Insurer, NFL team don't have to pay former player's concussion-related care
The player was active with the Cardinals from 2007-2009 and his workers' compensation claim was accepted in 2011.
An Arizona appellate court ordered more than $28,000 in medical expenses awarded to former Arizona Cardinals wide receiver Sean Morey be set aside after finding that the record lacked documentation about what led an administrative law judge to order that amount.
B&B Holdings, doing business as AZ Cardinals, and its carrier Nautilus Insurance Co., asked the Arizona Court of Appeals Division One to review an Industrial Commission of Arizona (ICA) award ordering the team to reimburse Morey for concussion-related medical expenses he paid out of pocket. Morey played for the Cardinals from 2007-2009 and his workers’ compensation claim was accepted in 2011.
But part of the record was missing as to how administrative law Judge Amy Foster arrived at the amount for the insurer to reimburse Morey.
“On the record provided, this court cannot determine the factual basis of the conclusion for the decision upon review or whether it is legally sound,” Judge Samuel Thumma wrote in the court’s decision, with Judges Jennifer Campbell and Maurice Portley joining.
“It is impossible to determine whether substantial justice was achieved … because there is no record by which to evaluate any decisions made at the unrecorded status conference,” the court added.
In 2011, Morey moved to New Jersey, where he received treatment for a traumatic brain injury stemming from multiple concussions. Around the same time, an ICA award authorized Morey to be treated outside of Arizona and that Nautilus would be liable only for medical expenses exceeding the fee schedule.
Morey began receiving treatment from neuropsychologist Dr. Jonathan Silver beginning in 2017. He paid out of pocket for treatment and medications and then sought reimbursement from Nautilus, according to court documents.
In June 2020, Morey filed a request for reimbursement of $28,339.07. He included invoices from the physician as well as handwritten notes from the doctor and a list of medications he paid for. Morey also submitted documents and requests for subpoenas for Silver and others while the petitioner did not submit documents or evidence, according to the court’s record.
A remote hearing was conducted Aug. 18, 2020, where the petitioners said they needed additional documents before they could make payment. Under law, Morey was required to show that the treatment was medically necessary, the reimbursement requests were timely, proof of payment must be shown and the charges were in line with applicable fee schedules. Thumma said an Aug. 20, 2020, email seemed to indicate that Nautilus attempted to obtain further information from Silver.
But Thumma also said the record is “murky and with gaps” and an unrecorded status conference Sept. 1, 2020, left the record blank regarding each side’s argument and who attended. There is also no record of whether the Aug. 20 email was addressed during the conference. Two days later, the administrative law judge ordered full reimbursement to Morey.
Thumma said the judge also failed to clarify whether the order was meant to be capped by the fee schedule.
“Thus, the award can be read two ways. Taken literally, the award may not apply the fee schedule to reimbursement, which appears contrary to ICA rule. But this court will not guess as to what the award sought to do,” Thumma wrote.
Morey announced his retirement due to concussions prior to training camp with the Seattle Seahawks in 2010.
Related: