Keep Head Trauma in Mind- Part 2
This is part two of a two-part Risk Insider post by Allied World’s president of North America Casualty Joe Cellura on the dangers of scholastic athletic head injuries.
Part One can be seen here.
In last week’s post I detailed the breadth of the athletic head injury program and talked about how substantial legal settlements with the National Football League could become.
One question now before us is can municipalities be liable for student injuries that occur on the sports fields, or even those that arise years later when students’ time playing at their alma mater has become a blurred memory?
While team sports are a huge part of school cultures, the coverages in place today are unlikely to address this risk.
Municipalities and risk managers alike must ask, is being reactive the right strategy here? Is education and response enough or do we need to do more in terms of prevention?
Do waivers cover any responsibility in this regard? Contact sports, football especially, are deeply embedded in American culture, core to the identity like apple pie or Uncle Sam.
While team sports are a huge part of school cultures, the coverages in place today are unlikely to address this risk. As a result, municipalities could be on the hook. For such a critical topic, the insurance industry to date has taken very little proactive action to address very real concerns.
Insurers need to immediately start treating this emerging risk with focused underwriting, engineering and appropriate coverage terms. The exposure is upon us and remaining silent could ultimately become a recipe for expensive litigation and loss.
Underwriters should have exposure specific questionnaires targeted to sports related head injuries. An example could include questions regarding history of incidents, training, injury documentation and tracking.
Loss control and engineering services could be provided focusing on appropriate preventative measures and safeguards, which could include everything from appropriate liability waivers to on-site medical staffing, injury identification and treatment protocols.
Finally, exposure specific coverages will need to be developed. These coverage’s could address the date of, as well as the number of, occurrences, how to address pre-existing injury and defense obligations.
Long-term monitoring costs could also be considered along with policy conditions for notification and liability waiver warranties. The public entity sector has seen similar advances in underwriting, loss control and coverage in the wake of the increased incidence of sexual abuse cases.
It’s time for the industry to consider similar advances in the area of sports related head injury.
The growing trend of concussions at the municipality level, and the rise of attention given to research and settlements at a collegiate and professional level, presents insurance carriers and risk managers with an opportunity to address this issue head on – pun intended – and be more proactive in thinking about how to address the serious risks associated with contact sports at all levels.
As the number of concussions grows among student athletes, perhaps the number of conversations among insurers will grow as well. And that’s a good and necessary thing.
Keep Head Trauma in Mind
This is part one of a two-part Risk Insider post by Allied World’s president of North America Casualty Joe Cellura on the dangers of scholastic athletic head injuries.
He runs the plays from yesterday’s practice in his head.
Flashing back to last week’s game, he remembers the sharp crack of the helmets as he and the other team’s wide receiver collided. He vaguely remembers everything going black as teammates and coaches gathered around him in a circle of concern.
He needs to push aside fear and get pumped up. What are the chances he gets hit again anyway?
Pretty high, actually.
Concussions among high school and middle school athletes are becoming increasingly common. While high school football accounts for 47 percent of all reported sports concussions, it is estimated that one in five high school athletes will sustain a sports concussion during any given season.
The rising prevalence of concussions in sports at the high school and middle school levels pose a difficult dilemma for risk managers and insurers.
Today, the risks of injury from high impact sports at these levels have serious implications for the risk management landscape and for municipalities more broadly.
While football is a key driver of concussion related injuries at the high school level, and the focus of much attention at a college and professional level, ice hockey and soccer pose significant head health risks as well.
Across all sports, four to five million concussions occur annually, with the numbers rising among middle school athletes. When signing their children up for team sports, most parents do not expect that their child will sustain injuries to this level of severity at such a young age.
In fact, many would think that concussions are more likely to occur in a professional setting, where the stakes of winning or losing are higher, and players are more willing to take risks.
But here are the stark facts. Concussion rates among students age 8-19 have more than doubled in sports such as basketball, soccer and football between 1997 and 2007, even though participation in these sports overall has declined.
Research shows the number of concussions across all high school sports to demonstrate the amount of risk associated with each sport. The chart below indicates the average amount of sports concussions taking place per 100,000 athletic exposures.
An athletic exposure is defined as one athlete participating in one organized high school athletic practice or competition, regardless of the amount of time played.
