Monetary Awards

74. Who can submit a claim for a Monetary Award?

Retired NFL Football Players who are registered in the Settlement Program and believe they have a Qualifying Diagnosis can submit a claim for a Monetary Award. Also, the Representative Claimants of a deceased or legally incapacitated or incompetent Retired NFL Football Player with a Qualifying Diagnosis may submit a claim for a Monetary Award on behalf of that Player.

75. What is a Claim Package?

A Claim Package includes a Claim Form, HIPAA Form, Diagnosing Physician Certification Form and medical records reflecting the Qualifying Diagnosis. You also can send proof of Eligible Seasons if you think you have more than what the Claims Administrator already credited to you during the registration process. All required forms are available on the Settlement Website.

Reminder: The Settlement Program uses different HIPAA Forms for different purposes. Your Claim Package must include the “Monetary Award Claim Package HIPAA Authorization Form.” This is different from the Baseline Assessment Program HIPAA Authorization Form. Click here for a copy of the Claim Package HIPAA Authorization Form that you can print and download from the Settlement Website.

76. How do I submit a Claim Package?

If you created a Portal account on the Claims Administrator’s Settlement Website (https://www.nflconcussionsettlement.com/Login.aspx), log in and follow the directions to submit your Claim Package. If you do not have a Portal account, you can create one now if you would like and submit your Claim Package online. If you do not wish to create one, you can mail your Claim Package to the Claims Administrator. Click here for the Claims Administrator’s mailing and delivery addresses.

Reminder: The Portal is a secure website where you (or, if you are represented, your lawyer) and the settlement administrators can exchange information easily and quickly. You do not have to use the Portal to participate in the Settlement Program. Even if you use the Portal, you can tell the Claims Administrator you prefer to send and receive information by mail.

77. Where do I send my Claim Package if I do not use an online Portal?

You can send your Claim Package to the Claims Administrator using one of these methods:

78. When can I submit a Claim Package?

You can submit a Claim Package after you receive a Qualifying Diagnosis. You cannot receive a Monetary Award without a Qualifying Diagnosis. Click here to read an FAQ about Qualifying Diagnoses.

79. Is there a deadline to submit my Claim Package?

Yes. Your deadline depends on the Qualifying Diagnosis date.

(a) Diagnoses on or before February 6, 2017: you must have submitted your claim by February 6, 2019.

(b) Diagnoses after February 6, 2017: submit your claim within two years after the date of the diagnosis.

80. How can I change answers I made in my Claim Form?

If you are a Portal user, log in to your Portal account and edit your submitted Claim Form as often as necessary until the Claims Administrator begins reviewing it. Each time you change your Claim Form, you must re-sign it to confirm your changes. You cannot edit your Claim Form after the Claims Administrator has started reviewing your claim, because the Claims Administrator cannot reliably review a claim that keeps changing. You can check the status of your claim through your Portal account.

If you do not have a Portal account, mail a new, signed Claim Form to the Claims Administrator. The Claim Form is available on the Portal, or you can request a copy from the Claims Administrator by calling 1-855-887-3485. You can also call if you need help editing your Claim Form or want to check the status of your claim and a Program Specialist will help you.

81. What is a Qualifying Diagnosis?

These diagnoses are eligible for a Monetary Award:

(a) Level 1.5 Neurocognitive Impairment;

(b) Level 2 Neurocognitive Impairment;

(c) Alzheimer’s Disease;

(d) Parkinson’s Disease;

(e) Death with CTE (for a Retired NFL Football Player who died before April 22, 2015); and

(f) ALS.

82. Should I get a BAP exam or see a Qualified MAF Physician?

This is up to you and depends on the Qualifying Diagnosis.

Level 1.5 and Level 2: If you are eligible for the BAP, you can get your diagnosis from either Qualified BAP Providers or a Qualified MAF Physician. The BAP exam is free.

Alzheimer’s Disease, Parkinson’s Disease and ALS: You must see a Qualified MAF Physician. These Qualifying Diagnoses cannot be made in the BAP.

83. What kind of physicians are currently authorized to make a Qualifying Diagnosis?

This depends on the kind of Qualifying Diagnosis and when it was made. Click here for the Diagnosis and Review Table showing how this works. Find the kind of Qualifying Diagnosis in column 1 of Row A, B or C of the Diagnosis and Review Table. Then look at column 2 for when the diagnosis was made and column 3 for what kind of doctor has authority under the Settlement Agreement to make that diagnosis for purposes of a Monetary Award.

This is what the Diagnosis and Review Table shows for diagnoses made after January 7, 2017:

(a)    Level 1.5 or Level 2 Diagnoses: After January 7, 2017, these must be diagnosed either by a Qualified BAP Provider in the BAP or by a Qualified MAF Physician;

(b)    Alzheimer’s Disease, Parkinson’s Disease, or ALS: After January 7, 2017, these can be diagnosed only by a Qualified MAF Physician.

84. Who is a Qualified MAF Physician?

A Qualified MAF Physician is a board-certified neurologist, board-certified neurosurgeon, or other board-certified neuro-specialist physician, who is part of a list of physicians approved by Class Counsel and the NFL Parties as authorized to make a Qualifying Diagnosis after January 7, 2017. A physician is not a Qualified MAF Physician until he or she has been approved by the Parties and has signed a contract with the Claims Administrator. The list of Qualified MAF Physicians eligible to make Qualifying Diagnoses is posted on the Settlement Website (click here to see it). Also click here to see the Diagnosis and Review Table, which summarizes Qualifying Diagnoses that Qualified MAF Physicians make and the diagnostic criteria they use to make those diagnoses. Click here for an FAQ about who helps with the operation and implementation of the network of Qualified MAF Physicians. Certain Qualified MAF Physicians serve on the Claims Administrator’s MAF Steering Committee.

85. Who helps with the operation and implementation of the network of Qualified MAF Physicians?

Under its responsibilities for the fair and efficient administration of the Settlement Agreement and in light of the Court’s rulings, the Claims Administrator has full authority to help with the operation and monitoring of the network of Qualified MAF Physicians and to take the actions described in the Rules Governing Qualified MAF Physicians and these FAQs.

86. What is the MAF Steering Committee?

A group of not more than 10 Qualified MAF Physicians may serve as the Claims Administrator’s MAF Steering Committee to render advice and assistance on providing peer-to-peer feedback to Qualified MAF Physicians and suggestions to the Claims Administrator on how to improve the operations and performance of the network of Qualified MAF Physicians. The MAF Steering Committee is appointed by and works at the Claims Administrator’s direction, as overseen by the Special Masters.

87. How do I get evaluated for a Qualifying Diagnosis if I do not already have one?

You can make an appointment with either:

(a) Qualified BAP Providers (if you are BAP-eligible) who can determine whether you have Level 1.5 Neurocognitive Impairment or Level 2 Neurocognitive Impairment; or

(b) A Qualified MAF Physician, who can determine whether you have Level 1.5 Neurocognitive Impairment, Level 2 Neurocognitive Impairment, Alzheimer’s Disease, Parkinson’s Disease, or ALS.

88. Is there any limit on which Qualified MAF Physician I may choose to examine me?

Yes. You must be examined by a Qualified MAF Physician who has a pre-existing office located within 150 miles of your primary residence. If you send in a diagnosis done by a physician more than 150 miles from your primary residence, the Claims Administrator may:

(1)   Have the diagnosis reviewed by a member of the AAP and/or AAPC for a determination.

(2)   Deny your claim as ineligible.

(3)   Investigate further through Audit.

(4)   Direct re-examination by a different Qualified MAF Physician and/or neuropsychologist, or such other actions determined appropriate.

(5)   Accept the diagnosis.

Contact the Claims Administrator before your exam to ask for an exception, if you feel that you need one. You will have to fill out a 150-Mile Rule Exception Request Form. The Claims Administrator may grant you an exception to this rule if:

(1)   There is no Qualified MAF Physician located within 150 miles of your primary residence;

(2)   The wait time for a Qualified MAF Physician within 150 miles of your primary residence is more than 100 days;

(3)   You and the Qualified MAF Physician have a current or pre-existing doctor-patient relationship; or

(4)   Other circumstances are found to warrant an exception.

89. If my diagnosing physician is both a Qualified BAP Provider and a Qualified MAF Physician, how do I know if the diagnosis is made in or outside the BAP?

Qualifying Diagnoses of Alzheimer’s Disease, Parkinson’s Disease and ALS cannot be made through the BAP. After January 7, 2017, a Qualifying Diagnosis of Alzheimer’s Disease, Parkinson’s Disease, or ALS must be made by a Qualified MAF Physician, even if he or she is also a Qualified BAP Provider. However, a Qualifying Diagnosis of Level 1.5 Neurocognitive Impairment or Level 2 Neurocognitive Impairment may be made after January 7, 2017, by Qualified BAP Providers or a Qualified MAF Physician.

Most of the Qualified BAP Providers are also Qualified MAF Physicians. If you or your lawyer scheduled a BAP exam with the BAP Administrator, then you will receive a BAP exam. If you have any doubt about in which capacity the physician is acting, then ask him or her during your visit.

90. Does the physician who makes the Qualifying Diagnosis of a Retired NFL Football Player have to see and examine that Player in person?

Yes, for all types of Qualifying Diagnoses other than Death with CTE, which could have been diagnosed only after the death of the Player.

