Appeals

331. Are there any rules covering appeals of claim determinations?


Yes. The Special Masters adopted the Rules Governing Appeals of Claim Determinations, which cover appeals made by a Settlement Class Member, Co-Lead Class Counsel or the NFL Parties under Section 9.5 of the Settlement Agreement from Claims Administrator’s determinations on Monetary Awards and Derivative Claimant Awards. These Rules are available here.

332. Can I appeal the Claims Administrator’s determination of any amounts deducted from my Monetary Award or Derivative Claimant Award for Liens?


No. You cannot appeal the Claims Administrator’s determination of a Lien deduction (see Rule 9 of the Rules Governing Appeals of Claim Determinations, available here). However, there is a separate process for you to dispute a Lien. Click here to read an FAQ about how to dispute a Lien.

333. Who are the appellant and the appellee on an appeal of a claim?


The appellant is the one who brings an appeal. You, Co-Lead Class Counsel, or the NFL Parties may be an appellant. The appellee is the one on the other side of the appeal and can respond to the arguments made by the appellant.

334. Why was my claim remanded to the Claims Administrator?


If the Special Master decides to allow new evidence after the Claims Administrator issued the notice being appealed, the claim is remanded—meaning sent back—to the Claims Administrator to review again. The Special Master also can remand claims for other reasons as he or she deems appropriate. The Claims Administrator will have the claim re-reviewed on the issue(s) on appeal that led to the remand, including review of any new evidence introduced in the appeal. For more information about the Appeals process, click here to read the Rules Governing Appeals of Claim Determinations.

335. If my claim is remanded from an appeal to the Claims Administrator, what happens to the $1,000 Appeals Fee I paid? 


The $1,000 Appeals Fee will be refunded to you.

336. May the NFL Parties offer medical or other new evidence on appeal?


Yes. Nothing in the Settlement Agreement prohibits the NFL Parties from submitting medical records or other factual evidence during an appeal. Section 9.5 of the Settlement Agreement allows the NFL Parties to be an appellant on a claim, and Section 9.7(a) says that an appellant “must present evidence in support of [its] appeal.”

337. If a party offers new evidence in a brief on appeal, how does that affect the due date for the responding party’s brief? How will I know whether there will be a remand or whether I need to address the new evidence in what I file?


The Claims Administrator issues a Filed Appeal Alert to notify you, Co-Lead Class Counsel and the NFL Parties that there has been an appeal of a Monetary Award determination. That Filed Appeal Alert triggers the time for the appellees and Co-Lead Class Counsel to respond to the appeal. If the appellant who brings the appeal offers new evidence with the appeal, the Claims Administrator will not issue that Filed Appeal Alert until after the Special Master rules on whether to admit the new evidence. If the Special Master admits the new evidence, the claim will be remanded to the Claims Administrator and there will be no further briefing by anyone on the appeal. The Claims Administrator will send out notices if the claim is remanded. If the Special Master does not admit the new evidence, the claim will not be remanded to the Claims Administrator. Instead, the Claims Administrator will issue a Filed Appeal Alert and it will tell everyone involved in the appeal when the responses of the others are due in the appeal. 

The Appeals Rules do not allow replies to the briefs of the appellees, so if an appellee submits new evidence, it does not affect any reply times. However, if Co-Lead Class Counsel offers new evidence with its Statement of Co-Lead Class Counsel, the Claims Administrator will not begin the 15-day period the other parties have to respond to that Statement until after the Special Master rules on whether to remand the claim to the Claims Administrator.

338. If new evidence added on appeal leads to remand to the Claims Administrator, can a party offer new evidence in every appeal to force a remand and re-review, either to get another chance at payment or denial, or to delay things?


There are safeguards in place to avoid abuse of the appeals process. All parties must act in good faith and without ulterior motives on appeals. Both Section 9.6(b) of the Settlement Agreement and the Rules Governing Appeals of Claim Determinations allow Co-Lead Class Counsel to petition the Court for relief if it believes that the NFL Parties are submitting vexatious, frivolous, or bad faith appeals. The Rules Governing Appeals of Claim Determinations also allow the Special Master to order relief “as to the conduct of any Party to the Appeal or to multiple Appeals concerning Monetary Awards that the Special Master determines to be vexatious, frivolous or in bad faith.” This will control abuse of the system. Click here for the Settlement Agreement and here for the Rules Governing Appeals of Claim Determinations.

339. Will the Court review a decision by a Special Master allowing or excluding new evidence on a claim appeal?


No. This is a factual determination, not a conclusion of law. The Special Master’s factual determinations are final and binding. Only the Special Master’s conclusions of law are reviewable by the Court.

340. How will remands of claims on appeal work?


If the Special Master allows the introduction of new evidence under Rule 23(c) (click here to read the Rules Governing Appeals of Claim Determinations) and remands (sends back) the claim to the Claims Administrator, the claim will be reviewed again. This leads to other questions:

(a) Will the re-review be assigned to the same AAP doctor who reviewed it before?


Yes, unless the Special Master orders otherwise. In general, if an AAP doctor reviewed the claim originally, on remand the same AAP doctor will re-review the claim.


(b) If the Special Master remands my claim, will the Claims Administrator or the AAP review the entire claim all over again?


No, not unless the Special Master orders it. A remand review usually is a focused re-review. The Claims Administrator or AAP doctor will assess the claim only for the issue(s) raised on the appeal that led to the remand. For example, if the Special Master remands a claim only for an issue involving Eligible Seasons, the Claims Administrator will review the Claim Package and any new evidence presented in the appeal to determine the correct outcome on Eligible Seasons, but will not re-review the medicine and the Qualifying Diagnosis found in the original review. Conversely, if the Special Master remands a claim for a medical issue, the Claims Administrator and the AAP (if it is a claim reviewable by the AAP) will review the Claim Package and any new medical evidence presented in the appeal to determine the correct outcome on the medicine and the Qualifying Diagnosis, but will not re-review the number of Eligible Seasons found in the original review. The Special Master, however, does have discretion to direct other relief on any remand. 


(c) If an AAP doctor reviews the claim after remand, will that AAP doctor see the entire claim file on remand, or only the new evidence?


The AAP doctor will see all the evidence in the claim file that relates to the issue(s) on appeal that led to the remand. If the remand is for a medical issue, the AAP doctor will see and assess all the medical evidence in the file relating to the medical aspects of the claim that triggered the remand, including any new evidence presented in the appeal.


(d) Does that mean that AAP doctor will see all the briefs on the appeal too?


Yes. The AAP doctor doing the re-review will see the briefs and arguments on the appeal that led to the remand. 


(e) On remand, does the original outcome set a floor for the result, or can the claim go down in value?


There is no floor or limit. In a re-review after a remand, the claim can go up in value, go down in value, stay the same, or be denied completely.


(f) What if the Claims Administrator did the original review and not the AAP. Do these same rules apply?


Yes. Remand reviews by the Claims Administrator will be done in the same manner as AAP reviews.


341. Can a claim be appealed again after the Special Master remands it and the Claims Administrator issues a new notice?


Yes. After the re-review of the claim, the Claims Administrator will issue a new notice on the outcome of the review. That notice starts the time to appeal all over again.