INJURIES AND ILLNESSES
Reporting Injuries and Illnesses
- Student-athletes should report all injuries or illnesses to Sports Medicine as soon as possible.
- The Sports Medicine team will evaluate and determine a management plan for student-athletes based on initial diagnosis.
- The management plan may include immediate care, treatment, rehabilitation, reconditioning, team physician referral, and/or Health Center referral.
- Any appointment with team physicians or consultants will be made through the Sports Medicine team, except in emergency cases.
Chaperone Policy
- Injuries and general medical conditions may be sustained during participation in intercollegiate athletics. Sports Medicine team members must receive permission from student-athletes before performing an evaluation and/or therapeutic intervention involving sensitive areas of the body.
- To ensure a safe and secure environment, student-athletes and Sports Medicine team members may request the presence of a chaperone to observe and/or take part in the procedure.
- If an alternative Sports Medicine team member is not available, another Lehigh Athletics employee can serve as the chaperone.
- All on-campus team physician clinics are supervised by a member of the Lehigh University Sports Medicine team serving as the chaperone for student-athlete examinations.
- Student-athletes may request a private team physician consultation without the presence of the chaperone.
Participation Status
- Decisions concerning medical clearance and return-to-participation of a student-athlete is ultimately the responsibility of the Lehigh University team physicians.
- Team physicians have the authority to override medical clearance given by external providers as long as they are made within reason and with full regard to possible and reasonable accommodations (Palulu v. University of Kansas; Knapp v. Northwestern University).
- The team physicians and Sports Medicine team members, who work under the direction of the team physicians, have autonomous, unchallengeable authority to evaluate student-athletes and change their participation status at any time (NCAA Division-I Constitution 3.2.4.16).
- All medical professionals affiliated with Lehigh University Sports Medicine meet standard licensure requirements and adhere to NCAA rules including best practice guidelines for the health and well-being of our student-athletes.
Pre-Existing Injuries and Illnesses
- Student-athletes are responsible for all medical expenses related to pre-existing injuries and illnesses.
- Sports Medicine services will not be provided for the following pre-existing conditions until student-athletes have been cleared for full participation by a Lehigh University team physician:
- Post-operative cases in which surgery was performed by an external physician after completing pre-operative therapy with the Sports Medicine team.
- Post-operative cases involving specific risks identified by the Sports Medicine team and/or team physician.
- Post-op cases for which the attending external surgeon does not approve the Sports Medicine rehabilitation program.
- Non-surgical chronic or overuse injuries that preclude participation in training, practice, and/or competition.
- Pre-existing injuries or illnesses will be identified through the Recruit Medical Screening Questionnaire, the Pre Participation Questionnaire, the Sport Physical, and/or the Orthopedic Screening.
- Conditions not disclosed during this process or later exacerbated by intercollegiate sport participation remain the financial responsibility of the student-athlete.
- Student-athletes with a pre-existing condition including, but not limited to those listed above will be referred to our medical provider or an alternate physical therapy clinic for rehabilitation regardless of the attending physician.
- Surgical and non-surgical injuries are no longer considered pre-existing once they have been cleared for full participation by a Lehigh University team physician with the following exceptions:
- Surgical candidates who opt for non-surgical management contrary to Lehigh University team physician recommendations will be considered pre-existing regardless of clearance for full participation.
- Non-surgical candidates with chronic or overuse conditions involving specific risks identified by the Lehigh University team physician will be considered pre-existing regardless of clearance for full participation.
Non-Sport Related Injuries
- Sport related injuries are conditions that occur during participation in:
- Any supervised training program or sport-specific activity involving a Lehigh University coach, Athletic Trainer, and/or Sports Performance team member.
- Any unsupervised training program or sport-specific activity performed independently as directed by a Lehigh University coach, Athletic Trainer, and/or Sports Performance team member.
- All other injuries are considered non-sport related.
- Sports Medicine services will not be provided for non-sport related injuries requiring more than 4 weeks of therapy.
- Student-athletes with non-sport related injuries requiring extended rehabilitation will be referred to our medical provider or an alternate physical therapy clinic regardless of the attending physician.
Medical Expenses
- Lehigh Athletics’ sport excess policy is intended to assist with medical expenses resulting from sport related injuries.
- Non-sport related injuries and general medical conditions are not eligible for coverage under the sport excess policy.
- To be eligible for coverage under our sport excess policy, the following requirements must be met:
- The injury must be a result of a sport related accident.
