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Sometimes the USTA is a little skittish about collecting and evaluating medical information. I suspect that a primary factor is the Health Insurance Portability and Accountability Act (HIPPA). That law requires the protection of personal health information to prevent disclosure without a person’s consent. Additionally, the USTA is sensitive about the evaluation of medical information by personnel who for the most part do not have a license to practice medicine.

On the tournament side of the organization, withdrawals from back-draw matches has reached epidemic proportions. That effect is particularly pronounced for juniors. In fact, an independent study examining the correlation of injury withdrawal with the total number of tournament matches played, also revealed that withdrawal rates in consolation brackets were excessively higher than in the main draw. The data suggests that many players citing injury or illness when refusing consolation match play did so for non-medical reasons.

I was once told that the USTA used to require a doctor’s note to avoid suspension points when withdrawing from junior tournaments. I also have it on good authority that some coaches were traveling with a sheath of signed medical notes in case the “need” arose for one of their players. The USTA doesn’t want to be in the position of evaluating these medical excuses. The prospect of a lawsuit from a legitimately injured player is simply not worth the risk.

It is very important to remember that USTA Leagues, USTA Adult Tournaments, and USTA Junior Tournaments are all administered through three independent USTA Committees. While a single Legal Counsel at the USTA will influence the policies of all three of these bodies, they rarely act in lockstep unison.

One example of divergence is the reluctance of the Junior Tournament Committee to collect or evaluate any medical justification from players who drop out of a tournament for medical reasons. Since junior tournaments are largely transient events, there is no ongoing pressing need for them to do so. Every junior with chronic back-draw syndrome will age out of junior tennis after a few years. The “problem” (sort of) solves itself.

The USTA League Committee does not operate under that luxury. Adults with legitimate Medical Appeal cases for their NTRP ratings, will not experience improvement in their condition over time. Consequently, a review of their medical information is necessary and in order for that to occur some information has to be collected.

It is no surprise that the person who signs and submits the forms required for an NTRP Medical Appeal explicitly grants authorization to the USTA to review and evaluate that information. That explicitly includes the Medical Review Committees at both the Sectional and National Levels.

By signing this form, I authorize a USTA League Section Designated Medical Review Committee and the National Medical Appeal Committee to review, for the purpose of evaluating my medical appeal, any protected health information, including my medical records, that I have provided as part of this appeal.

Signature Block from USTA Medical Appeal Form [4].

I am 100% sure that everybody involved with reviewing Medical Appeal information for the USTA has signed a strict Non Disclosure Agreement. As I observed last week, if I had ever been in or around the Medical Appeals process I am pretty sure I would not be able to write about that topic at all.

Next week I will start to break down the information a person has to provide on an NTRP medical appeal form. I cannot imagine a person filling out information for a dubious medical appeal and signing the form without some degree of awareness that any falsification constitutes fraud.

On a somewhat related note, I have previously suggested that the NTRP Self-Rating process should be transformed from referenced guidelines into a binding attestation. To put that more bluntly, I believe there should be a form submitted to the USTA with a physical signature that acknowledges that the USTA has the right to verify the accuracy of the information that was provided in support of each player’s self-rating. Additionally, it should be clear that any discovered falsehoods will result in disqualification and possible suspension.

I personally think that a lack of veracity during the self-rating process is a much larger issue for the USTA than people filing fraudulent Medical Appeals. At least… I hope so. Otherwise, we are all playing NTRP tennis against a bunch of criminals.


  1. Risk Factors for Medical Withdrawals in United States Tennis Association Junior National Tennis Tournaments, Neeru A. Jayanthi et al, Sports Health, May 2009.
  2. USTA League Regulations, 2022, downloaded October 29, 2022.
  3. NTRP Medical Appeal Procedures – Questions and Answers, Undated USTA Artifact, downloaded October 29, 2022.
  4. USTA League Medical Appeal Form,

2 thoughts on “Throwing Out a HIPPA: USTA Medical Appeals

  1. Jack says:

    I would say scofflaws not criminals. It’s too easy to get around the current self-rating process without the background checks you suggested.
    To wit, this past weekend I played a local NTRP tournament where the winner of each division advances to the sectional tournament. When I arrived I noticed a guy playing a match who was ripping balls and rushing the net and thought to myself, I hope he’s not in my 4.5 round robin flight. Later, I found out he was a self-rated 4.0 player. Unsurprisingly, he crushed his competition and easily won the tournament. I expect he’ll have an excellent chance to win sectionals and advance to nationals. He’ll likely get bumped up at the end of the year but it won’t matter for this season.
    Point being, self-rated players shouldn’t be allowed to advance to sectionals/nationals in their first year playing. Full stop.

    1. V says:

      Agree! I think many of these issues would go away if self-ranked and medical appeal players were ineligible for post season play.

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