The diagnosing physician who signs a Diagnosing Physician Certification Form for a diagnosis made on a living Retired NFL Football Player must have examined that Player in person. Section 8.2(a)(iii) of the Settlement Agreement allows a physician to make a Qualifying Diagnosis for a living Player relying on the records and work done by a prior physician and to use that earlier date as the diagnosis date only if that prior physician is deceased or incompetent and only if the new physician independently examines the Player. This means that other than those situations, a Qualifying Diagnosis of a living Player must be made by a physician based on his or her own examination and records, rather than the examination and records of someone else.

As a result:

(1) The diagnosing physician cannot base a Qualifying Diagnosis solely on a review of test results or the medical records of another physician; and

(2) The diagnosing physician must have met with the Player in person, rather than communicating with him by email, texts, letters, or on the phone.

91. If a Retired NFL Football Player shares past medical records with a Qualified MAF Physician, is that physician permitted to ask the Player to submit additional records?

Yes. If a Player shares past medical records (or any other records, including affidavits), the Qualified MAF Physician must ask whether such records were previously submitted as part of his Claim Package and what the outcome was on that claim. If the Player submitted the records as part of a Claim Package, the outcome on that previous claim controls what the Qualified MAF Physician must request: 

92. May Qualified MAF Physicians rely on records from providers who were disqualified or terminated because their medical practices and/or reasoning did not comply with the Settlement Program's specific requirements and criteria?  

This depends on whether a provider has been disqualified by the Special Master or terminated by the Claims Administrator. Each Qualified MAF Physician has a list of all such providers and must follow these rules: 

93. Do I need to tell the Qualified MAF Physician about my work and other activities?

Yes. You and any informant, or person on whom you are relying to provide information about your conditions (spouse, parent, etc.), must tell the Qualified MAF Physician (and any neuropsychologist to whom you are referred by that Qualified MAF Physician) about all employment, business, income sources (such as investments unrelated to your business or employment), social, community, recreational or other activities you engage in outside the home. The information on employment, business and income sources must cover the five years leading up to the exam, and information on the things you do outside the home should cover how they have changed in the last five years.

You can use the Employment History and Social and Community Activity of Retired NFL Football Player (Form for Use by Retired Player) on the Settlement Website to help do this; a person on whom you are relying to provide information about your conditions can use the Employment History and Social and Community Activity of Retired NFL Football Player (Form for Use by Knowledgeable Informant) on the Settlement Website. Be sure to complete the "What do you do?" section for each item to describe the extent of the activity. The physicians also will ask questions that you and any informant you bring with you to your exam must answer truthfully and fully. Any person, including anyone working in a law office or in a claims preparation office, who helps a Retired Player or Knowledgeable Informant complete a section in one of these forms about the Retired Player's employment, business, income sources, social, community, recreational or other activities outside the home must sign the form attesting that he or she accurately conveyed the statements of the Retired Player or Knowledgeable Informant. Click here to read an FAQ about how these forms differ from the SWS-3 ("Third-Party Sworn Statement: Functional Impairment").

Reminder: All reported employment and activities may be verified through interviews with employers and/or checked against tax records and publicly available information, including through investigation and observation. 

On any Claim Package presenting an issue about whether the doctors had complete information, the Claims Administrator may: 

(a)   Ask you, the Qualified MAF Physician, and/or the neuropsychologist involved in the diagnosis to explain their diagnosis.

(b)   Ask a member of the AAP and/or AAPC to review the diagnosis for a determination.

(c)   Send you a notice requesting additional information and/or documents.

(d)   Deny the claim as ineligible.

(e)   Direct re-examination by a different Qualified MAF Physician and/or neuropsychologist, or such other actions determined appropriate.

(f)    Investigate further through Audit if there is a question about honesty.

94. What kinds of communications may I have with the Qualified MAF Physician?

You, or your family member or other authorized representative, may communicate with a Qualified MAF Physician and his or her office staff in the same way you do with any physician you are seeing for an exam. In fact, it is very important that you talk openly and honestly with the Qualified MAF Physician about your medical condition and that you provide complete and truthful answers to the doctor’s questions about your employment, business, social, community, recreational and any other activities you do outside the home (click here for an FAQ about this). You also may cover other things with the Qualified MAF Physician and office staff, such as scheduling appointments, paying for the exam, getting records from the exam, correcting factual things the records may have wrong, and the doctor’s diagnosis and advice. If you have a lawyer representing you, then with your permission, that lawyer may also communicate with the physician and staff about those same things.

But some communications and actions are not appropriate. Neither you nor your representatives or lawyer may do any of these things:

1. Financial Incentives/Negotiations: Do not attempt to offer anything in exchange for a Qualifying Diagnosis or negotiate the making of one. The only acceptable payment is the usual and customary charge for the services rendered. Lawyers cannot enter any contractual relationship with physicians about doing MAF exams, pay a retainer fee for a doctor's services, or offer or agree to pay more if a Qualifying Diagnosis is found.

2. Question Methodology: Do not attempt to instruct or influence how the doctor performs the examination and makes a diagnosis. A Qualified MAF Physician must do exams in accordance with: (a) the Settlement Agreement, including the Injury Definitions in Exhibit 1 to the Settlement Agreement; (b) the Rules Governing Qualified MAF Physicians; (c) the Qualified MAF Physician Manual and any other instructions and materials provided by the Claims Administrator; and (d) sound medical judgment.

3. Challenging Conclusions or Asking for Changes: Do not ask the doctor to change a diagnosis in any way. Each Qualified MAF Physician exercises sound professional medical judgment in evaluating Retired NFL Football Players for potential Qualifying Diagnoses and cannot be influenced or requested to change outcomes.

Reminder: The Qualified MAF Physician may send you for testing by a neuropsychologist. It is very important that you talk openly and honestly with the neuropsychologist and put forth your best effort in the completion of this testing.

Reminder: Communications solely between a Settlement Class Member's lawyer, law firm, or any other person or entity to the exclusion of the Settlement Class Member are prohibited without the express prior written permission from the Claims Administrator, except for administrative items such as scheduling or medical record requests.

95. Is there any limit on which neuropsychologist the Qualified MAF Physician may refer me to for neuropsychological testing?

Yes. If a Qualified MAF Physician refers you to a neuropsychologist for testing and evaluation, that neuropsychologist must be a Qualified BAP Provider or otherwise approved by the Claims Administrator before the neuropsychological examination. In addition, the practice of the neuropsychologist must be located within 50 miles of the office of the Qualified MAF Physician (unless the Claims Administrator has granted an exception to this requirement) and the examination must occur in an office or medical facility of that practice.

96. Can the representative of a deceased Retired NFL Football Player submit a claim now?

It depends on when the diagnosis of the Retired NFL Football Player was made. For Qualifying Diagnoses of Level 1.5 Neurocognitive Impairment, Level 2 Neurocognitive Impairment, Alzheimer’s Disease, Parkinson’s Disease and ALS, the Player had to have been diagnosed while he was living by a physician with the appropriate qualifications, which are described in the FAQ found here. If the Player received one of these diagnoses while he was alive, then:

(a) For diagnoses made on or before February 6, 2017, the Representative Claimant must have submitted a Claim Package on or before February 6, 2019. That deadline has passed and the Claims Administrator no longer can accept these claims unless you can show substantial hardship.

(b) For diagnoses made after February 6, 2017, you must submit the Claim Package no later than two years after the date the diagnosis was made. Click here for more information about deadlines to submit Claim Packages.

The only type of Qualifying Diagnosis that could be made after the Player died is Death with CTE. To qualify for a Monetary Award under the Settlement Agreement, the Player had to have died before April 22, 2015, and received a post-mortem diagnosis of CTE from a board-certified neuropathologist before that same date, April 22, 2015, except if the Player died between July 7, 2014, and April 22, 2015, the Player had to receive a post-mortem diagnosis of CTE from a board-certified neuropathologist within 270 days after the Player's death. The deadline to submit Claim Packages for Death with CTE was February 6, 2019.

97. What should I do if I already have a Qualifying Diagnosis?

The deadline to submit a Claim Package for Pre-Effective Date Qualifying Diagnoses was February 6, 2019.

If you have a diagnosis from a Qualified MAF Physician or Qualified BAP Providers made after February 6, 2017, you must submit a Claim Package for that Qualifying Diagnosis no later than two years after the date the diagnosis was made, including a Diagnosing Physician Certification Form and any medical records from the physician who made the diagnosis and the other required parts of a Claim Package. If you received a Qualifying Diagnosis through the BAP or from a Qualified MAF Physician, the Claims Administrator may already have your medical records and Diagnosing Physician Certification Form, so check your Claim Package documents on your Portal or contact the Claims Administrator to see if some of these items are already in your file. You must submit a Claim Form before the Claims Administrator will review your claim for a Monetary Award determination.

98. Does it matter when the Retired NFL Football Player was diagnosed?

Yes. The Settlement Agreement sets out what kind of doctors are authorized to make a Qualifying Diagnosis, depending on when the diagnosis is made. (See Section 6.3 of the Settlement Agreement, available by clicking here.)

The Settlement Agreement controls what medical criteria applies when making a Qualifying Diagnosis and who reviews that diagnosis to see if it qualifies for a Monetary Award, whether the Appeals Advisory Panel of neurologists or the Claims Administrator, and how the review is to be done. That also depends on when the diagnosis is made. (See Section 6.4 and Exhibit 1 of the Settlement Agreement, available by clicking here.)

Click here for the Diagnosis and Review Table showing how this works. Find your diagnosis in Column 1 and then look in Columns 2 through 6 of that table for who makes the diagnosis, who reviews it and how.