While the numbers vary, the trend is alarming as concussions occurring in both male and female athletes continue to grow. Fully 33 percent of high school athletes who have a sports concussion report two or more in the same year.
High school athletes who have been concussed are three times more likely to suffer another concussion in the same season. While the first hit can prove problematic, the second or third head impact can cause permanent long-term brain damage.
Ninety percent of most diagnosed concussions do not involve a loss of consciousness, so it’s not always glaringly obvious when a student should step off the field. Perhaps even more troubling, 15.8 percent of football players who sustain a concussion severe enough to cause loss of consciousness still return to play the same day.
Fifty percent of “second impact syndrome” incidents – brain injury caused from a premature return to activity after suffering initial injury (concussion) – result in death.
Cumulative sports concussions are shown to increase the likelihood of catastrophic head injury leading to permanent neurologic disability by 39 percent. The most prominent place where the effects of this kind of head trauma are evident is in the NFL.
NFL athletes have historically experienced concussions and head traumas as part of the sport, and for many years, the full extent of neurological damage was not appropriately discussed or acknowledged.
Rumors of retired players becoming disabled and whispers of players dying young from head injuries began to build, until a bright light was cast on the reality of the situation in a court of law.
In April the organization was ruled to be responsible for baseline medical exams for retired NFL players, monetary awards for diagnoses of ALS, Alzheimer’s, Parkinson’s, Dementia and certain cases of CTE, as well as education programs and initiatives related to football safety.
This settlement is costing the NFL an enormous amount of money, with some estimating the cost at $1 billion over 65 years. The NFL itself expects that 6,000 of the nearly 20,000 retired players will someday suffer from debilitating diseases caused by traumatic brain injuries.
It stands to reason that other organizations in the world of sports could face similar financial consequences. In my post next week I’ll discuss how broad the risk could spread and what carriers and risk managers should be thinking about.
The Doctor as Partner
Professionals helping employees return to work after being on disability or a leave of absence face many challenges. After all, there is a personal story behind each case and each case is unique.
In the end, the best outcome is an employee who returns to the job healthy and feeling well taken care of, while at the same time managing the associated claim costs.
Learn what most employers want from their group disability and life benefits program.
While many carriers and claims managers work toward these goals, in the end they often tend to focus on minimizing costs by aggressively managing claims to get the worker back on the job, or they “fast track” claims, approving everything and paying little attention to case management.
Aggressively managed claims can leave many employees and their doctors feeling defensive and ill-at-ease, creating an adversarial relationship that ultimately hinders return to work and results in higher direct and indirect employee benefit costs for the employer. Fast track or non-managed claims can lead to increased durations, costs and workforce productivity issues for employers.
Is it possible to provide a positive employee benefit experience while at the same time effectively managing disability and lowering an employer’s overall benefit costs?
A Unique Approach
Liberty Mutual Insurance’s approach to managing disability and absence management focuses on building consensus among all stakeholders – the disabled employee, treating physician, employer and insurer. And a key component of this process is a large team of consulting physician specialists, leading practitioners from a variety of specialties, highly regarded experts affiliated with leading medical universities across the country.
“About 16 years ago, our national medical director, Dr. Ed Crouch, proposed that if we worked with a core group of external consulting medical specialists – rather than sending most claims for Independent Medical Evaluations – we could do a better job making disabled employees and their attending physicians comfortable, and therefore true partners in producing better disability management outcomes and employee benefit experiences,” said Tim Kastrinelis, senior vice president, Distribution Partnerships at Liberty Mutual Benefits.
“In this way, our consulting physician and the attending physician are able to work with the disability case manager, the employee and the employer to deliver a coordinated, collaborative approach that facilitates a productive lifestyle and return to work.”
The result of Dr. Crouch’s initiative has produced positive results for the clients of Liberty Mutual Insurance. This consensus building approach to managing disability with consulting physician expertise has helped achieve industry leading client retention results over the past decade. In fact, 96 percent of Liberty Mutual’s group disability and group life clients renew their programs.
“By getting all stakeholders on the same page and investing heavily in consulting physician specialists, we have been able to lower claim costs and shortened claim duration for our group disability policyholders. …In the end, it’s a win-win for all.”