- The accidental sport related injury must occur while the student-athlete is participating in any supervised training program or sport-specific activity involving a Lehigh University coach, athletic trainer, and/or sports performance team member or any unsupervised training program or sport-specific activity performed independently as directed by a Lehigh University coach, athletic trainer, and/or sports performance team member.
- The accidental sport related injury must occur while the student-athlete is enrolled in a primary insurance policy.
- In the event medical costs for an eligible sport related injury exceed $2,000, the sport excess policy will be used in conjunction with the student-athlete’s primary insurance to assist with expenses not covered by their primary insurance (up to $90,000).
- To be eligible for benefits under Lehigh Athletics’ sport excess policy, the following requirements must be met:
- Student-athletes must utilize their primary insurance to its fullest which includes maximizing in-network benefits. Services rendered by out-of-network providers are not eligible. Services rendered by in-network providers who do not accept the standard in-network rates are not eligible.
- Student-athletes must meet the deductible. The first $2,000 of any sport excess policy claim is the responsibility of the student-athlete, their parents, and/or their primary insurance. This includes any out-of-pocket deductibles associated with the family’s primary insurance up to $2,000.
- Student-athletes and/or their parents are responsible for verifying in-network benefits prior to scheduling an office visit, diagnostic test, or procedure with a non-affiliated physician and/or medical group.
- Under the sport excess policy, a claim may be denied if the requirements of the primary policy are not met. Student-athletes and parents can facilitate this process by assuring claims are submitted quickly and properly under their primary insurance plan.
- If you have any questions, please feel free to contact AG Administrators at (610) 933-0800 or www.agadministrators.com.
How do I submit a claim?
- Claim Form: The Lehigh University Sports Medicine team will complete an insurance claim for AG Administrators, Inc. for eligible sport related injuries that will potentially exceed $2,000 in medical expenses.
- Itemized Bills: Student-athletes and/or parents must send copies of all medical bills incurred to AG Administrators, Inc. The medical bills must show the name and address of the medical service provider, date of service, type of service, and an itemized list of charges. Account statements or “balance due” statements are not acceptable.
- Explanation of Benefits: Student-athletes and/or parents must send a copy of the “Explanation of Benefits” from your primary insurance carrier to AG Administrators, Inc.
Itemized Bills and Explanation of Benefits should be mailed to:
A-G Administrators, Inc.
Claims Department
PO Box 21013
Eagan, MN 55121
Contact Information:
Claims Adjusters
Brittany Bishop
bbishop@agadm.com
Overview of Athletic Injury Claim Submission
Expenses less than $2,000
- Bills are submitted to student-athlete’s primary insurance policy.
- Any remaining unpaid balances are the responsibility of the student-athlete and/or their parents.
Expenses between $2,000 and $90,000
- Bills are submitted to student-athlete’s primary insurance policy first.
- Any remaining balances not covered by the student-athlete’s primary insurance policy are submitted to A-G Administrators, Inc.
Expenses over $90,000
- Any remaining balances are submitted to the NCAA Catastrophic Fund.
Prescription Drug Reporting
- When prescription medications are authorized for use by a Lehigh student-athlete, either by Lehigh team physicians or by outside physicians, the specific medications prescribed, and the dosage amount, frequency and duration must be reported to a Lehigh Sports Medicine team member.
- This reporting requirement helps to ensure compliance with NCAA Drug Testing obligations and serves as additional insurance that use of the medication is as directed and intended and safe in the context of athletics or rehabilitation activities.
- We ask student athletes to provide outside physicians with the Prescription Drug Reporting Form, which can be found within the Lehigh Sports Medicine website.
- Improper use of prescription medications is unsafe and may result in the loss of participation privileges.
Post Participation Process
- All student-athletes are required to complete the End of Season Medical Questionnaire at the conclusion of their team championship season in accordance with both institutional and intercollegiate post-participation requirements.
- Student-athletes whose intercollegiate athletic participation at Lehigh University ends for any reason, including but not limited to cuts, quits, medical retirements, graduation, or transfer, are required to complete the End of Season Medical Questionnaire in accordance with both institutional and intercollegiate post-participation requirements.
- Student-athletes who report unresolved issues on the End of Season Medical Questionnaire must complete a post participation orthopedic screening conducted by a member of the Sports Medicine team.
- Sports Medicine will recommend one of the following options based on clinical findings identified during post participation orthopedic screening:
- Mitigation strategies with identified expectations
- Post participation examination conducted by a Lehigh University team physician or consultant.
- Student-athletes who fail to fully and accurately complete the post participation process waive their rights to claim post eligibility insurance coverage under Lehigh Athletics' sport excess policy.