99. What dates matter for when the Qualifying Diagnosis is made?

The Settlement Agreement divides diagnoses into these time periods. The Claims Administrator created a Diagnosis and Review Table to show how this works. Click here to see column 2 of the Table, which shows:

(a) Diagnoses made on or before July 1, 2011;

(b) Diagnoses made from July 2, 2011 through July 6, 2014;

(c) Diagnoses made from July 7, 2014, the date the Settlement Agreement was preliminarily approved by the Court, through January 7, 2017, which was the date the Settlement Agreement became effective after all appeals;

(d) Diagnoses made on Players while living but who died before January 7, 2017;

(e) Diagnoses made on Players after January 7, 2017; and

(f) Diagnoses of Death with CTE made on Players who died on or before April 22, 2015, which was the date the Court finally approved the Settlement Agreement but before all appeals were done.

100. How is the date of a Qualifying Diagnosis determined?

The physician making a Qualifying Diagnosis of a Retired NFL Football Player must determine and verify the date on which that Qualifying Diagnosis was made. This date is important under the Settlement Agreement. It affects the amount of a Monetary Award, because the younger a Player is at the time of the Qualifying Diagnosis, the larger the award.

The diagnosing physician uses his or her professional medical judgment in deciding when the Player had the conditions amounting to a Qualifying Diagnosis under Exhibit 1 to the Settlement Agreement. There are some basic rules about this:

(a) Death with CTE: For these claims, the date of the Qualifying Diagnosis is the date of the Player’s death, even though the diagnosis is not made until after the Player dies. The Monetary Award is based on the Player’s age when he died.

(b) General Rule for the other Qualifying Diagnoses: The date of a Qualifying Diagnosis other than Death with CTE is when the diagnosing physician has enough information and materials, including test results, to be able to render a medically sound and reliable judgment about the Player’s condition, the way a physician normally does in his or her clinical practice. In some cases, using sound medical judgment, a physician may conclude that a Qualifying Diagnosis existed at some prior point in time. 

(c) Are there other cases when the Qualifying Diagnosis might be before the date the physician personally examines the Player? Maybe. The unique facts and circumstances of a particular claim may allow the diagnosis date to be before the date the diagnosing physician personally examined the Player. Here are the rules:

(1) Diagnosing Physician is deceased or legally incompetent: Section 8.2(a)(iii) of the Settlement Agreement allows use of the date of an earlier Qualifying Diagnosis to calculate a Monetary Award where: (a) the Player received a Qualifying Diagnosis; (b) the diagnosing physician died or was deemed by a court to be legally incapacitated or incompetent before the January 7, 2017 Effective Date or before completing a Diagnosing Physician Certification Form; (c) a separate qualified physician made an independent examination and reviewed the Player’s medical records that formed the basis of the Qualifying Diagnosis; and (d) that physician found the same Qualifying Diagnosis. Here, the Settlement Agreement allows a later physician to adopt the date of diagnosis based upon the earlier medical records of another physician.

(2) 88 Plan diagnoses: If the diagnosis was made by an 88 Plan neutral physician who cannot or will not sign the Diagnosing Physician Certification Form, the date of the diagnosis made as part of the 88 Plan Independent Medical Examination (“IME”) may be used where: (a) the Player sees a Qualified MAF Physician for an independent examination or Qualified BAP Providers for a BAP exam; (b) the Player provides the Qualified MAF Physician or Qualified BAP Providers with all records of the prior 88 Plan IME diagnosis in his possession or to which he has access and all records of evaluation and treatment for that impairment between the dates of the 88 Plan IME and the Qualified MAF Physician appointment or BAP exam in his possession or to which he has access; (c) the Qualified MAF Physician performs an independent examination or the Qualified BAP Providers perform a BAP exam of the Player and review the additional records provided by the Player; and (d) if the Qualified MAF Physician or Qualified BAP Providers find the same Qualifying Diagnosis – both as of the date of the independent examination and the prior IME for the 88 Plan – then the date of Qualifying Diagnosis will be the date of the 88 Plan IME.

This exception applies only to diagnoses made through the 88 Plan. If you received a diagnosis through another NFL disability plan, such as the Neuro-Cognitive Disability Benefit Plan or the NFL Player Supplemental Disability Plan, contact the Claims Administrator to see if the date of diagnosis made through that plan can be used as the date of the Qualifying Diagnosis for purposes of a Monetary Award. The Claims Administrator will review your case with Class Counsel and Counsel for the NFL Parties.

(3) Medical Records unavailable: If the Player died before the January 7, 2017 Effective Date of the Settlement Agreement and the medical records reflecting the Qualifying Diagnosis are unavailable because of a force majeure type event or for some other reason the Claims Administrator deems acceptable, the date of the Qualifying Diagnosis will be the earlier of: (1) the date of the onset of the Qualifying Diagnosis reflected in other available contemporaneous medical records or the death certificate; or (2) the date of the Player’s death provided on the death certificate.

(4) Other instances where the earlier diagnosing doctor or medical records are not available: If you face other situations not covered by the terms of Section 8.2(a)(iii) of the Settlement Agreement and not involving a Plan 88 IME, then contact the Claims Administrator and explain the problem you have. There may be other circumstances in which a diagnosis by a later physician might adopt the earlier date of a diagnosis by another doctor.

(5) Sound clinical medical judgment: Also, the physician making a diagnosis may conclude, in the exercise of his or her sound medical judgment, that he or she has enough information from personal examination, medical records from other healthcare providers, medical history, corroborating evidence from non-family members and other information that medical specialists rely on in their clinical practices, to form a sound medical judgment that the Player’s Qualifying Diagnosis conditions existed at a date earlier than the date of a personal examination of the Player by the physician making the diagnosis and signing the Diagnosing Physician Certification Form. The Settlement Class Member is best served by having the doctor who made an earlier diagnosis sign the Diagnosing Physician Certification Form. But there may be situations where the diagnosing physician can pinpoint an earlier date that is based on sound clinical judgment and best medical practices.

101. Which diagnostic criteria must a physician use when making my Qualifying Diagnosis? When and to what diagnoses does the “generally consistent” criteria apply?

The Diagnosis and Review Table shows how this works; click here to review the Table.

For diagnoses of Level 1.5 and Level 2 Neurocognitive Impairment made in the BAP, Qualified BAP Providers follow the diagnostic criteria set forth in Exhibits 1 and 2.

Diagnoses of Level 1.5 and 2 Neurocognitive Impairment made outside the BAP must show that the evaluation and evidence behind those diagnoses is “generally consistent” with the diagnostic criteria set for Qualified BAP Providers and outlined in Exhibits 1 and 2. Click here for an FAQ with more information about Level 1.5 and Level 2 diagnoses made by Qualified MAF Physicians.

Diagnoses of Alzheimer’s Disease, Parkinson’s Disease, ALS and Death with CTE are not made in the BAP and are all made following the diagnostic criteria set out in Exhibit 1 (and the “generally consistent” standard does not apply).

102. What does “generally consistent” mean?

Something is “generally consistent with” something else if the two things have more elements or characteristics in common with each other than they have elements or characteristics that differ from each other. The common elements or characteristics must predominate over the uncommon ones.

The Settlement Agreement states specifically that diagnostic criteria for a diagnosis made outside the BAP do not have to be identical to the diagnostic criteria for a diagnosis made in the BAP. The diagnostic criteria, or the medical rules the doctor must follow to make the diagnosis, outside the BAP do not have to be 100% the same as the Exhibit 1 criteria. The burden is not to replicate the Settlement criteria for a Qualifying Diagnosis, but rather to offer evaluation and evidence "generally consistent" with them (click here to read one of the Special Master's full decisions on this topic).

With this said, the closer a set of diagnostic criteria match those specified in Exhibit 1, the more “consistent” it will be with Exhibit 1.

A claim based on a Qualifying Diagnosis is most solid when its elements match closely those required in Exhibit 1. For example, where Exhibit 1 requires documentary evidence or a third-party sworn affidavit corroborating functional impairment, or neuropsychological testing, the claim of a Qualifying Diagnosis is most solid when its Claim Package contains documentary evidence or a third-party sworn affidavit corroborating functional impairment and proof of neuropsychological testing that serve the majority of purposes of those specified in Exhibit 1 for the diagnosis and that do not conflict in any manner with those criteria and requirements.

103. What makes a Claim Package complete?

Your Claim Package is complete if it includes these items:

(a) A filled out Claim Form signed by you;

(b) A filled out Claim Package HIPAA Form signed by you;

(c) A Diagnosing Physician Certification Form filled out and signed by the physician who made the Qualifying Diagnosis;

(d) Medical records reflecting your Qualifying Diagnosis (additional medical records may be requested and/or required by the Claims Administrator or an AAP doctor during the Claim Package review); and

(e) In the event you want to prove more Eligible Seasons than what the Claims Administrator has already found for you when you registered for the Settlement Program, submit records showing employment or participation in NFL Football.

104. What can I submit to prove that I have more Eligible Seasons than what the Claims Administrator found for me when I registered?

To prove more Eligible Seasons, submit records to the Claims Administrator showing you earned them. These records may include any game box scores, media reports, game day programs, or other documents that show your participation in NFL Football games. Click here to see the definitions of Eligible Season and half an Eligible Season and a helpful guide to calculating Eligible Seasons.

If you want to prove more Eligible Seasons but cannot find any documents or other evidence, contact the Claims Administrator. Do not contact the NFL or a Member Club directly to ask for records. The Claims Administrator will research the situation further and ask the NFL Parties for any records the NFL or a Member Club may have and then get back to you. The Claims Administrator created the “Sworn Statement by Retired NFL Football Player: Reasons for No Objective Evidence of Eligible Season(s) (SWS-4)” for you to explain why no proof is available. Click here to download the form. The Claims Administrator has the discretion to credit you with one or fewer Eligible Seasons based on the explanation you provide.

105. What counts as a medical record?

The Claims Administrator considers these documents or items to be medical records, if they are contemporaneous with the event they describe:

(1) Results from medical procedures, tests, or studies;

(2) Reports made after reviewing results from medical procedures, tests, or studies;

(3) Consultation or examination reports from a healthcare provider;

(4) Visit or examination summaries or notes prepared or dictated by a healthcare provider;

(5) Prescriptions written by a healthcare provider;

(6) An email, letter, declaration, affidavit, or sworn statement by a healthcare provider made in the normal course of business, which summarizes his or her conclusion about a medical condition; or

(7) Any other record that a healthcare provider made in the normal course of his or her practice, which relates to a diagnosis or its course and care of treatment.

106. What does it mean for medical records to “reflect” my Qualifying Diagnosis?

A Claim Package contains medical records “reflecting the Qualifying Diagnosis” rendered by the diagnosing physician in the Diagnosing Physician Certification Form if it contains:

(1) Medical records generated by the diagnosing physician or his or her practice establishing that the diagnosing physician personally met with, interviewed and examined the Retired NFL Football Player (phone calls, emails, or other communications between the diagnosing physician and the Player are not sufficient);

(2) Medical records, other than those included in (1), if the diagnosing physician’s medical records indicate that they were relied upon or considered by the diagnosing physician in reaching the Qualifying Diagnosis stated in the Diagnosing Physician Certification Form; and

(3) Medical Records that refer specifically to the Qualifying Diagnosis or contain other evidence of that diagnosis.

107. What does it mean for medical records to “support” my Qualifying Diagnosis?

Medical records supporting the Qualifying Diagnosis means those records documenting the diagnosis. In other words, these are medical records that suggest that the Retired NFL Football Player has the claimed Qualifying Diagnosis or medical records showing or reporting symptoms, behavior, or conditions consistent with the claimed Qualifying Diagnosis.

When considering whether a Claim Package is complete, the Claims Administrator does not evaluate the merits of the medical records. However, if the Claim Package is missing an item which the Claims Administrator can tell the diagnosing physician relied upon (for example, MRIs, PET scans, or other test results) or a record documenting his or her diagnosis, the Claims Administrator will insert a customized comment in the Notice of Preliminary Review to inform the Settlement Class Member exactly what should be submitted. These additional records, if available, must be submitted.

108. What must the medical records show for Level 1.5 and Level 2 Neurocognitive Impairment diagnoses made in the BAP by Qualified BAP Providers?

The medical records must show:

(1) Concern of the Retired NFL Football Player, the physician, or someone who knows the Player and has knowledge of his condition, that there has been a severe decline in cognitive function;

(2) Evidence of a cognitive decline from a previous level of performance, according to the neuropsychological testing described in Exhibit 2 to the Settlement Agreement, in two or more of these cognitive domains:

(a) Complex attention;

(b) Executive function;

(c) Learning and memory;

(d) Language; or

(e) Perceptual-spatial.

At least one cognitive domain must be complex attention, executive function, or learning and memory.

For Level 1.5 diagnoses, this decline must be “moderate to severe.” For Level 2 diagnoses, it must be “severe.”

The neuropsychological test results must include raw scores as well as the T scores. Click here for more information about the different types of scores included in neuropsychological testing reports.

(3) Documents showing that the Retired NFL Football Player exhibits functional impairment generally consistent with a Category 1.0 (“Mild”) impairment (for Level 1.5 diagnoses) or Category 2.0 (“Moderate”) impairment (for Level 2 diagnoses), according to the National Alzheimer’s Coordinating Center’s Clinical Dementia Rating (“CDR”) Scale, in the areas of:

(a) Community Affairs;

(b) Home & Hobbies; and

(c) Personal Care.

There must be documentary evidence to corroborate the Player’s functional impairment (for example, medical records showing the Player’s declining ability to function, employment records citing the Player’s condition, or other materials referencing his cognitive function). Such corroborating evidence must be dated on or before the Qualifying Diagnosis date. The diagnosing physician determines whether there is sufficient documentary evidence of functional impairment.

If there are no documents available to corroborate the Player’s functional impairment, the medical records must:

(a) Show evidence of “moderate to severe” (for Level 1.5 diagnoses) or “severe” (for Level 2 diagnoses) cognitive decline from a previous level of performance, according to the neuropsychological testing described in Exhibit 2 to the Settlement Agreement, in executive function or learning and memory, plus at least one other cognitive domain; and

(b) Include a sworn statement (like the SWS-3 form, available here) from someone who is familiar with the Player’s condition, but not the Player or one of his family members. The diagnosing physician will decide if this statement corroborates the Player’s functional impairment. The sworn statement must be dated on or before the date of the Qualifying Diagnosis.

(4) The cognitive deficits do not occur exclusively in the context of a delirium, acute substance abuse, or as a result of medication side effects.

109. What must the medical records show for Level 1.5 and Level 2 Neurocognitive Impairment diagnoses made outside the BAP for living Retired NFL Football Players?

The medical records must show:

(1) A diagnosis of “early dementia”/Level 1.5 Neurocognitive Impairment or “moderate dementia”/Level 2 Neurocognitive Impairment;

(2) The diagnosis was based on evaluation and evidence generally consistent with the diagnostic criteria used for diagnoses made in the BAP; and

(3) A Qualified MAF Physician or a board-certified or otherwise qualified neurologist, neurosurgeon, or other neuro-specialist physician, as set forth in Sections 6.3(b)-(d) of the Settlement Agreement, made the diagnosis.

(1) The Qualified MAF Physician must refer a Retired NFL Football Player for neuropsychological testing by a neuropsychologist who is either a Qualified BAP Provider or otherwise approved by the Claims Administrator before the neuropsychological examination. In addition, the practice of the neuropsychologist must be located within 50 miles of the office of the Qualified MAF Physician (unless the Claims Administrator has granted an exception to that requirement) and the examination must occur in an office or medical facility of that practice.

If a Player had neuropsychological testing done in the past, the Qualified MAF Physician may use that testing to measure impairment if it was done within a year before the Player's MAF exam in the BAP by a Qualified BAP Provider. Because evidence of moderate to severe (for Level 1.5 diagnoses) or severe (for Level 2 diagnoses) cognitive decline as determined by and in accordance with the standardized neuropsychological testing protocol in Exhibit 2 to the Settlement Agreement is a key component of these Qualifying Diagnoses, the neuropsychological testing must be contemporaneous. If a Player's past neuropsychological testing was done more than a year before his MAF exam, or was done by anyone other than a Qualified BAP Provider in the BAP, the Qualified MAF Physician may use it as a baseline assessment to compare against contemporaneous neuropsychological testing but cannot use it to measure impairment unless the Claims Administrator approves the Qualified MAF Physician to use it in that manner.

The Claims Administrator also may use its discretion to decide whether to accept neuropsychological testing from other sources based on the unique facts and circumstances of a particular claim, with such input from Class Counsel and the NFL Parties as the Claims Administrator deems appropriate.

(2) The Qualified MAF Physician must submit to the Claims Administrator any questionnaires or worksheets completed by the Qualified MAF Physician and/or the neuropsychologist when deciding the level of functional impairment according to the National Alzheimer’s Coordinating Center’s CDR Scale.

110. Are Qualified MAF Physicians required to follow the strict BAP criteria when making a diagnosis of Level 1.5 or Level 2 Neurocognitive Impairment?

No. However, the Qualified MAF Physician and/or neuropsychologist must explain to the Claims Administrator whenever:

(1)  The full BAP test battery is used but the resulting test scores do not support a Level 1.5 or Level 2 Qualifying Diagnosis under the BAP criteria;

(2)  The full BAP test battery was not used;

(3)  Additional testing not in the BAP test battery was used;

(4)  The Player failed two or more performance validity measures; and/or

(5)  The Claims Administrator determines a Claim Package presents other issues about the Qualifying Diagnosis or work of the Qualified MAF Physician or supporting neuropsychologist. 

The Claims Administrator has discretion to accept the Qualified MAF Physician’s explanation and find a claim eligible, but also may: 

(1)  Ask a member of the AAP and/or AAPC to review the diagnosis.

(2)  Send you a notice requesting additional information and/or documents.

(3)  Deny the claim as ineligible.

(4)  Investigate further through Audit.

(5)  Direct re-examination by a different Qualified MAF Physician and/or neuropsychologist, or such other actions determined appropriate.

111. How are diagnosing physicians to apply the Clinical Dementia Rating (CDR) scale to Level 1.5 and Level 2 Neurocognitive Impairment Qualifying Diagnoses?

112. What must be included in a sworn statement corroborating a Retired NFL Football Player’s functional impairment for a Level 1.5 or Level 2 claim?

