2006  Medical Appeal Procedures

NTRP MEDICAL APPEAL PROCEDURES - QUESTIONS AND ANSWERS

FOR

USTA SOUTHERN SECTION LEAGUE PROGRAMS

1. What is a Medical Appeal?

A medical appeal is a formal, written request from a player for reconsideration of his/her

NTRP Rating based on a permanent, disabling illness or injury that has occurred since the player generated the year-end or early-start NTRP Rating.  USTA League Tennis Regulation 3.05B(2) states, “If intervening permanent disabling injury or illness indicate that a rating may be too high, the player may request a reconsideration of such rating……. ”  

2. Who can file a medical appeal of a player’s NTRP Rating?

Only the player whose rating is being appealed can file an appeal.  A team captain, another player, a spouse, or a physician may not file an appeal on the player’s behalf. 

3. Where should a medical appeal be filed?

All medical appeals are submitted to the state association.  The State Association website provides proper forms with instructions.  The state league coordinator, or designee, will forward to a higher authority if applicable.  

4. When can a medical appeal be filed?

The timing of filing a medical appeal varies depending on where it is filed.

1. Local and/or State “Benchmark” Appeals:  Some states allow year round filing for local and/or state “Benchmark” appeals.  Other states have defined specific time periods for filing.  Player appealing should refer to his/her State League Regulations. 
2. Sectional “Benchmark” Appeals: These may be filed year round.

              c.  National “Benchmark” Appeals: These may be filed year round.

5. What information should be included in a medical appeal? 
   1. Written request from player that includes substantiating evidence to validate appeal.
   2. Name of player as listed in TennisLink
   3. Date of Birth.
   4. USTA Number.
   5. Current NTRP Rating and date Rating generated.
   6. Level playing when current NTRP Rating generated. (Did player get moved up when current NTRP Rating received or was Rating level left the same?). 
   7. Dates, location and name of division (adult, senior, mixed doubles, combo, etc.) of last tennis season played.
   8. Has player played tennis since current NTRP Rating was received?
   9. NTRP Level requesting.
   10. A current attending Physician’s Statement (physician who is actually treating patient for the described illness or injury) that is dated, written on the physician’s letterhead stationery and includes an evaluation of the player’s current condition.

Specific information from the physician must include:

(1)    date of onset of the player’s illness or injury

(2)    diagnosis

(3)    extent of the illness or injury that specifically defines what the player can or cannot physically do. (i.e., cannot lift arm above head, cannot see out of left eye, etc.)

(4)    player’s prognosis: how long will injury or illness last, what permanent limitations will the player have, will player eventually have full recovery?

(5)    medical release to play tennis which includes date when player may resume playing. 

6. What information is not acceptable and/or considered in a medical appeal?
   1. Operative notes, progress notes, prescriptions, x-rays, Cat Scans, MRIs or other medical reports may not be submitted instead of an Attending Physician’s Statement.  An Attending Physician’s Statement, as described in Question # 5, is required and must also be submitted.
   2. A statement from the physician saying what specific NTRP level the player should play.  It is the responsibility of the committee, not the physician, to determine the skill level where the player should play.
   3. Statements from the physician like:

.  “Mr. Smith has asked me to request that he be allowed to move down from 4.0 as he feels

     he can no longer compete at that level”      

.  “Mrs. Jones has shown considerable improvement since starting on her

     medication but, her illness or limitations will progress over time and is

     therefore permanent” (This may be true but does not refer to current status.)

.  “Mr. Ross would like to play with his friends, spouse, etc.”

.  “Ms. Harris may need surgery in the future.”  (Not current status)  

4. A player’s appeal of their current NTRP Rating when player has not been medically released to play. (Appeal must be current.)
5. A player’s appeal of their current NTRP Rating when registration for the league season, in which they desire to play, does not begin for several months or longer. (Appeal must be current.)

7. What type illnesses or injuries in an NTRP medical appeal are not normally granted?

*Please note that while the following conditions are not usually granted an appeal, each player’s appeal is reviewed and considered on an individual basis before the NTRP Appeal Committee makes a decision.

