The Institutes

Lawsuit Alleges NFL Directed Cigna To Deny Disability Claims

 Friday, May 3, 2019

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.

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