The sworn statement must include the name of the person who is familiar with the Retired NFL Football Player’s condition and describe his or her relationship to the Player. The statement must also include the date it was prepared. The person who signs this cannot be a member of the Player's family. Click here for an FAQ describing who is considered to be a "family member." Click here for the SWS-3 (“Third-Party Sworn Statement: Functional Impairment”), the form that the Claims Administrator created for Settlement Class Members with diagnoses of Level 1.5 and Level 2 Neurocognitive Impairment made after January 7, 2017, to meet the sworn statement requirement for corroborating the Player’s functional impairment when there are no other documents available to corroborate such functional impairment. While use of the SWS-3 form is not mandatory and homemade versions are allowed, the Claims Administrator will require that such homemade versions be substantially similar to the SWS-3 and include appropriate penalty of perjury language and statements on truthfulness. Any person, including anyone working in a law office or in a claims preparation office, who helps a Third Party complete Section III of the SWS-3 must attest that Section III accurately reflects the statements of the Third Party and sign the SWS-3 under penalty of perjury

113. How is the SWS-3 (Third-Party Sworn Statement: Functional Impairment) different from the Employment History and Social and Community Activity of Retired NFL Football Player Forms?

(a) What is the purpose? 

SWS-3: Submitted to corroborate a Retired NFL Football Player’s functional impairment where there is no documentary evidence of functional impairment in the areas of Community Affairs, Home & Hobbies and Personal Care. This is a requirement in Exhibit 1 of the Settlement Agreement for Level 1.5 and 2 Qualifying Diagnoses.  

Employment and Activities Forms: Submitted by the Retired NFL Football Player or a friend or family member to give the evaluating Qualified MAF Physician (and any neuropsychologist to whom a Player is referred) details on the Player’s employment, business, income sources, social, community, recreational or other activities outside the home.  

 (b) What is the authority behind it? 

SWS-3: Exhibit 1 to the Settlement Agreement.  

Employment and Activities Forms: Rules Governing Qualified MAF Physicians (Rules 15 and 16).  

(c) To what does it apply? 

SWS-3: BAP and MAF diagnoses of Level 1.5 and Level 2 Neurocognitive Impairment.  

Employment and Activities Forms: All MAF examinations done after April 11, 2019.  

(d) Who may fill it out? 

SWS-3: Someone who personally knows the Player, is familiar with his condition and can describe his functional impairment, but who is not a “family member.” That means the Player’s (1) spouse and his or her parents; (2) sons and daughters and their spouses; (3) parents and their spouses; (4) brothers and sisters and their spouses; (5) grandparents, grandchildren and their spouses; and (6) domestic partner and his or her parents, and the domestic partners of any of these family members cannot complete this form.  

Employment and Activities Forms: The Player and anyone on whom he is relying to provide information to the Qualified MAF Physician about his conditions, including a family member. 

Reminder: There are two versions of the Employment History and Social and Community Activity of Retired NFL Football Player Form posted on the Settlement Website, one for use by the Player and another for use by a knowledgeable informant. Click here for an FAQ about these two forms.  

(e) What is the relevant time period? 

SWS-3: Should cover the period from when the person first started noticing a decline from a previous level of performance.  

Employment and Activities Forms:  

1.      Information on employment, business and income sources must cover the five years leading up to the exam; and 

2.  Information on other things done outside the home should cover how they changed in the last five years.  

(f) Is it signed under penalty of perjury? 

SWS-3: Yes. Those who sign an SWS-3 declare, under penalty of perjury, that all information provided is true and correct.  

Employment and Activities Forms: No. However, honest answers are required, and those who sign the forms must attest to the truthfulness of statements made therein. To safeguard the integrity of the Settlement Program, the Claims Administrator carefully assesses all claims before payment of an award. This assessment may include interviews with employers, review of tax filings and publicly available information, and assessment of the Player’s engagement in daily living.

114. Are raw scores and/or raw data required for all Monetary Award claims?

Raw scores and/or raw data from neuropsychological testing are not required on claims for Alzheimer’s Disease, Parkinson’s Disease, ALS, or Death with CTE, and they are not required on any Level 1.5 or Level 2 claim unless an AAP doctor or the Claims Administrator determines them necessary to review a particular claim.

However, it is very helpful in the review of a Level 1.5 or Level 2 claim to be able to see the complete neuropsychological testing records, including the raw scores. A claim of a Qualifying Diagnosis of Level 1.5 or Level 2 is best supported by test scores that match those diagnoses and so should be part of a Claim Package. If your Claim Package for a Level 1.5 or Level 2 claim does not include these raw scores, the Claims Administrator will send you a notice telling you they are missing. If you do not have them (for example, because your diagnosis was made before the Settlement Agreement was preliminarily approved on July 7, 2014) or choose not to send them, you can tell the Claims Administrator to proceed without them.

Reminder: A raw score is an unaltered measurement – it is how many questions the test taker answered correctly. For example, if you took a test in class and scored 85, the 85 is the raw score, that is, an unaltered measurement of how you did. Raw data is the psychological test materials, manuals, instruments, protocols and test questions or stimuli, client/patient responses to test questions or stimuli and psychologists’ notes and recordings concerning client/patient statements and behavior during an examination. If you took a test in a class, the raw data would be your actual test paper. Click here for a guide explaining the different types of neuropsychological testing scores.

115. What must the medical records show for Alzheimer’s Disease?

The medical records must show a diagnosis made, while living, of “Alzheimer’s,” “Alzheimer’s Disease,” “AD,” or “Major Neurocognitive Disorder due to probable Alzheimer’s Disease.” However, this is a non-exhaustive list, and the medical records also may show other terms that are not set out here.

The Settlement Agreement says this in Exhibit 1:

(a) For living Retired NFL Football Players, a diagnosis while living of the specific disease of Alzheimer’s Disease as defined by the World Health Organization’s International Classification of Diseases, 9th Edition (ICD-9), the World Health Organization’s International Classification of Diseases, 10th Edition (ICD-10), or a diagnosis of Major Neurocognitive Disorder due to probable Alzheimer’s Disease as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), made by a Qualified MAF Physician or a board-certified or otherwise qualified neurologist, neurosurgeon, or other neuro-specialist physician, as set forth and provided in Sections 6.3(b)-(d) of the Settlement Agreement.

(b) For Retired NFL Football Players deceased before January 7, 2017, a diagnosis of Major Neurocognitive Disorder due to probable Alzheimer’s Disease consistent with the definition in Diagnostic and Statistical Manual of Mental Disorders (DSM-5), or a diagnosis of Alzheimer’s Disease, made while the Retired NFL Football Player was living by a board-certified or otherwise qualified neurologist, neurosurgeon, or other neuro-specialist physician, or by a physician with sufficient qualifications in the field of neurology to make such a diagnosis, as set forth and provided in Sections 6.3(c)-(e) of the Settlement Agreement.

116. Is a biomarker test (such as an amyloid PET, spinal fluid test) enough to establish my Qualifying Diagnosis of Alzheimer's Disease?

No, a biomarker test, by itself, is not sufficient to establish a Qualifying Diagnosis of Alzheimer's Disease under the Settlement criteria. The Settlement Agreement states that the identification of a condition - for example, through a blood test, genetic test, imaging technique (e.g., quantitative MRI), or otherwise - that has not yet resulted in actual cognitive impairment and/or actual neuromuscular impairment experienced by the Retired NFL Football Player does not qualify as a Qualifying Diagnosis. There must be an actual manifestation of cognitive impairment and/or actual neuromuscular impairment. 

117. What must the medical records show for Parkinson’s Disease?

The medical records must show a diagnosis made, while living, of “Parkinson’s,” “Parkinson’s Disease,” or “Major Neurocognitive Disorder probably due to Parkinson’s Disease.” However, this is a non-exhaustive list, and the medical records also may show other terms that are not set out here.

The Settlement Agreement says this in Exhibit 1:

(a) For living Retired NFL Football Players, a diagnosis while living of the specific disease of Parkinson’s Disease as defined by the World Health Organization’s International Classification of Diseases, 9th Edition (ICD-9), the World Health Organization’s International Classification of Diseases, 10th Edition (ICD-10), or a diagnosis of Major Neurocognitive Disorder probably due to Parkinson’s Disease as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), made by a Qualified MAF Physician or a board-certified or otherwise qualified neurologist, neurosurgeon, or other neuro-specialist physician, as set forth and provided in Sections 6.3(b)-(d) of the Settlement Agreement.

(b) For Retired NFL Football Players deceased before January 7, 2017, a diagnosis of Parkinson’s Disease, made while the Retired NFL Football Player was living by a board-certified or otherwise qualified neurologist, neurosurgeon, or other neuro-specialist physician, or by a physician with sufficient qualifications in the field of neurology to make such a diagnosis, as set forth and provided in Sections 6.3(c)-(e) of the Settlement Agreement.

118. Are auxiliary tests, including biomarker tests, enough to establish my Qualifying Diagnosis of Parkinson’s Disease?

119. What must the medical records show for Death with CTE?

120. What must the medical records show for ALS?

The medical records must show a diagnosis made, while living, of “Amyotrophic Lateral Sclerosis,” “ALS” or “Lou Gehrig’s Disease.” However, this is a non-exhaustive list, and the medical records also may show other terms that are not set out here.

The Settlement Agreement says this in Exhibit 1:

(a) A diagnosis while living of the specific disease of Amyotrophic Lateral Sclerosis, also known as Lou Gehrig’s Disease (“ALS”), as defined by the World Health Organization’s International Classification of Diseases, 9th Edition (ICD-9) or the World Health Organization’s International Classification of Diseases, 10th Edition (ICD-10), made by a Qualified MAF Physician or a board-certified or otherwise qualified neurologist, neurosurgeon, or other neuro-specialist physician, as set forth and provided in Sections 6.3(b)-(d) of the Settlement Agreement.

