A group of former NFL players is suing the league’s disability benefit program, commissioner Roger Goodell and the disability board, accusing them of routinely denying disability claims.
In a lawsuit filed Thursday in the District Court for the District of Maryland, 10 players – including two-time Pro Bowl running back Willis McGahee and Super Bowl XLII champion Jason Alford – said they were “seeking redress for the wrongful denial of benefits, the denial of statutorily mandated full and fair review of benefits denials, violations of plan terms or governing regulations, and breaches of fiduciary duty.”
The lawsuit alleges the accused parties acted in “an overly aggressive and disturbing pattern of erroneous and arbitrary benefits denials, bad faith contract misinterpretations, and other unscrupulous tactics” when it came to withholding disability benefits and a lack of thoroughness when reviewing medical records.
It alleged the board “members have engaged in repeated and substantial derelictions of their responsibilities, have repeatedly refused to pay contractually mandated benefits, and have statistically proven conflicts.”
The lawsuit alleges the league’s disability benefit program, commissioner Goodell and the disability board found ways “to limit the payment of benefits to the very Players whom the Plan was designed to help” and that players were “forced to navigate a byzantine process in order to attempt to obtain those benefits, only to be met with denial.”
It accuses the disability board of not hiring neutral physicians to carry out assessments of players’ injuries, saying these were “biased.”
The lawsuit alleges a correlation between the amount of money paid to physicians and the likelihood a player’s claim would be denied.
In the period between March 31, 2019, and April 1, 2020, 4.5% of players were found to be totally and permanently disabled by physicians paid more than $210,000, said the lawsuit.
Conversely, in the same period, 30% were found to be disabled by physicians paid $54,000-$60,000.
‘Head, neck, and lumbar spine impairments’
Eric Smith, who played for the New York Jets until 2012, suffered 13 documented traumatic brain injuries. He was denied line of duty (LOD) benefits in 2013 and his appeal was denied a year later, according to the lawsuit.
He reapplied for LOD benefits in 2015 after being seen by a physician who was paid $34,268 and had found 20 LOD impairments among players.
After Smith was awarded benefits, according to the lawsuit, the physician’s compensation from the board fell sharply the next year to $16,711.
When Smith applied for permanent and neurocognitive disability in 2018, he was repeatedly denied by physicians – some paid over $1 million – despite his “head, neck, and lumbar spine impairments” and “marked decreased shoulder range of motion, rotator cuff weakness, and moderate to severe shoulder arthritis,” according to the lawsuit.
The lawsuit alleges that when the plan and the board reviewed a players disability claim, they chose to only use the case summaries prepared by the plan’s law firm, the Groom Law Group, rather than the full medical records, which goes against federal law.
CNN has reached out to the NFL Players Association and the Groom Law Group for comment.
“The disability plan, which is established by the NFL-NFLPA as part of the CBA, includes an uncapped financial commitment to provide benefits for any retired player that meets the eligibility requirements set by the parties,” an NFL spokesperson said in response to CNN’s request for comment.
“These eligibility requirements and administrative procedures were developed after consultation with occupational, mental and physical health experts. The plan annually provides more than $330 million to deserving players and their families.
“The NFL-NFLPA disability plan is fair and administered by a professional staff overseen by a board comprised of an equal number of appointees of the NFL Players Association and the league, which includes retired players.
“This board reviews the activities of the office and operation of the benefit program, including every contested application for benefits to ensure that retired players who are entitled to disability benefits receive them as intended.”
Before the lawsuit was filed, Goodell was asked during his pre-Super Bowl news conference about the denial of benefits for some players.
He said that he believes the “benefits are extraordinary for our players, but as you know, it’s a defined benefit plan also.”
“A defined benefit plan operates under governmental law and we have to obviously have a system to be able to identify who qualifies for those benefits and who doesn’t qualify for those benefits, and that’s done with union and management.
“And the facts are that’s done independently with doctors, who make a determination of whether the benefit and an individual qualifies under that program. So you don’t want people to benefit from it that don’t qualify for it, because it takes away from people who do qualify for it.
“You’re always going to have people who may think they qualify for it. Doctors disagree, the joint board disagrees, that’s a way the system works. But I would tell you, the benefits in the NFL are off the charts.”
The lawsuit seeks to be given class action status, the removal of the six members of the board – for “their repeated and substantial breaches of the fiduciary duty of loyalty to the Plan” – and an unspecified amount of money as compensation.