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washingtonpost OP t1_j7qvhbd wrote

From reporter Will Hobson:

Pressured by Congress, the league and its union promised reforms years ago. But a Washington Post investigation shows a system still stacked against players left broken by football.

The 2022 NFL season will be remembered, in part, for two shocking scenes that renewed focus on the damage America’s most popular sport inflicts on its players. One was the sight of Miami Dolphins quarterback Tua Tagovailoa writhing on the field after suffering his second concussion in five days, briefly bringing a Thursday Night Football game to a halt. The other was Buffalo Bills safety Damar Hamlin collapsing with a cardiac arrest, ending a Monday Night Football game and briefly bringing the sport to a standstill.

Both events brought swift public responses from the NFL and the NFL Players Association, professing their concern for the health and safety of the league’s players.

But beyond the glare of national television, debilitated former NFL players continue to encounter a benefit plan, jointly managed by the league and union, that fights aggressively to deny claims and repeatedly shirks legal obligations to fairly review cases, a Washington Post investigation found.

Over the past six months, The Post reviewed thousands of pages of medical records, denial letters and other plan documents produced in lawsuits since 2008, the year after former players went to Congress to complain of onerous red tape, biased doctors and a rigged claims process. League and union officials disputed those allegations but promised reforms.

In the 15 years since, though, eight players have successfully sued the league’s plan, triggering tense and protracted legal fights that have revealed repeated instances in which the NFL’s plan seized on technicalities, ignored medical evidence and flouted federal judges to justify denying claims.

The NFL declined to make any official available for an interview. In a statement, the league dismissed the plan’s losses in court as a small fraction of the thousands of cases it has handled. And even in cases where federal judges ruled the plan wrongly denied a claim, the NFL asserted, the judges were wrong.

“There have been roughly 10,000 claims considered since 2008,” wrote league spokesman Brian McCarthy. “Even if those less than a dozen cases were improperly decided — and they were not — the less than one dozen cases hardly amount to a pattern.”

The NFL and the union, NFLPA, both emphasized the sum the plan pays out to disabled retirees: more than $320 million last year, a substantial increase from the $20 million the plan told Congress it was paying out in 2007.

The NFL’s plan is unique, making it difficult to compare its record in the courts to peers. A typical disability insurer manages plans for many companies, covering millions more customers than the NFL plan. But playing in the NFL is also far more likely to leave players with potentially disabling injuries than perhaps any other job in America, increasing the likelihood for lawsuits.

Several experienced disability attorneys who have battled the NFL’s plan in court, in interviews, said the league’s plan stands apart in how vociferously it fights claims. And they expressed outrage that the NFL maintains every judge who has ruled against the plan was mistaken.

Read more about our investigation into these lawsuits here, and skip the paywall with email registration: https://www.washingtonpost.com/sports/2023/02/08/nfl-disability-players-union/?utm_campaign=wp_main&utm_medium=social&utm_source=reddit.com

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c0wpig t1_j7so28c wrote

> “There have been roughly 10,000 claims considered since 2008,” wrote league spokesman Brian McCarthy. “Even if those less than a dozen cases were improperly decided — and they were not — the less than one dozen cases hardly amount to a pattern.”

This seems like a pretty brazen statement. Shouldn't a single case be cause for serious concern? Shouldn't the standard be never improperly rejecting legitimate healthcare claims?

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wrongbutt_longbutt t1_j7spi9t wrote

It's like the state saying they've only wrongly executed a few innocent people.

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jacobobb t1_j7ubtt2 wrote

Point taken, but they would say they have only executed people found guilty. That includes people wrongfully found guilty.

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FellKnight t1_j7vuyf1 wrote

and that's kind of the reason why most scholars are against capital punishment. You can't take it back once you kill someone.

In theory, in a perfect world where you can be 100% certain of guilt, I don't have a problem with capital punishment, but we do not live in that world, and as such, I have to be against capital punishment.

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coronavirusrex69 t1_j7v5ahd wrote

can the players not buy insurance? and their contracts account for the risk and short shelf life that is assumed in the league. and at least at my job, once i'm no longer employed by them, I don't have any sort of benefit plan? and i don't make millions a year.

i get it that it's sad, but nobody is going into the NFL thinking it's not going to take a toll on their body.

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PangwinAndTertle t1_j7sz9hg wrote

I very well could be wrong, but I read that as of the 10,000 cases submitted, only 12 were denied. Which would absolutely “hardly amount to a pattern.” If its 10,000 cases denied, which thinking more about it, is probably the correct understanding, I agree with you we should never be improperly rejecting legitimate healthcare claims. In fact, I’d argue the approval process should be done by a neutral, third party.

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314159265358979326 t1_j7tasy9 wrote

12 were decided in court to have been improperly denied by the plan. It doesn't say how many of the 10,000 were decided in favour of the player, but surely thousands of them were denied that didn't successfully sue.