(b) For Retired NFL Football Players deceased before January 7, 2017, a diagnosis of ALS, made while the Retired NFL Football Player was living by a board-certified or otherwise qualified neurologist, neurosurgeon, or other neuro-specialist physician, or by a physician with sufficient qualifications in the field of neurology to make such a diagnosis, as set forth and provided in Sections 6.3(c)-(e) of the Settlement Agreement.

121. What if I cannot get medical records or a Diagnosing Physician Certification Form from the diagnosing physician?

If you have questions about the unavailability of your medical records and/or your inability to get a Diagnosing Physician Certification Form from your diagnosing physician, including those records from 88 Plan physicians, contact the Claims Administrator to see if it has these records and the Diagnosing Physician Certification Form from the BAP Administrator, if you received a Qualifying Diagnosis through the BAP, or if the records or Diagnosing Physician Certification Form can be excused based on Section 8.2(a) of the Settlement Agreement.

122. If I cannot get medical records or a Diagnosing Physician Certification Form from the diagnosing physician, is there anything specific I should submit to show my attempts to get such documents?

You should keep records from all your communications and attempted communications with the physicians or medical providers from whom you tried to get medical records and/or a Diagnosing Physician Certification Form. If you speak with someone over the phone, ask that person to confirm in writing your conversation. You can submit these records and a written explanation of your efforts and the Claims Administrator will consider them when determining whether you qualify for an exception under Section 8.2(a) of the Settlement Agreement.

123. What exceptions are allowed under Section 8.2(a) of the Settlement Agreement for Representative Claimants of deceased Retired NFL Football Players?

All three subsections of Section 8.2(a) apply to Representative Claimants of deceased Retired NFL Football Players.

1. 8.2(a)(i): The Claims Administrator excuses a Diagnosing Physician Certification Form when all these requirements are met:

(a) The Player died before January 7, 2017;

(b) The physician who provided the Qualifying Diagnosis died or was deemed legally incapacitated or incompetent before January 7, 2017;

(c) The Representative Claimant provides evidence of the physician’s death, incapacity, or incompetence; and

(d) The Representative Claimant provides evidence of the physician’s qualifications to make the Qualifying Diagnosis.

(a) Medical Records:

(1) They are unavailable due to a flood, hurricane, or fire;

(2) The Representative Claimant makes a showing of a reasonable effort to obtain the medical records from any available source; and

(3) There is a certified death certificate referencing the Player’s Qualifying Diagnosis that was made while he was living.

(b) Diagnosing Physician Certification Form:

(1) The unavailability of medical records causes the diagnosing physician to be unable to provide a Diagnosing Physician Certification Form;

(2) The diagnosing physician provides a sworn affidavit stating why he or she is unable to complete a Diagnosing Physician Certification Form without medical records (for example, the SWS-2); and

(3) There is a certified death certificate referencing the Player’s Qualifying Diagnosis that was made while he was living.

(a) The physician who made the original (or earlier) diagnosis cannot sign a Diagnosing Physician Certification Form because he or she died or was deemed legally incapacitated or incompetent;

(b) The physician who completes the Diagnosing Physician Certification Form performs his or her own independent examination of the Player; and

(c) The physician who completes the Diagnosing Physician Certification Form reviews the medical records that formed the basis of the earlier physician’s diagnosis.

124. What is the SWS-2?

The SWS-2 is the “Diagnosing Physician Sworn Statement: Inability to Provide a Diagnosing Physician Certification for a Deceased Retired NFL Football Player Without Medical Records” (click here to download and print the SWS-2). It is used by Representative Claimants of deceased Retired NFL Football Players who cannot provide a Diagnosing Physician Certification Form because of missing medical records and seek an exception under Section 8.2(a)(ii) of the Settlement Agreement. Click here to read an FAQ for more information on that. The diagnosing physician must sign the SWS-2 and state the reason(s) why he or she cannot complete a Diagnosing Physician Certification Form without the missing medical records.

125. What exceptions are allowed under Section 8.2(a) of the Settlement Agreement for living Retired NFL Football Players or Representative Claimants of legally incapacitated or incompetent Players?

Only one exception in Section 8.2(a) applies to living Retired NFL Football Players or Representative Claimants of legally incapacitated or incompetent Players. Section 8.2(a)(iii) allows these people to submit a Diagnosing Physician Certification Form from a physician who did not make the Player’s original diagnosis but later diagnosed the Player. The Claims Administrator applies this exception if:

1. The physician who made the original (or earlier) diagnosis cannot sign a Diagnosing Physician Certification Form because he or she died or was deemed legally incapacitated or incompetent;

2. The physician who completes the Diagnosing Physician Certification Form performs his or her own independent examination of the Player; and

3. The physician who completes the Diagnosing Physician Certification Form reviews the medical records that formed the basis of the earlier physician’s diagnosis.

126. Are there other instances not listed in Section 8.2 of the Settlement Agreement where the medical records or Diagnosing Physician Certification Form requirement may be excused?

The Claims Administrator has discretion to review and submit to the parties to the Settlement Agreement for their approval Settlement Class Members’ requests to excuse the Diagnosing Physician Certification Form and/or medical records reflecting Qualifying Diagnosis requirements where not explicitly allowed by the Settlement Agreement. When deciding whether to submit such an exception request to the parties, the Claims Administrator will follow these general rules:

For living Retired NFL Football Players and Representative Claimants of deceased Players, the Claims Administrator will exercise its discretion to ask the parties to approve a request to excuse medical records, excuse a Diagnosing Physician Certification Form, or accept a Diagnosing Physician Certification Form from a different diagnosing physician after considering these factors:

1. The overall reliability of the Settlement Class Member’s explanation;

2. Whether the Claims Administrator can confirm the reason(s) why medical records are missing or a physician is unavailable; and

3. The availability of other documents or information to verify that the claimed Qualifying Diagnosis occurred.

1. There is no Qualifying Diagnosis asserted on the Claim Form and no Qualifying Diagnosis can be identified based on all available information; or

2. The only evidence of a Qualifying Diagnosis is the Settlement Class Member’s own assertion.

127. What happens after the Claims Administrator grants an exception under Section 8.2(a) or the parties to the Settlement Agreement grant an exception for a situation not covered by Section 8.2(a)?

The Claims Administrator or AAP will review your Qualifying Diagnosis based on the available documents to determine if you are eligible for a Monetary Award. Click here to read an FAQ describing how the date of diagnosis is determined.

128. Who reviews my claim for a Monetary Award?

The Claims Administrator first reviews all Claim Packages to make sure they have the necessary information and documents.

If the Claim Package is complete or once it is made complete after notices from the Claims Administrator on what is missing, either the Claims Administrator or a doctor from the Appeals Advisory Panel (click here for an FAQ about the AAP) reviews it to determine if there is a Qualifying Diagnosis made by a physician with the proper credentials and whether it is eligible for a Monetary Award.

The Claims Administrator reviews Qualifying Diagnoses that were made:

(a) After January 7, 2017, by Qualified BAP Providers or Qualified MAF Physicians; and

(b) On or before July 1, 2011, by a board-certified neurologist, board-certified neurosurgeon, or other board-certified neuro-specialist physician.

An AAP doctor reviews all other Qualifying Diagnoses made on or before January 7, 2017. In addition, an AAP doctor reviews all claims that rely on neuropsychological testing that was rescored under the Norming Agreement. 

Click here for the Diagnosis and Review Table, which summarizes who reviews each Qualifying Diagnosis and what review standard applies. Find the kind of Qualifying Diagnosis in column 1 of the Diagnosis and Review Table. Then look at column 2 for when it was made and column 5 for who reviews it.

129. How is my diagnosis reviewed? When and to what does the “generally consistent” standard apply?

The Diagnosis and Review Table shows how this works; click here to review the Table.

A Qualifying Diagnosis that must be made following the criteria in Exhibit 1 is reviewed by the Claims Administrator to see if it followed the criteria outlined in Exhibit 1.

When a Qualifying Diagnosis has been made based on evaluation and evidence “generally consistent” with the criteria set in Exhibit 1, the Claims Administrator or the doctors on the Appeals Advisory Panel, as appropriate, review these diagnoses to ensure that they have been made on principles generally consistent with the Exhibit 1 criteria. Click here for an FAQ about the Claims Administrator's actions on Level 1.5 and Level 2 diagnoses made by Qualified MAF Physicians.

130. What is the AAP and what does it do?

The Appeals Advisory Panel (“AAP”) consists of board-certified neurologists whom the Court approved to make recommendations to the Court and the Special Masters, upon their request, about the medical aspects of the Settlement and to review claims for certain Qualifying Diagnoses. The AAP also may be asked by the BAP Administrator to determine a Retired NFL Football Player’s level of neurocognitive impairment when there is a lack of agreement between two Qualified BAP Providers. The AAP, upon request, also provides the Claims Administrator advice and assistance about medical issues that arise during the claim review process. 

A member of the AAP (known in these FAQs as an “AAP doctor”) reviews Qualifying Diagnoses (click here for an FAQ about what Qualifying Diagnoses the AAP reviews) based on principles generally consistent with the diagnostic criteria set forth in Exhibit 1 to the Settlement Agreement, including consideration of, without limitation, the qualifications of the diagnosing physician, the supporting medical records and the year and state of medicine in which the Qualifying Diagnosis was made. The AAP doctor also will confirm that the Qualifying Diagnosis was made by an appropriate physician, as set forth in Section 6.3 of the Settlement Agreement. Click here for the Diagnosis and Review Table, which summarizes what Qualifying Diagnoses the AAP reviews and what review standard applies.