–Tim Kastrinelis, Senior Vice President, Distribution Partnerships, Liberty Mutual Benefits
A Collaborative Approach
In the case of complex disability medical health situations, Liberty Mutual’s disability case managers play a vital role in seeking additional expertise—an area where the industry’s standard has been to outsource the claimant for independent medical examinations.
However, Liberty Mutual empowers its disability case managers with the ultimate responsibility for the outcome of each claim. The claimant and the case manager stay together throughout the life of the claim. This relationship is the foundation for a collaborative approach that delivers a better employee benefit experience and enables the claimant to return to work sooner; which more effectively controls total disability claim and absence costs.
Sending a disabled employee with complex medical needs to an external specialist may sound like a cost-effective path, but it often comes at the cost of sacrificing the relationship and trust built between the employee and case manager. The disabled employee must explain their medical history to a new clinician, which he or she is often reluctant to do. The attending physician may be uncooperative as this move can appear to question his or her treatment plan for the employee.
As a result, the entire claims process takes on an adversarial atmosphere, building major roadblocks to the ultimate goal of helping the claimant return to a productive lifestyle.
Liberty Mutual takes a different approach. Nearly 100 physicians representing more than 30 medical specialties are available to consult with its medical and claims professionals, working side-by-side with case managers.
More than 95 percent of these consulting physicians are in active practice, and therefore up-to-date on the latest clinical best practices, treatment guidelines, therapies, medications, and programs. Most of these physicians are affiliated with leading medical universities across the country. “We recruit specialists from around the country, getting the best from such prestigious institutions as Harvard, Yale, and Duke,” said Kastrinelis.
These highly-credentialed physicians help case managers focus on providing the support needed for the disabled employee to successfully return to work as quickly as appropriate. Their collaborative work with the attending physicians provides the behind-the-scenes foundation that leads to a positive claimant experience, results in a better outcome for the claimant, and more effectively reduces total claim costs.
Coordinated Care Plan
When one of these consulting physicians reaches out to an attending physician, there’s an immediate degree of respect and high regard for his or her opinion. This helps pave the way to working together in the best interest of the employee, improving treatment plans and return to work results.
In this process, the claimant is not sent to yet another doctor; instead, the consulting specialist works with the attending physician to help fill in the gaps of knowledge or provide information that only a specialist would have. Although not an opportunity to direct care, these peer-to-peer discussions can help optimize care with the goal of helping the employee return to work.
The attending physician may have no knowledge of the challenges the employee faces in order to return to work. A return to work plan created in concert with the specialist, disability case manager, employer, and attending physician can set expectations and provide the framework for a proactive and effective return to a productive lifestyle.
“Our consulting physicians bring sophisticated medical expertise to the discussion, and help build consensus around a return-to-work plan, helping us more effectively impact a claim’s outcome and costs, and at the same time provide a better claimant experience,” said Kastrinelis.
“We can work more collaboratively with the attending physician, manage expectations, and shepherd the employee through the process much more effectively and in a much more high-touch, caring, and compassionate manner. Overall, we’re able to produce better outcomes as a result of this consensus building approach.”
“Our approach – including the use of consulting medical experts – helped us significantly reduce disability costs over two years for one large health service company,” notes Kastrinelis. “We cut average short-term disability claim durations by 4.2 days in that time, while increasing employee satisfaction with our unique disability management model and collaborative, partnership approach.
How did Liberty Mutual’s unique approach lower claim costs, reduce disability duration and improve the benefit experience for one customer?
“By getting all stakeholders on the same page and investing heavily in consulting physician specialists, we have been able to lower claim costs and shortened claim duration for our group disability policyholders,” said Kastrinelis.
“Plus, we, the employee, and the employer also get the bonus of creating a better employee benefit experience. This model has shaped our disability and absence management program to more aptly reflect our core mission of helping people live safer, more secure lives. In the end, it’s a win-win for all.”
How does Liberty Mutual provide a superior employee benefit experience?
Tim Kastrinelis can be reached at email@example.com. More information on Liberty Mutual’s group disability and absence management offerings can be seen at https://www.libertymutualgroup.com/business-insurance/business-insurance-coverages/employee-benefits.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Liberty Mutual Insurance. The editorial staff of Risk & Insurance had no role in its preparation.