DALLAS (CN) — A federal judge in Texas Friday dismissed a clinic’s lawsuit claiming the National Football League pressured a health insurer to deny former players’ medical treatment claims in retaliation for test results being used in disability claims against the league.
U.S. District Judge Joe Fish in Dallas concluded the claims brought by Illinois-based clinic Advanced Physicians S.C. are preempted by the Employment Retirement Income Security Act — a law setting minimum standards on retirement and health plans established for employees of private employers. The clinic sued the NFL in Illinois state court last year, alleging the league engaged in economic interference by instructing insurer Cigna to reject the claims.
The clinic says it had submitted claims as an out-of-network medical provider since 2007 for former NFL players it treats and that the claims started being rejected in 2015. Under collective bargaining agreements, vested league veterans and their relatives are covered by the NFL Player Insurance Plan for up to five years after retirement.
The clinic claims the sudden denials were due to some of the former players using diagnostic test results it provided as evidence in applications for separate disability benefits with the league. The denials started the same year the NFL entered into a $1 billion settlement with former players who suffered from neurodegenerative diseases relating to concussions and other head injuries. Players diagnosed with ALS, Parkinson’s Disease, Alzheimer’s Disease and moderate or early dementia are eligible for payments under the deal. The settlement fund has paid on over 1,173 claims totaling over $796 million.
The clinic’s case was later removed to Chicago federal court and then transferred to Dallas federal court.
Judge Fish relies on the Chicago federal judge’s ruling in the case last year that the clinic’s state claim is preempted by ERISA in dismissing the case under the “law of the case” doctrine. The procedural doctrine prevents reconsideration of an issue that has already been decided in a case without a significant change in the circumstances.
“To avoid ‘a vicious circle of litigation,’ the court determines that, in applying the law of the case doctrine, Advanced’s claims are preempted by ERISA,” the 15-page ruling states.
Fish further concludes the clinic failed to establish the NFL as the proper defendant in the case, citing a separate lawsuit the clinic filed against Cigna in 2016 in Illinois state court.
“Advanced argues that the NFL effectively made the decision to deny benefit payments to Advanced by directing Cigna to deny Advanced’s benefit claims as work-related,” the opinion states. “However, the NFL is not actually the employer of the players or retired players, the individual teams are.”
The clinic’s earlier lawsuit against Cigna proves “the plan has a meaningful existence apart from the employer,” the judge wrote.
Attorneys for the NFL and Advanced Physicians did not immediately respond to requests for comment Friday.
Fish said he will dismiss the case with prejudice if the clinic fails within 14 days to file an amended complaint showing how the NFL is the correct defendant and to make any ERISA claims against the league.
Critics of the NFL’s $1 billion head injury settlement contend it does not protect living former players suffering from CTE because it is currently only possible to confirm CTE after death when an autopsy is performed. Only after death are doctors able to study brain tissue for signs of degeneration and buildup of tau proteins.
Upholding the settlement in 2016, the Third Circuit concluded the omission of living players with CTE in the settlement does not leave it “fundamentally unfair” enough to reject.
“This settlement will provide significant and immediate relief to retired players living with the lasting scars of a NFL career, including those suffering from some of the symptoms associated with CTE,” U.S. Circuit Judge Thomas Ambro wrote at the time. “We must hesitate before rejecting that bargain based on an unsupported hope that sending the parties back to the negotiating table would lead to a better deal.”