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skaterrj t1_j7uax6w wrote

In addition to what /u/314159265358979326 said, note that the NFL plan said that the judge in each of those cases was wrong. The sheer arrogance makes me even more suspicious of this plan - there's no sense of, "Hey, maybe we did get it wrong this time, and we should think about that."

Ever read Grisham's "The Rainmaker"? The movie was good, but the book was much, much better. In the book, the insurance company basically has a plan that they will reject every claim and then set up a loop between underwriting and claims so that no claim was ever paid. Someone dies after not receiving a treatment that should have been covered, which prompts the lawsuit.

While that's fiction, there's no doubt in my mind that there's some root in fact in it. There's no question that insurance companies make more money when they deny claims, so it's in their interest to do so, which automatically makes them biased against people filing claims.

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coronavirusrex69 t1_j7v5tw0 wrote

> there's no sense of, "Hey, maybe we did get it wrong this time, and we should think about that."

do many companies think like this? I've had tons of wrongfully denied claims via insurance and yet they still deny claims as much as they can. most of the time i don't even know what it means or why it was denied or it's just "because we said so," and so I have to pay. Companies are not in the business of giving things away, and if they were suddenly approving claims without trying to deny them first, they would make less profit.

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skaterrj t1_j7ve3kb wrote

Let me put it this way - I can't remember the last time my insurance (medical, dental, vision, Flexible Spending Account) denied a claim. Obviously these are more like traditional requests (checkups, pain that isn't going away, dental cleanings, etc.), but they definitely don't seem to have a "deny first" policy in my experience.

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coronavirusrex69 t1_j7vian4 wrote

tbh without going into details of my life, that's really great for you. IMO, we should have nationalized healthcare/insurance so that everyone can have that same luxury. until rich NFL players start arguing for me to have the same healthcare as them, i'm not going to feel bad about millionaires who had to work for a few years to retire not having the benefits they feel they deserve.

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skaterrj t1_j7vj9c7 wrote

Part of the problem here is that many of them aren't millionaires. The average career span in the NFL is four years, and most of them do not get signed to those multi-million dollar contracts we're always hearing about. Even if they come out of it with perfect health, most of them are going to have to continue to work to survive the rest of their lives.

Also, I ranted about our health care system elsewhere in this thread so don't go assuming that I think the current system is fine.

Finally, your original comment was:

> do many companies think like this?

And I responded that my health care insurance rarely decline claims. You asked, I answered. Maybe you've had a different experience, and that's legit, too, but then I'm not sure why you asked the original question, which was in response to the NFL plan declining a lot of seemingly legit claims.

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coronavirusrex69 t1_j7vl4ny wrote

>Part of the problem here is that many of them aren't millionaires. The average career span in the NFL is four years, and most of them do not get signed to those multi-million dollar contracts we're always hearing about.

"rookies with zero years of service will earn a minimum salary of $705,000."

median individual income in the US in 2022 was $46k, likely with bad/no benefits at that kind of salary, likely with a work schedule/environment that is going to increase long term health issues. in two years, an NFL player on the literal minimum salary possible grosses more than what the median worker makes in 30 years.

>And I responded that my health care insurance rarely decline claims. You asked, I answered. Maybe you've had a different experience, and that's legit, too, but then I'm not sure why you asked the original question, which was in response to the NFL plan declining a lot of seemingly legit claims.

Because every claim denied increases profits, and insurance companies are businesses? I get that you haven't had any claims denied, but the more claims they successfully deny, the further they go towards accomplishing their goal. as long as healthcare/insurance stays a for profit system, this will be the case.

NFL players should use their platform to promote nationalized healthcare/insurance programs if they want my sympathy. i'm not arguing that no claims get denied unfairly, i'm arguing "duh, why wouldn't they deny every claim they can?" that's how they make money.

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skaterrj t1_j7vmycj wrote

> median individual income in the US in 2022 was $46k, likely with bad/no benefits at that kind of salary, likely with a work schedule/environment that is going to increase long term health issues. in two years, an NFL player on the literal minimum salary possible grosses more than what the median worker makes in 30 years.

You don't have sympathy for them, okay, fine. Does that mean they should get screwed by the NFL plan that they thought provided them coverage? No, of course not. No one should be screwed by health insurance, it doesn't matter how much they make.

> i'm arguing "duh, why wouldn't they deny every claim they can?" that's how they make money.

I made that argument as well, in the first comment of mine you replied to. I'll quote it since you seem to have missed it:

> There's no question that insurance companies make more money when they deny claims, so it's in their interest to do so, which automatically makes them biased against people filing claims.

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coronavirusrex69 t1_j7vos91 wrote

i guess we're not disagreeing then we're just talking in circles on something we agree about.

