External Evidence means any information or materials (such as documentary, photographic, video or other evidence) relating to a Monetary Award Claim or group of Monetary Award Claims, that was not provided by the Settlement Class Member(s). External Evidence may be submitted to the Claims Administrator by either the NFL Parties, Class Counsel, or a Third Party. The Claims Administrator also may obtain External Evidence during an audit investigation or through its verification and investigative actions under Section 8.6(b) of the Settlement Agreement.
The NFL Parties, Class Counsel, or a Third Party may provide the Claims Administrator with External Evidence that is: (1) believed to present a question of misrepresentation, omission or concealment of a material fact in connection with a claim or group of Claims; or (2) relevant to verify whether the Settlement Class Member is eligible for an Award. Additionally, under Rule 23(c) of the Rules Governing Appeals of Claim Determinations, a Party or Third Party may submit External Evidence as new evidence on a claim if it is on appeal to the Special Master and the Special Master approves the submission.
There are three potential outcomes of the Claims Administrator’s review of External Evidence:
(a) Audit Investigation: If the Claims Administrator determines that the External Evidence presents a question of whether there may have been a misrepresentation, omission or concealment of a material fact made in connection with a claim or claims and no Audit Investigation is already underway as to such Claim(s), the Claims Administrator will issue a Notice of Audit to each affected Settlement Class Member and conduct an Audit Investigation of the Claim(s). Further actions on the Claim(s), including the opportunity for the affected Settlement Class Member to address the External Evidence, will occur pursuant to the Procedure for the Audit of Claims and the Audit Rules, provided that no Report of Adverse Finding in Audit under Audit Rule 15 may be issued until after the affected Settlement Class Member(s) have received notice of the External Evidence and had the opportunity to view and respond to it. The Claims Administrator may ask the AAP, the AAP Leadership Council and/or the AAPC for advice and assistance on any medical issues in the claim or claims presented by the External Evidence.
(b) Further Verification in Claims Review: If the Claims Administrator determines there was no misrepresentation, omission or concealment of a material fact made in connection with a claim or claims, the Claims Administrator will consider the External Evidence as part of the verification of whether the affected Settlement Class Member is eligible for an Award. The Claims Administrator will notify a Settlement Class Member with a claim subject to further verification in Claims Review of the nature of the action taken by the Claims Administrator and of the External Evidence resulting in such action and provide the Settlement Class Member the opportunity to view and respond to the External Evidence before a determination is made on the claim. The Claims Administrator may ask the AAP, the AAP Leadership Council and/or the AAPC for advice and assistance on any medical issues in a claim before making a determination on the claim.
(c) No Audit Investigation or Further Verification Steps in Claims Review: If the Claims Administrator determines that there is no issue raised by the External Evidence warranting either an Audit Investigation or further verification in Claims Review, but the External Evidence is something that may be offered by the Settlement Class Member or a Party on an appeal of a Notice of Monetary Award or Notice of Denial, the Claims Administrator will notify the Settlement Class Member of the External Evidence and provide the ability to view the External Evidence. The Settlement Class Member will also have the opportunity to respond to the External Evidence at that time if the Settlement Class Member chooses to do so.
Yes. The Parties are able to see Notices issued on Claims and the contents of all Claims Packages through their NFL Portals with the Claims Administrator. This Procedure does not affect the rights of the Parties under Section 10.3(a) of the Settlement Agreement.
The Claims Administrator will provide you an opportunity to review and respond to any External Evidence before it makes a substantive determination about the claim(s). You are encouraged to respond to the External Evidence within the 30-day response window listed on the Notice. If you choose to respond to any External Evidence, you must do so truthfully. Your reply should provide a thorough explanation of this new information, including why you believe the new information does not call into question your claimed Qualifying Diagnosis.