Osteoarthritis, Bunions, Plantar Fasciitis, Lateral Epicondylitis (tennis elbow), most orthopedic problems or injuries including sprains, back problems, back surgery, rotator cuff problems, arthroscopic shoulder or knee surgeries, total knee replacements, hip replacements, Achilles Tendon tears or surgical repairs, Diabetes, thyroid conditions, heart conditions and/or surgery, kidney conditions, kidney donors, gastrointestinal disorders, cancer, players receiving chemotherapy and/or radiation and players going through rehabilitation.

Very few medical appeals should be granted, as it is usually better to let the computer determine the NTRP Skill Level based on actual match play.  Rationale:

. If illness or injury is not permanently disabling, appeal cannot be granted even if treatment,

  recovery and/or rehabilitation may take a year or longer.

. Individuals respond to illnesses and/or injuries in different ways so it is hard to predict

  the impact on their skill level.  

. Many illnesses, such as osteoarthritis, are chronic, progressive, permanent conditions.

  However, the rate of progression of the illness, resulting symptoms and degree of

  impairment, as well as reaction to medication and treatment, varies in different people. 

. Most individuals actually play better after knee, hip and shoulder surgery due to  

  decrease in pain and possible increase in mobility from their pre-operative status.
. Most individuals who have heart disease, cancer, etc., if medically released to play tennis, will probably be able to play at their previous skill level.             . If medically released to play tennis, potential pain, shortness of breath and risk of injury should not be factors in determining NTRP skill level, as these could occur no matter what NTRP level playing.
. Endurance issues may occur at any skill level and varies from individual to individual.  More energy may be exerted at the lower skill levels than the higher skill levels depending on the player’s style of play, court position and placement of the ball.  Therefore, the amount of energy exerted while playing tennis varies in individuals and cannot be accurately predicted.              

8. Can a player be disqualified if a medical appeal is granted?

Yes.  He/She is treated as a self-rated player and entered into the computer as a medical appeal. 

9. Who should serve on the NTRP Medical Appeals Committee in the USTA Southern

      Section?  

       . A minimum of three persons, one of whom shall serve as chair.
       .  Individuals who are very league knowledgeable including knowledge of NTRP skill levels.
       .  Individuals who have current medical knowledge are helpful but not required.
       .  A medical consultant is required to be accessible to the committee for consultation and input as needed. 

10. What are the responsibilities of the NTRP Medical Appeals Committee?

             The committee’s responsibilities are to:

1. determine if the player has sustained a permanent, disabling injury or illness since generating his/her current NTRP Rating.
2. determine if the intervening, permanent illness or injury has impacted the player’s skill level and resulted in an NTRP Rating that is currently too high.
3. make sure the player appealing has been medically released to play when medical appeal is filed, not at some point in the future. (Appeal must be current.)
4. make sure the player appealing is planning to register for a league season close to the time of filing, not at some point in the future.  (Appeal must be current.)
5. determine if information as stated in question # 5 has been included in the appeal.
6. maintain confidentiality of the player’s medical information.
7. abide by the USTA Southern Section Leagues Code of Ethics.
8. send a written decision of the committee’s decision in a timely manner to the player and the

appropriate coordinator.                  

11.  Does a player have a right to appeal the decision of the NTRP Medical Appeals Committee?

             No.  The decision of the NTRP Medical Appeals Committee is final and binding. 

12.  What are the written requirements for communication in filing an NTRP Medical Appeal?

             The requirement that a letter or document be in writing is satisfied if it is sent by a telegram, fax, e-mail or equivalent communication. Verbal appeals are not accepted.    

13.  What type communication is acceptable for a NTRP Medical Appeals Committee?

 The committee chair has the authority to use his/her discretion to allow committee

 members and/or medical consultants to participate by conference call, fax, e-mail

 or equivalent communication.  However, conference calls are encouraged to allow

 discussion and input from all committee members at the same time.