The possibility of multiple insurance claims by sports professionals across a spectrum of sports for injuries arising from concussive events appears to be looming
Following the recent US NFL litigation concerning concussion, the possibility of multiple insurance claims by sports professionals across a spectrum of sports for injuries arising from concussive events appears to be looming. Such issues are already being seen in US sports personal accident insurance context and the debate has started in the UK, particularly among those involved in elite rugby.
For the accident and health insurance industry the issue of concussion raises questions as to their exposure for concussion-related injuries, as well as how action taken to mitigate risks – such as withdrawal from play or delay in return to play – may affect clubs and players. Beyond professional sports there are a range of paid and unpaid activities that also expose individuals to a heightened risk of a concussion event.
When considering the risk arising from concussion, medical evidence is likely to be crucial and medical understanding continues to evolve. Concussion can be classed as the temporary loss or alteration of consciousness or amnesia. However, it is uncertain whether this represents a physical injury, particularly where a brain scan indicates no damage.
It does appear to be a trend that those who suffer from concussion may go on to have further episodes. Whether there is a causal link between the occurrences of concussion or it is behavioural (ie, the individuals affected continue to undertake dangerous activities with the resultant elevated risk of future episodes) is an issue being considered carefully by the medical profession.
However, the possible cumulative nature of a series of increasingly severe concussions raises questions in relation to policy requirements in personal accident policies that "disablement" results from a single traumatic event.
While most individuals will recover from a standard concussion event within a matter of days, the nature of the long-term risk from repeated concussions is not fully known. Medical experts are concerned about chronic traumatic encephalopathy, a degenerative disease of the brain found in people with a history of repetitive brain trauma, and early onset dementia. An established phenomenon in boxing, it is an open question whether there is a risk it will manifest itself in individuals who have suffered instances of milder head trauma.
This means it may be difficult to ascertain whether there are injuries caused by the concussive event(s) and whether any subsequent disablement results solely and independently from those injuries.
While many manual workers or sports professionals will accept that physically their body will degenerate quicker than the average person because of the additional stress it has been placed under, mental degeneration is not so widely acknowledged within the medical sector or accepted as a risk of certain occupations by individuals.
Therefore, one of the issues for insurers of personal accident policies where concussion has been raised is the extent to which their degeneration or "degenerative process" exclusions will operate where a brain impact occurs.
Furthermore, a key problem with identification and treatment of cognitive difficulties is they are often diagnosed by reference to the individual's subjective reports of their symptoms: there is little in the way of objective measures to ascertain whether a player suffers from concussion-related injuries or to which "accident" those injuries may relate. The absence of baseline testing can also be problematic.
Underwriters would be well advised to review their policy wording with the above in mind and consider gathering information about historical concussion experience within medical questionnaires.
Article first published in Insurance Day
