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BY DAN REYNOLDS, senior editor of Risk & Insurance®

Sports fans follow their teams, in some respects, for the same reason theater, film and concertgoers pursue their forms of entertainment. By buying a ticket and taking their seat, they are given a window to acts and feelings that they themselves might not experience in their every day lives.

Goaded by recent events and in fear for its own reputational health, the National Hockey League has become the latest global sports organization to start taking a closer look at how head injuries, commonly known as "dingers" among jocks, are impacting not only the reputation of its sport but the health and well-being of its players.

According to Associated Press reports, as many as 40 NHL players this season had lost playing time to concussions by the first week in March.

For the 2010-2011 season, the NHL is attempting to implement a "hit-to-the-head" rule, making it a five-minute "intentional" penalty or a two-minute "accidental" violation for a player to strike an opposing player's head as part of a check.

Well-established hockey players are now calling for the measure. Bill Guerin, a forward with the Pittsburgh Penguins, said he feels the rule should be implemented, even though it was his own teammate, defenseman Matt Cooke, who delivered the most recent headline grabbing hit on an opposing player.

"If a guy gets hurt like that with a shot to the head, there's got to be something," Guerin told the Associated Press a few days after Cooke flattened Boston Bruin Marc Savard, leaving Savard with a Grade 2 concussion on March 7.

Cooke's hit followed another infamous hit on Oct. 24 from Philadelphia Flyer Mike Richards that left Florida Panther David Booth with a concussion: Neither Richards nor Cooke was penalized.

And as many bloggers and fans have pointed out, Cooke, at the very least, is a repeat offender. In November, he was suspended for two games for a hit to the head of New York Rangers forward Artem Amisimov. In January of 2009, he was suspended for two games for a head hit on Carolina forward Scott Walker.

So, as in many things risk, oftentimes, there are numerous signposts along the way that something should have been done: And hockey better watch out.

FOOTBALL PLAYERS VULNERABLE TOO

This fall, sports headlines were grabbed in a different way, when Philadelphia-based La Salle University found itself on the losing end of a $7.5 million settlement in the case of Preston Plevretes, a La Salle linebacker who suffered permanent brain injury when he collided with another player in a game against Duquesne University.

Plevetres' attorney argued that the university had not taken adequate measures to test and protect Plevetres after he had suffered a concussion in a previous game. As numerous risk management professionals said in the aftermath of the Plevretes settlement, the liability from athletic injury has been on the radar of university risk managers for a long time.

From a claims perspective, Plevretes' catastrophic injury fell into the most severe class of injury, according to Constance Neary, vice president for risk management with the Bethesda, Md.-based educational insurer United Educators.

She said athletic injuries are a persistent concern for the more than 1,100 member institutions of United Educators. The injuries account for as much as 15 percent of annual claims. "So it is a healthy stable of claims," said Neary.

According to a United Educators' study of five years worth of athletic injury loss data, the average nonvarsity (intramural or club sport, for example) injury loss was $150,000. The average varsity sport loss was $300,000.

But it's the prominence that concussive brain injury has gotten in the case of National Football League players that has created the most traction on the topic in the past year, and a leading researcher and advocate on the subject of athletic head injuries said he believes the tide is turning in the realm of athletic risk management.

"I am incredibly pleased and I think real change is coming," said Chris Nowinski, the co-founder of the Waltham, Mass.-based Sports Legacy Institute, an organization dedicated to the prevention and study of Chronic Traumatic Encephalopathy (CTE), a degenerative brain condition that affects athletes who have suffered repeated concussions.

Along with several Boston-based physicians, Nowinski is also the founder of the Center for the Study of Traumatic Encephalopathy (CSTE) at the Boston University School of Medicine.

Nowinski, a former Harvard football player and professional wrestler, saw his professional wrestling career ended prematurely by concussions in 2003. He's since made it his life's work to advocate on behalf of wrestlers, football players and others who as a part of their sport or profession run the risk of permanent brain injury.

He's been successful in getting several NFL players, including Matt Birk of the Baltimore Ravens, Sean Morey of the Arizona Cardinals and Lofa Tatupu of the Seattle Seahawks to donate their brains to research after they die. All three players are still alive.

Just how devastating those repeated blows to the head are was perhaps most tragically played out in the life and death of Mike Webster, the Hall of Fame center for the legendary Pittsburgh Steelers teams of the 1970's and 1980's.

Known as "Iron Mike," Webster played on all four of the Pittsburgh Steelers Super Bowl teams of that era and played 177 straight games between 1976 and 1986. But the post-NFL years for the native of Tomahawk, Wis. were dark ones.

Webster suffered from depression, alienation, pain and drug addiction and lived out of his pickup truck or in train stations before he died, broke and alone, at the age of 50 in a motel room in Wisconsin in September 2002.

Other NFL players determined to have succumbed to CTE include Wally Hilgenberg, who played in four Super Bowls for the Minnesota Vikings and who died at the age of 56 in September 2008, and John Grimsley, a former middle linebacker for the Houston Oilers who died from an accidental shooting, also in 2008.

RESEARCH KICKS IN

More research on athletic brain injury is being put forth. And beyond the well-documented quality-of-life degradation suffered by the Mike Websters of football legend, the connection between concussive sports injury and classroom performance, even family relationships, is also being plumbed.

Tamara Valovich McLeod, an associate professor in the athletic training department at A.T. Still University in Mesa, Ariz. received a $102,153 grant this winter from the National Operating Committee on Standards for Athletic Equipment to study the impact of concussions on high school athletes.

"We as athletic trainers tend to think most about the return to sport and what we are starting to see is there is definitely some other issues related to school and hanging out with their friends, and their friends not understanding them because they can't see an injury, and this whole other psychological dynamic that is going on with some of these kids," McLeod said.

McLeod's study will span the next two years. The study will take into account the experiences of around 3,000 student-athletes, most of them from Arizona. In some cases, students that had suffered a concussion on the playing field may need to rest their brains, literally, not just their bodies, in healing themselves enough to not only go back to the playing field but the classroom as well.

McLeod also said the impact on a high school player who has had a concussion can be physical, academic and social.

"Their grades start to slide a little bit, they are having academic issues - not only having trouble returning to their sport but also in a classroom setting," McLeod said.

The study will take a balanced look at the traditional return-to-play decision and those less-studied academic and quality-of-life factors. "We also want to compare concussed athletes with other athletes who have other sports-related injuries," McLeod said.

When it comes to insuring professional athletes and teams, from an insurance perspective, at least in the NFL, the carriers and their brokers saw a while ago that the technology and the education needed to identify a concussion was improving were getting more accurate, according to Dan Burns, the president of sports insurer Pro Financial Services LLC, which is based in Schaumburg, Ill.

Burns, who sells policies to NFL teams that help cover the loss of value to teams when players are sidelined by injuries, said rates in that area hardened considerably about 10 years ago and haven't moved much since. Nor has claims frequency changed much, he said.

"The only thing that would change is how long the player is kept off of the playing field when diagnosed with a concussion. It used to be you might miss a week if even that. Now teams are much more conservative especially if it is past the first occurrence," Burns said.

May 1, 2010

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