We learned this week that a group of former NFL players has sued the league based on an alleged pattern of denying disability benefits for both physical and psychiatric limitations.
Living in the world of disability law, this doesn’t sound surprising, since it’s what I handle every day against the government and private and employer-sponsored insurers. But the Players’ suit sheds light on an issue we often don’t see in our day-to-day lives.
There are a few issues in the suit that are variations on the playbook for any insurance company.
Insurance Company Denial Tactics
First, NFL disability cases are evaluated by NFL doctors. The complaint alleges that these doctors are highly paid by the league, and so are incentivized to minimize the players’ conditions. The Complaint even cites to the fact that some of these doctors have denial rates of over 90%. While these reviewing physicians are supposed to be neutral, there is no system in place to audit the doctors or object to qualifications.
One of the examples showed a reviewing doctor concluding that a player seeking disability benefits was “unimpaired.” In other words, had no issues of any kind, despite external testing showing decreased cognitive functioning.
What’s interesting about these cases, is just like any group disability plan offered by an employer, these plans for NFL players are governed under a federal law known as ERISA (Employee Retirement Income Security Act).
This law is usually designed to protect employees from losing benefits that are considered part of their income (like pensions and other benefits, that are offered in exchange for work). Unfortunately, in the disability context, the application of this area of law has meant that a decision on benefits can usually only be overturned if the decision is an “abuse of discretion” or in other words, is irrational. This means that the players, like any other employee seeking to appeal a denial of benefits, has to prove that it wasn’t just wrong, but it was nonsensical to deny benefits.
The good news for the NFL players bringing the suit is that the facts are on their side even with this high burden. This is because, having the protection of a very hard standard to prove, the NFL, like other insurance companies doesn’t have a lot of incentive to get things right. So, they often resort to paper file reviews and hired doctors who will deny just about anything that comes across their desk.
But this is where the players might have a shot, and where other employees seeking benefits can make a dent in that wall. When a doctor offers an opinion that you’re not impaired at all, that’s usually a lot easier to show as “nuts” (the medical term) than an opinion that you are limited, just not enough to be disabling. Most people, including those working full-time and living a normal life, have some sort of impairment. Maybe they have some tinnitus, some anxiety, or a bad knee.
Everyone has something that’s limiting, the question is whether those impairments add up to an inability to work.
Here, the NFL Players are blowing the lid off a pattern of bad conduct by a single insurance company. This could help all of us, as the high-profile nature of this case will help expose the everyday bad conduct of the insurance companies that administer similar plans throughout the country.
I’ve gotten very good at appealing these cases and getting bad decisions reversed, but the way the law is applied, giving deference to insurance companies that have a serious reason (their money) to deny claims, has been a flaw in the system that has existed for far too long. Maybe the players will finally get us the highlight on that issue and move the chains for the rest of us.
Rich Frankel is the managing partner of Bross & Frankel. He is a member of the New Jersey and Pennsylvania bars. He has focused exclusively on disability and social security benefits since 2005.
Mr. Frankel joined what is now Bross & Frankel after having watched his father struggle with disability, fighting a lengthy illness. Mr. Frankel founded the firm’s veteran’s law practice and substantially grew the social security disability practice, focusing Bross & Frankel’s ability to fight for all of the disability benefits available to his clients.
Mr. Frankel additionally fights for clients in court, obtaining frequent victories in Social Security appeals and against insurance companies in Federal court.