The Unjust Evaluation
In his quest for line-of-duty benefits, Mr. X was mandated to undergo a medical examination with Dr. B. The results were disheartening. Dr. B only awarded him 5 points for his orthopedic impairments, far below the 10 points required by the Plan to qualify for benefits. But this decision was riddled with errors.
A Clear Oversight
Dr. B's points breakdown was as follows:
- 2 points for a pectoralis major tendon tear
- 1 point for decreased range of finger motion, leading to a loss of grip strength in the left hand
- 2 points for residual weakness in the right knee due to a quadricep, hamstring, adductor, or gastric/soleus tear
However, Dr. B overlooked crucial elements. He failed to award points for Mr. X's glenohumeral joint degenerative joint disease, despite acknowledging its presence. Additionally, he ignored Mr. X's documented PCL tear, even though it was noted in his report.
The Correct Evaluation
According to the Plan’s guidelines, Mr. X should receive an extra:
- 3 points for the PCL tear
- 3 points for the glenohumeral joint degenerative joint disease
This adjustment would bring his total to 11 points, qualifying him for benefits under the Plan.
Expert Opinions
Dr. M reviewed Mr. X's point denial, evaluating Mr. X’s right shoulder degenerative joint disease. He remarked:
"With regard to the right shoulder degenerative joint disease demonstrated by loss of motion as well as radiographic findings, there is no explanation for degenerative joint disease at 32 years of age other than his participation in professional football."
Understanding the NFL Player Disability & Neurocognitive Benefit Plan
The NFL Player Disability & Neurocognitive Benefit Plan (the "Plan") is a safety. It provides financial and medical support to former NFL players who, as a result of their careers, suffer from disabilities or neurocognitive impairments. The Plan includes a variety of benefits intended to address the long-term health and well-being of its participants.
Key benefits of the Plan include line-of-duty disability benefits, intended for those whose impairments arose directly from their professional football activities. The eligibility criteria are stringent, often requiring thorough medical examinations and documentation to support the claims. The Plan mandates that an impairment must substantially limit an individual's ability to perform activities of daily living or work-related tasks, which can be a high threshold to meet.
Additionally, the Plan encompasses neurocognitive benefits for players experiencing conditions such as dementia, Alzheimer's disease, and other cognitive impairments tied to their time on the field. This aspect of the Plan is particularly vital given the increasing awareness of chronic traumatic encephalopathy (CTE) and other brain-related conditions prevalent among former players.
The process of securing benefits under the Plan can be complex and often contentious, as demonstrated by Mr. X's ongoing struggle. Despite its intent to provide support, discrepancies and challenges in the evaluation and approval processes can leave eligible players without the assistance they deserve. This problem reflects a broader need for transparency, consistency, and fairness in the Plan’s administration. It must ensure that all former players receive the benefits required for their continued health and quality of life.
Championing Mr. X's Cause
When Mr. X's rightful claim was unjustly denied, Dabdoub Law Firmstepped in to provide the necessary support and expertise. Recognizing the significant gaps and errors in Dr. B's evaluation, the legal team meticulously gathered and presented comprehensive evidence that irrefutably demonstrated Mr. X's disability.
The team collaborated with top medical professionals to secure detailed assessments that underscored the severity of Mr. X's conditions, emphasizing the inaccuracies in the previous examination. By highlighting compelling medical data and expert testimonies, Dabdoub Law Firm strengthened Mr. X's case, ensuring every aspect of his impairments was accurately represented. This unwavering commitment to justice and precision amplified the credibility of Mr. X's claim.
Disability Insurance Companies Have Lawyers. Shouldn’t You?
Because this law firm was created to focus on disability insurance, we have developed an expertise in this complex area of the law.
Our expertise in long-term disability claims means our clients have the backing of a law firm that has attorneys who:
- are experts in disability claims;
- fought all major disability insurance companies and know their tactics;
- a track record of success;
- won major disability lawsuits that created good law; and
- recovered millions of dollars in disability benefits.
All our lawyers commit every day of their legal career to helping people get disability benefits from MetLife, UNUM, Prudential, Northwestern Mutual, Hartford, CIGNA, and others.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help. We help clients nationwide.
Call to get experienced disability lawyers on your side with:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; and/or
- Filing a lawsuit against your disability insurance company.
If you are struggling to get disability benefits you deserve, trust Dabdoub Law Firm to help. You can reach us online or call us at (800) 969-0488. Initial consultations are free.