131. What is the AAP Leadership Council?

Two AAP Members serve as the Claims Administrator’s AAP Leadership Council to provide the Claims Administrator advice and assistance on any medical issues arising in the oversight of the work of Qualified MAF Physicians. This includes review of specific claims or groups of claims at the Claims Administrator’s request to determine compliance by Qualified MAF Physicians with the Settlement Agreement, the Qualified MAF Physician Manual and any guidance materials or instructions the Claims Administrator has issued to Qualified MAF Physicians, and whether the Claim Package reflects and supports the Qualifying Diagnosis stated in the Diagnosing Physician Certification form on a claim. The AAP Leadership Council is selected by and works at the Claims Administrator’s direction, as overseen by the Special Masters.

132. What is the AAPC and what does it do?

The Appeals Advisory Panel Consultants (“AAPC”) are board-certified neuropsychologists approved by the Court to give advice about neuropsychological testing and cognitive impairment to the Court, Special Masters, Claims Administrator, and/or AAP doctors.

The AAP may ask the AAPC about Level 1.5 and Level 2 Neurocognitive Impairment Qualifying Diagnoses or the neuropsychological testing that supports an Alzheimer’s Disease diagnosis. An AAP doctor does not have to follow the AAPC’s advice.

133. I received a Qualifying Diagnosis through the BAP. Do I have to do anything else to receive a Monetary Award?

Yes. You must submit a Claim Form to the Claims Administrator to be considered for a Monetary Award. The BAP Administrator will provide the Claims Administrator with the records from your BAP exams, including the BAP Diagnosing Physician Certification Form, but you must submit the other parts of your Claim Package to the Claims Administrator before it can make a Monetary Award determination for your claim (click here to read an FAQ about what is in a Claim Package). 

134. I received a Qualifying Diagnosis from a Qualified MAF Physician. Do I have to do anything else to receive a Monetary Award?

Yes. You must submit a Claim Package to the Claims Administrator to be considered for a Monetary Award (click here to read an FAQ about what is in a Claim Package). The Claims Administrator may have received the MAF Diagnosing Physician Certification and/or medical records reflecting your Qualifying Diagnosis directly from the Qualified MAF Physician, so check your Claim Package documents on your Portal or contact the Claims Administrator to see if some of these items are already in your file. You are responsible for submitting the other parts of your Claim Package. The Claims Administrator will review your claim to make sure it is complete and will tell you if you need to provide anything that is missing.

135. If I received a Qualifying Diagnosis from a Qualified MAF Physician, what types of records will the physician send to the Claims Administrator?

The Qualified MAF Physician must send the Claims Administrator the MAF Diagnosing Physician Certification Form and medical records on the Player. Those records must include:

(a) The report summarizing the Qualified MAF Physician’s evaluation of the Player;

(b) Any CDR questionnaire/worksheet completed by the Qualified MAF Physician or the neuropsychologist for evaluating the Player’s functional impairment;

(c) Any documentary evidence or third-party sworn affidavit corroborating the Player’s functional impairment that the Qualified MAF Physician reviewed in making the diagnosis;

(d) Any neuropsychological testing evaluation the Qualified MAF Physician reviewed or relied on to make the diagnosis. For diagnoses of Level 1.5 or 2 Neurocognitive Impairment, the neuropsychological testing evaluation should identify the tests that were administered and include both the raw and scaled scores from those tests;

(e) Any historical medical records from other providers that the Qualified MAF Physician reviewed or relied on to make the diagnosis;

(f) Any other imaging or test results the Qualified MAF Physician reviewed or relied on to make the diagnosis; and

(g) For Level 1.5 and Level 2 diagnoses, an explanation when there is a deviation from the strict BAP criteria and/or the Player fails two or more validity measures (click here for more on this).

136. What happens after I submit my Claim Package?

The Claims Administrator will review your Claim Package to determine whether you have sent in everything required to make your claim complete. If you have, your claim will be reviewed on its merits either by the Claims Administrator or by an AAP doctor. If you have not sent in everything to make your claim complete, you will receive a Notice of Preliminary Review or a Notice of Request for Additional Documents describing what has been excluded and what you need to do next.

137. Can I receive a Monetary Award for more than one Qualifying Diagnosis on the same claim?

No. If your Diagnosing Physician Certification Form states more than one Qualifying Diagnosis, the Claims Administrator or AAP doctor will determine if you are eligible for a Monetary Award based on the Qualifying Diagnosis that will pay the higher Award, according to the Monetary Award Grid found here, unless you direct the Claims Administrator to review a different Qualifying Diagnosis. The Claims Administrator will confirm with you which Diagnosis to process and will supplement your Claim Package with any correspondence confirming this decision.

138. I received a Notice of Preliminary Review. What does that mean?

If you submitted a claim for Level 1.5 Neurocognitive Impairment or Level 2 Neurocognitive Impairment diagnosed outside of the BAP and your Claim Package has excluded something, you will receive a Notice of Preliminary Review telling you what you might consider sending to the Claims Administrator. This notice does not mean your claim is being denied. Instead, it gives you the chance to submit your best claim. Only certain fundamental items must be submitted before your claim can be evaluated, such as a signed HIPAA Form, a signed Claim Form and a Diagnosing Physician Certification Form signed by the doctor who made the Qualifying Diagnosis. For certain other items, you may choose not to submit the requested documents and instead tell the Claims Administrator to review the Claim Package as submitted. But as stated above, it is to your benefit to provide the information requested. If you are not clear on what is being requested, contact the Claims Administrator for help.

139. I received a Notice of Request for Additional Documents. What does that mean?

If you submitted a claim for Level 1.5 Neurocognitive Impairment or Level 2 Neurocognitive Impairment diagnosed through the BAP or for Alzheimer’s Disease, Parkinson’s Disease, ALS, or Death with CTE and your Claim Package has excluded something, you will receive a Notice of Request for Additional Documents telling you what you might consider sending to the Claims Administrator. This notice does not mean your claim is being denied. Instead, it gives you the chance to submit your best claim.

You also may receive a Notice of Request for Additional Documents if an AAP doctor is reviewing your claim and has requested additional information. In this situation, the “What is Missing” column in Section II of the notice will say that the doctor on the Appeals Advisory Panel reviewing your claim has requested additional information and the “How to Address this Item” column will tell you what the AAP doctor has requested. This notice does not mean your claim is being denied, either. If you are unable to provide the requested information, you should tell the Claims Administrator why. The Claims Administrator will share your reason with the AAP doctor, who will decide whether he or she can finish reviewing your claim without the requested information.

140. What happens after I respond to my notice asking for more information for my claim?

The Claims Administrator will review your Claim Package again and either: (1) determine that the requested information has been provided and review it on the merits or send it to an AAP doctor for merits review; or (2) determine that the requested information has not been provided and send another notice asking for more information, if necessary. If the AAP doctor believes additional information is necessary, you will receive a new Notice of Preliminary Review or Notice of Request for Additional Documents telling you what is needed and giving you another chance to respond before the Claims Administrator takes further action on your claim. Ultimately, not providing the requested information may result in denial of the claim.

141. What happens if I never respond to the Notice of Preliminary Review or the Notice of Request for Additional Documents?

If the notice listed one of the fundamental items needed for every claim, such as a signed HIPAA Form, a signed Claim Form, or a Diagnosing Physician Certification Form signed by the physician who made the Qualifying Diagnosis, the Claims Administrator will have to deny your claim and will send you a notice explaining why. You will have the opportunity to appeal that denial if you wish. If the Claim Package contains all the fundamental items, the Claims Administrator or the AAP doctor will determine whether the claim qualifies for a Monetary Award and then the Claims Administrator will send you a notice explaining the result. You can appeal that determination if you wish.

142. May I get more time to respond to a notice from the Settlement Program?

If you are unable to respond to a notice that you received from the Settlement Program by the deadline listed on the notice, you may submit to the Claims Administrator a request for more time, along with an explanation of why you are unable to meet the deadline and any documents you want the Claims Administrator to consider on your request. The Claims Administrator will decide whether to grant your request and will notify you of that decision.

If you have already missed a deadline, you should immediately take the action that you failed to do by the deadline and submit to the Claims Administrator your request for excuse from the deadline, no later than 60 days after the deadline passed. Explain why you missed the deadline and submit any documents you want the Claims Administrator to consider on your request. The Claims Administrator will decide whether to grant your request and will notify you of that decision. The Claims Administrator will not consider any requests to re-open a deadline more than 60 days after the deadline has passed.

143. Does the Claims Administrator question the medical judgment of the physician who made the Qualifying Diagnosis?

The Claims Administrator has to make sure that all necessary documents and information are included in your Claim Package, that the Settlement Agreement, the Rules Governing Qualified MAF Physicians and all FAQs were followed and that the diagnosis complies with all those standards. The Claims Administrator will notify you if there is conflicting information in the medical records so you can provide additional information to try to clarify the discrepancy. The Claims Administrator may deny a claim where the rules and criteria were not followed and the issue was not or cannot be cured, which may require analysis of the reliability of the diagnosis stated. The Claims Administrator also has to review the integrity of the medical information and diagnosis made on any claim subject to audit under Section 10.3 of the Settlement Agreement.