>You don't have sympathy for them, okay, fine. Does that mean they should get screwed by the NFL plan that they thought provided them coverage? No, of course not.

i guess i just don't see it as getting screwed because they are participating in the system and they know how the system works. if i go to a car dealership and the guy blows a bunch of fluff up my ass and i overpay, did i get screwed? or did i participate in an activity that is designed to exploit me for my resources?

if i go play roulette and put all of my life savings on 00 and it hits any other number, did I get screwed? if i go kick a venomous snake and get bit, screwed? if i go drink and drive and get pulled over, did i get screwed?

did anyone put a gun to these guys heads and force them to playing the NFL? because maybe i'm missing that part.

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skaterrj t1_j7vqss3 wrote

None of those examples you gave compare to paying for health insurance and believing you are covered, then discovering it's useless. This one is closest:

> i guess i just don't see it as getting screwed because they are participating in the system and they know how the system works. if i go to a car dealership and the guy blows a bunch of fluff up my ass and i overpay, did i get screwed? or did i participate in an activity that is designed to exploit me for my resources?

If your employer had you paying into a health care plan then you later discovered it was smoke and mirrors, you would be screwed, yes. How in the world would that be your fault?

You're blaming the victims.

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coronavirusrex69 t1_j7vt0ln wrote

>believing you are covered, then discovering it's useless.

i can believe that i'm a snake whisperer. it doesn't mean it's true.

>If your employer had you paying into a health care plan then you later discovered it was smoke and mirrors, you would be screwed, yes. How in the world would that be your fault?

my brother in christ, I do pay into my employers health care plan and it is smoke and mirrors. this isn't me being screwed or anything. this is me living in America where health insurance is a profit driven business. Also, my employer health care plan doesn't cover me once I'm no longer employed by them.

there are no victims. this is the system that we live by in the US. i'm not sure if you're here or what, but we aren't the victims. we vote for the people who design these laws. there were major presidential candidates (well, one) that ran on universal healthcare, and the US overwhelmingly voted for the guy who specifically said he would VETO any universal healthcare bill. this is the system, by design, not a surprise.

you're acting like you see an advertisement that says "Best pizza on the planet!" and feel screwed when it's, shockingly, not the best pizza you have ever tasted. saying stuff like your health matters to us and blah blah is marketing - ie smoke and mirrors, and yes, that is how the US health system is run... if you believe everything you read in an advertisement, you are going to have a bad time here.

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Wisdomlost t1_j7v6i6b wrote

10k claims but by how many people. If a part of the red tape their talking about is every single issue needs to be a new claim then 1 person could rack up hundreds of claims in a year. I find it hard to believe there are 10k retired NFL players all making unique claims.

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Addictd2Justice t1_j7w1vaz wrote

It also misses the point and directs you to a misleading statistic (less than a dozen out of 10,000).

That statistic does not address the issue of the insurer’s conduct in specific cases. For example, a case where they fought and fought against a good claim and ultimately caved would fall into one of the 10,000.

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actibus_consequatur t1_j7tdfr8 wrote

On the brighter flipside, is disabled pitcher Matt LaChappa:

In 1996, while warming up in the bullpen to enter what would have been the first game of his season as a relief pitcher, LaChappa collapsed and suffered a heart attack. The Quakes athletic trainer performed CPR on LaChappa for 20 minutes until he was taken to a local hospital. At the hospital, he suffered a second heart attack. LaChappa survived, but suffered brain damage from the lack of oxygen and is mostly confined to a wheelchair and has difficulty moving and speaking. Since the incident, the Padres organization has signed him yearly to a basic Minor League contract so that he can maintain his health insurance.

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eric2332 t1_j7tl2qw wrote

I'm surprised that's necessary. The heart attack occurred while he was working and likely at least partly as a consequence of his work. Shouldn't his care be covered under routine workplace insurance?

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actibus_consequatur t1_j7tseu3 wrote

The wiki article doesn't explain, but the article it references does:

“What happened,” says Priscilla Oppenheimer, the Padres’ director of minor-league operations, “is that he had a virus around his heart. He’d just undergone a physical, too, but something like that can only be picked up on an ecocardiogram.”

I'm NAL, but with the presence of the virus, I'd think both workplace insurance and workers' comp would've been very combative over the claim, especially since it happened while he was only warming up which is far less stressful than actual gameplay. His family could (and maybe did) fight and so they are possibly getting some additional income from it, but I'm not sure how well the protections and such were almost 30 years ago.

Also, on top of the Padres still employing him, they apparently released him from having to repeat the bonus he got for the contract he couldn't fulfill, so that's pretty decent too.

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confirmd_am_engineer t1_j7tz5ea wrote

Not necessarily. You can still suffer personal medical issues while at work. In order to be work-related you would need to prove that your job caused the heart issue. For someone like Demar Hamlin that’s pretty easy, but for many others it’s not so cut and dried.

This happens a lot in other industries too. I actually had an employee with suspected cardiac issues at work yesterday. They were taken offsite to a hospital. It’s been filed as a personal medical issue.

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coronavirusrex69 t1_j7v60zw wrote

most people who have heart attacks at work are covered forever via insurance? i don't think that's how it works, but maybe i'm wrong??

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