whether a benefits review 

board (“Board”) properly exercised its discretionary authority to interpret a 

benefit plan. Under the Employee Retirement Income Security Act 

* Pursuant to 5th Circuit Rule 47.5, the court has determined that this 

opinion should not be published and is not precedent except under the limited 

circumstances set forth in 5th Circuit Rule 47.5.4.

United States Court of Appeals

Fifth Circuit

FILED

April 16, 2021

Lyle W. Cayce

Clerk

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(“ERISA”) and the facts of this case, it did, and the judgment of the district 

court is AFFIRMED.

The facts of this case are largely undisputed. Ashton Youboty played 

six seasons in the National Football League (NFL), suffered various injuries 

while playing, and eventually retired. As part of his job, Youboty had a 

benefit plan subject to ERISA which “covers partial disabilities and is called 

“line of duty” (LOD) benefits.” Youboty v. NFL Player Disability &

Neurocognitive Benefit Plan, No. 4:19-CV-2306, 2020 WL 5628020, at *1

(S.D. Tex. Aug. 17, 2020). “Each eligible player ... must apply for benefits

within 48 months after retirement. In this case, Youboty's application

deadline was August 25, 2018. He submitted his application in May of 2018. 

On that application he indicated Youboty was not expecting any additional 

surgeries in the next year and was not planning on submitting additional 

documentation. While his application appears to have been based upon 

multiple conditions, the only one that is pertinent in this case concerns his 

LOD application based upon orthopedic impairments.” Id.

When a player applies for LOD orthopedic benefits he is examined by 

one of the Board’s neutral physicians. See id. These neutral physicians are 

chosen and approved by both sides of the Board, which includes three 

members appointed by NFL Players Association and three members 

appointed by NFL management. Id. The player must have a substantial 

disability to qualify for these benefits. Id. The physician reviews the player’s

medical history and the player, and he scores the player’s injuries or

conditions on a point system. Id. If a player accumulates 10 points based

upon this examination, he qualifiesfor LOD benefits. Id. A neutral physician

(and then a second neutral physician after an appeal) reviewed Youboty and

scored Youboty’s orthopedic impairments at eight, two short of what

Youboty needed to receive LOD benefits.

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The dispute is whether the Board should have awarded points based

on a 2019 knee surgery Youboty underwent after he had already filed his

application and the deadline to file his application had passed. Had the Board

awarded points based on the 2019 surgery, Youboty would have qualified for

LOD benefits.

Youboty’s claims were first reviewed and rejected by the Disability 

Initial Claims Committee. Youboty then appealed to the six-member 

Disability Board that has discretion to decide appeals of those who are denied 

benefits. The Board unanimously denied his appeal. Youboty then brought 

suit in federal district court. He alleged that “under the authority of 

29 U.S.C. § 1132(a)(1)(B) of ERISA,” the Board’s decision “not to count his 

left knee surgery as an orthopedic impairment under the Plan’s orthopedic 

point system because it occurred after his deadline for submitting his LOD 

application was contradicted by the Plan’s plain language.” Therefore, “the 

Board’s interpretation of the Plan was an abuse of discretion.” The district 

court affirmed the Board’s decision, finding that the Board did not abuse its 

discretion in its interpretation of the benefits plan.

Since the Board was vested with discretionary authority to interpret 

the benefits plan and whether Youboty qualified, the district court was 

correct to review the Board’s decision under an abuse of discretion standard. 

Connecticut Gen. Life Ins. Co. v. Humble Surgical Hosp., L.L.C., 878 F.3d 478, 

483 (5th Cir. 2017) (quoting Vega v. Nat'l Life Ins. Servs., Inc., 188 F.3d 287, 

295 (5th Cir. 1999) (en banc), overruled on other grounds by Metro. Life Ins. Co. 

v. Glenn, 554 U.S. 105, 128 S. Ct. 2343, 171 L.Ed.2d 299 (2008)) (“[W]hen 

an administrator has discretionary authority with respect to the decision at 

issue, the standard of review should be one of abuse of discretion.”). The

district court found that the Board did not abuse its discretion in refusing to 

award points for the 2019 knee surgery.

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After carefully considering the briefs, we affirm the district court for 

essentially the same reasons.

In a case involving a plan administrator’s (here, the Board) 

interpretation of a benefits plan, we first consider whether the 

administrator’s interpretation is legally correct. If it is not legally correct, we 

must consider whether the administrator abused its discretion. In 

determining legal correctness, we examine: “(1) whether the administrator 

has given the plan a uniform construction, (2) whether the interpretation is 

consistent with a fair reading of the plan, and (3) any unanticipated costs 

resulting from different interpretations of the plan.” Wildbur v. ARCO 

Chem. Co., 974 F.2d 631, 637 (5th Cir. 1992) (citing Jordan v. Cameron Iron 

Works, Inc., 900 F.2d 53, 56 (5th Cir. 1990)). In determining whether the 

plan administrator abused its discretion, we consider three additional factors: 

“(1) the internal consistency of the plan under the administrator's 

interpretation, (2) any relevant regulations formulated by the appropriate 

administrative agencies, and (3) the factual background of the determination 

and any inferences of lack of good faith.” Id. (citing Batchelor v. Int’l 

Brotherhood of Elec. Workers Local 861 Pension & Ret. Fund, 877 F.2d 441, 445-

48 (5th Cir.1989)).

Here, the Board’s interpretation is legally correct. There is no 

evidence on the record that the plan was not applied uniformly. The plan is 

completely silent on whether surgeries that occur after the application 

deadline should count toward the LOD determination, but it does note an 

application deadline. Interpreting this deadline also to serve as a deadline for 

surgeries that count toward the LOD determination is a fair reading of the 

plan.

The plan’s requirement that the Board “take into account all 

information” (whether or not that information was available to the Board 

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during its first review) is a broad statement that does not specifically require 

the Board to award points based on surgeries that occurred after the 

application deadline. For example, it is imaginable that a surgery that 

happened well before the application deadline was inadvertently not included 

in the application, and that the Board should consider that. But even if it 

meant that post-application surgeries must be considered, the plan does not 

say those surgeries must be awarded points. The Board did consider the 2019 

surgery, but it did not ultimately decide to award points because the surgery

occurred after the application deadline.

Allowing players to submit claims even after the application deadline

would significantly increase costs for the plan, both in amount of payout and 

in administrative costs, because appeals could be stretched out or brought 

some time later after a new surgery. Also, allowing post-application events 

to influence the claims furnishes no guideline for how long the process could 

be strung out, or what limitation must be placed on such events.

Even if we disagreed with the Board’s interpretation, we cannot say it 

is an abuse of discretion to decide that surgeries occurring after the 

application deadline do not count toward the determination. There is 

nothing internally inconsistent about the Board’s interpretation that 

surgeries must happen before the application date to be counted, but it would 

arguably be inconsistent to interpret the plan the other way since the plan 

does specify an application deadline. Further, there is no bad faith or conflict 

apparent; indeed, the Board’s decision was unanimous, which means all the 

NFL player appointed members agreed. Finally, ERISA’s requirement “that 

the claims administrator who is responsible for the initial decision advise the 

claimant what ‘additional material and information’ can be provided in order 

for the claimant to perfect the claim” means that the Board needed to give

Youboty an opportunity to submit something if there was a way for him to 

perfect his claim. See 29 CFR § 2560.503-1(g)(1)(iii)); It would be 

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unreasonable to read this as Youboty suggests – that ERISA requires a plan 

to allow him to submit information and have additional surgeries until he gets 

a desired result.

For the foregoing reasons, the judgment of the district court is 

AFFIRMED.

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