Lawsuit Alleges NFL Directed Insurance Carrier To Deny Disability Claims
A medical clinic in Illinois is accusing the NFL of instructing its insurance carrier to deny claims made by former players under the auspices of the league’s disability plan. The allegations are outlined in a lawsuit that also accuses the league of retaliating against the clinic for providing independent diagnostic services in lieu of the concussion settlement.
Advanced Physicians S.C. first filed the suit in Illinois state court in March, but the case was moved to federal court on Thursday. According to the suit, which was first reported by Law360, “[t]he NFL doesn’t want to pay its former players disability payments under the disability plan” that had been collectively bargained between the league and the NFLPA.
According to the suit, Advanced estimates it has treated more than 200 ex-NFL players since 2007 as an out-of-network provider. The clinic says it forwarded those players’ medical claims to the insurance carrier Cigna as part of its normal course of business. Cigna is the administrator for the NFL Player Insurance Plan, the terms of which are designated in Article 59 of the current CBA. That plan provides medical insurance for vested veterans and their families for up to five years after a player’s career has ended.
But beginning in June 2015, according to the suit, Advanced realized that Cigna was no longer processing its claims. Cigna initially told Advanced that the claims were in audit, but after the audit turned up nothing unusual, Cigna began questioning whether some procedures were medically necessary. More directly from the suit (emphasis mine):
“Advanced has discovered that the NFL directed Cigna to deny all of Advance’s claims as work-related. The NFL was upset that some of the retired players Advanced treated were using diagnostic tests provide by Advanced as evidence of a disability under the NFL’s disability plan.”
It was in 2014 that the league first reached a settlement agreement with the class of former players who had sued it for its manipulation of the science of head trauma. That agreement was not finalized and implemented until 2017. But even though the league’s insurance and disability plans are separate from the settlement, the league appears to be using the settlement’s enactment to discourage ex-players from getting independent medical evaluations—even as the NFL is gaming the settlement itself under similar circumstances.
Advanced further claims that the NFL’s actions resulted in a decline in player visits, which in turn has resulted in increased operational costs, a loss of financing, and increases in financing costs.
“The NFL does not want independent medical providers like Advanced to treat players and provide independent and honest medical opinions about a player’s brain health,” the suit continues. “The NFL made the decision to try and economically harm Advanced so that Advanced would no longer treat former NFL players and their dependents.”
The allegations made in the suit would represent the latest in a series of attempts by the NFL to minimize its exposure since it’s been revealed that the league withheld what it knew about the effects of brain trauma on former players. The claims are consistent with the way the NFL has consistently attacked disability and settlement claims, from Jesse Solomon’s to Mike Webster’s. Webster’s case, in particular, was cited in a recent filing that asked a federal judge to reconsider a new set of physicians’ rules that were recently approved for the settlement that appear to make it more difficult for players’ claims to get approved:
The NFL showed its modus operandi in the case of Mike Webster … In Webster’s case, the NFL used multiple layers of scrutiny and concocted almost any argument to minimize functional impairment for the purpose of limiting its obligation to pay.
That motion to reconsider, which is unrelated to Advanced’s lawsuit, was filed by three of the settlement’s co-lead class counsels. It will be the subject of a hearing on Tuesday morning in Philadelphia.
You can read Advanced’s lawsuit below.
h/t to Sheilla Dingus
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