144. I have provided my claim to the Claims Administrator and it is now complete enough to send to the AAP. What happens next?

If your claim is required to be reviewed by an AAP doctor, or is selected for AAP review by the Claims Administrator, the Claims Administrator will assign your claim to an AAP doctor, who will review it within 45 days after it has been assigned. There is no deadline for the Claims Administrator to assign the claim to an AAP doctor, but the Claims Administrator is doing that as quickly as possible. The AAP doctor will either:

(a) Find your Claim Package eligible for a Monetary Award;

(b) Deny your claim because the records do not support the Qualifying Diagnosis or the diagnosing physician did not have the necessary credentials; or

(c) Request more information or documents. The Claims Administrator will send you a notice asking for that information.

145. How can I check the status of my Claim Package review?

If you created an account on the Claims Administrator’s Settlement Website (www.nflconcussionsettlement.com), you can log in and check your claim status there. Or you may call the Claims Administrator at 1-855-887-3485 or email (ClaimsAdministrator@NFLConcussionSettlement.com) for an update.

146. How long could it take to review my Claim Package from start to finish?

This is different for each claim. If you provided all the required information and the Qualifying Diagnosis does not need AAP review, you could have a Claim Package decision in under 45 days. However, if your claim needs AAP review, the AAP doctor has another 45 days to complete his or her review. If any information is missing from your Claim Package, the review process will take longer. These are some other things that could affect the timing of your Claim Package determination:

(a) Your claim requires audit review under Section 10.3 of the Settlement Agreement;

(b) The status of your registration is not yet final (for example, because you challenged your Notice of Registration Determination);

(c) Confirmation of any applicable Lien holdback and deduction amounts (see more about Liens in FAQs here);

(d) Whether you have asked the Claims Administrator to stop processing your claim while you gather additional materials; and/or

(e) Some other issue arises that requires a more detailed analysis of your claim (for example, you seek an exception under Section 8.2(a) of the Settlement Agreement).

147. If I am eligible for a Monetary Award, how much money will I receive?

The amount of your Monetary Award will depend on the Retired NFL Football Player’s:

(1) Qualifying Diagnosis and his age at the time of that diagnosis (click here to see the Monetary Award Grid);

(2) The number of Eligible Seasons (click here to see the “How to Calculate Eligible Seasons” guide published by the Claims Administrator);

(3) Whether he had a Stroke or Traumatic Brain Injury that is related to the Qualifying Diagnosis; and

(4) Participation in a BAP exam for Qualifying Diagnoses made after January 7, 2017.

(1) Any valid Liens on the Award;

(2) Any Lien Resolution Administrator’s costs and expenses, where appropriate, as required under Sections 11.3(d) and (e) of the Settlement Agreement;

(3) Any payment arrangements you made with your lawyer;

(4) The 5% amount held back for Common Benefit Fees (click here for an FAQ on these fees);

(5) Whether a 1% offset is applied because at least one Derivative Claimant has registered; and

(6) Any further assessments ordered by the Court.

148. What is a Stroke or Traumatic Brain Injury in this Settlement Program?

“Stroke” means stroke, as defined by the World Health Organization’s International Classification of Diseases, 9th Edition (ICD-9) or the World Health Organization’s International Classification of Diseases, 10th Edition (ICD-10), which occurs before or after the time the Retired NFL Football Player played NFL Football and is unrelated to NFL Football play. A medically-diagnosed Stroke does not include a transient cerebral ischemic attack and related syndromes, as defined by ICD-10.

“Traumatic Brain Injury” means severe traumatic brain injury unrelated to NFL Football play, that occurs during or after the time the Player played NFL Football, where the Player lost consciousness for more than 24 hours and did not return to pre-existing conscious level, consistent with the definitions in the World Health Organization’s International Classification of Diseases, 9th Edition (ICD-9), Codes 854.04, 854.05, 854.14 and 854.15, and the World Health Organization’s International Classification of Diseases, 10th Edition (ICD-10), Codes S06.9x5 and S06.9x6.

149. Can I be found eligible for a Monetary Award based on a Qualifying Diagnosis that is different than the one I claimed?

Yes. If an AAP doctor reviews the Qualifying Diagnosis selected on your Claim Form and Diagnosing Physician Certification Form and finds it is not supported by the records, but believes the records show a Qualifying Diagnosis that is less severe medically or lower in value according to the Monetary Award Grid found here, he or she can approve the lesser condition. This rule allows a Settlement Class Member to receive a Monetary Award instead of a denial.

The Claims Administrator will not issue a Monetary Award for a Qualifying Diagnosis that is more severe or higher in value than the Qualifying Diagnosis selected on your Diagnosing Physician Certification Form. If the records support your claimed Qualifying Diagnosis, the Claims Administrator will find you are entitled to a Monetary Award for that Qualifying Diagnosis.

150. What can I do if I do not like my Claim Package determination (eligible or denied)?

You may appeal to the Special Master, who will decide an issue on appeal based upon a showing of clear and convincing evidence. Under that standard, whoever appeals must convince the Special Master that there is a high probability that the determination of the Claims Administrator being appealed was wrong. There is a $1,000 fee for a Player to appeal, which will be refunded if you win your appeal. If you are unable to pay the $1,000 appeal fee, you may ask for a waiver by submitting a request, along with documents showing financial hardship, to the Claims Administrator. Some examples of a financial hardship are eviction or foreclosure, receipt of government assistance and bankruptcy. The Claims Administrator will review your request and documents and notify you of its decision within 10 days. The Rules Governing Appeals of Claim Determinations provide detailed information about how appeals work and the procedural rules that apply (click here to read them).

Reminder: If your claim is denied, you can submit another claim in accordance with the terms of the Settlement Agreement. Click here to read an FAQ about this.

Reminder: If your claim is eligible, you cannot appeal any Lien deductions taken from your Award. You will be notified separately about any Liens to which you can object. Click here to read an FAQ about Lien disputes.

151. Can I withdraw my claim?

Yes, you can withdraw your claim by sending a written request to the Claims Administrator (click here for a form to use when requesting a withdrawal). However, you cannot withdraw a claim if it has already been closed because it was paid in full or denied as ineligible and all steps after a denial have been finished, or it was denied for fraud, misrepresentation, omission, or concealment of a material fact after concluding an audit investigation under Section 10.3 of the Settlement Agreement (click here to read an FAQ about the audit process).

152. Can the Claims Administrator change the outcome of my claim after I receive a notice?

Yes. There are some situations where the Claims Administrator has to take back a notice it has already issued, such as to correct an error in the review, because of the audit of a claim or to address a matter covered in the Rules Governing Qualified MAF Physicians [see especially Rules 25(b) and 27].

153. Can I submit a new claim for a Monetary Award if the Claims Administrator has denied my claim?

Yes. Section 9.1(c)(i) of the Settlement Agreement allows a Settlement Class Member to submit a new Claim Package after receiving a denial notice. The Claims Administrator will determine whether the new claim can be considered for a Monetary Award based on several factors, including whether the new claim is submitted before any applicable deadlines and shows materially changed circumstances from the earlier claim. These materially changed circumstances may include (a) a different type of Qualifying Diagnosis than the one that was denied, or (b) the same type of Qualifying Diagnosis but with a different diagnosis date supported by additional medical records.

If a claim is submitted within 365 days after a previous claim, Section 10.3(d)(ii) of the Settlement Agreement requires the Claims Administrator to audit it if it is based on the same Qualifying Diagnosis as the denied claim but the new diagnosis was made by a different physician. This will make the review take longer and you could be asked to provide additional documents or information to the Claims Administrator.

154. If I received a Monetary Award for one Qualifying Diagnosis, can I later receive a Monetary Award for a different Qualifying Diagnosis? What is a Supplemental Monetary Award?

Section 6.8 of the Settlement Agreement says that if a Retired NFL Football Player who receives a Monetary Award based on a certain Qualifying Diagnosis is later diagnosed with a different Qualifying Diagnosis, the Player (or his Representative Claimant) may be entitled to a Supplemental Monetary Award. This depends on whether the amount of the Monetary Award for the new Qualifying Diagnosis is more than the amount of the Monetary Award for the earlier Qualifying Diagnosis (click here to see the Monetary Award Grid illustrating the value for each Qualifying Diagnosis). If it is higher, the Player’s Supplemental Monetary Award will be the dollar amount of the new Monetary Award less the amount of the previously paid Monetary Award. 

To be eligible for a Supplemental Monetary Award, the Settlement Class Member must submit documents showing:

1. The new Qualifying Diagnosis is different than any Qualifying Diagnosis for which the Player has previously received a Monetary Award; and

2. The Player received the new Qualifying Diagnosis after the date of the Qualifying Diagnosis for which he previously received a Monetary Award.

155. Can Class Counsel or the NFL appeal my Claim Package determination?

Yes. Both have the right to appeal to the Special Master. If Class Counsel or the NFL appeals, you will have a chance to respond. The Rules Governing Appeals of Claim Determinations provide detailed information about how appeals work and the procedural rules that apply (click here to read them).

156. Are there any rules covering determinations that a Monetary Award claim is or is not barred by the statute of limitations under applicable state law?

Yes. The Special Masters adopted the Rules Governing Statute of Limitations Proceedings, which cover the Special Masters’ review under Section 6.2(b) of the Settlement Agreement, of whether a Representative Claimant is eligible for a Monetary Award for a deceased Retired NFL Football Player who died before January 1, 2006. These Rules are available here.