Athletes have bought disability insurance for decades as a hedge against career-ending injuries like torn ligaments and broken bones. But players who leave the N.F.L. because of severe head trauma are being forced to convince insurers that their often invisible injuries are both real and serious.
On Monday, Haruki Nakamura, a former defensive back who played for five seasons with the Baltimore Ravens and the Carolina Panthers, took the extraordinary step of suing the insurer Lloyd’s of London to force it to honor a $1 million policy it sold him. In all, Nakamura is seeking $3 million, or triple the value of the policy, to account for damages, as well as costs, interest and lawyer fees.
Nakamura said that the insurer had subjected him to “virtually impossible” procedures in investigating his claim, burying him in unnecessary and duplicative paperwork and delays. According to the complaint, the doctor hired by the insurer refused to allow Nakamura to bring an advocate with him to his examination, and claimed that Nakamura could return to football but should consider the long-term effects of concussions.
The case could become a litmus test for insurers who wrote so-called professional athletes’ insurance policies years ago, when the seriousness of concussions was less understood. The increasing awareness of the problems associated with severe head trauma could lead more players who suffer brain injuries to file claims, but it could also prompt insurers to increase the cost of their policies, or even exclude concussions from their coverage.
“There is an awareness that is so far from what existed even five years ago,” said Joshua Gold, a lawyer who specializes in insurance recovery cases. “It must be frightening for underwriters who took on these risks.”
The case also highlights the difficulty in determining whether head trauma — either from a single concussion or from multiple head hits — has permanently sidelined a player. Unlike, say, the effects of a torn rotator cuff, the lasting impact from head trauma can be measured by fewer objective means.
Nakamura retired after he sustained a severe head injury during a preseason game in August 2013. Five days later, the Panthers released him, citing his concussion as the reason. For months afterward, Nakamura continued to have severe headaches, blurry vision, fatigue and mood swings, making it impossible for him to do any strenuous activity, let alone play football.
Nakamura, now 30, applied for the N.F.L.’s Player Retirement Plan, which in 2015 determined that he had chronic postconcussion syndrome and was eligible for “total and permanent disability benefits” worth $10,000 a month. Dr. Michael Collins, the director of the UPMC Center for Sports Medicine, also determined that Nakamura “is permanently disabled and likely has no hope of improvement sufficient to participate ever again as a professional football player.”
Nevertheless, Lloyd’s, through an affiliated underwriter in the United States, Empirical Loss Management, denied Nakamura’s separate insurance claim, stating that he had failed to show that the concussion he sustained in 2013 had “solely and independently” led to his permanent disability.
Dr. Manish Fozdar, who was hired by the insurer, disputed Dr. Collins’s finding. He called the concussion that Nakamura sustained “minor” and said that it “does not lead to the development of major depression.” He added that Nakamura showed “clear evidence of postconcussive and cognitive symptom exaggeration in the absence of significant emotional factors.”
An executive handling Nakamura’s claim at Empirical Loss Management did not return calls for comment.
Nakamura’s lawyer, John Schryber, of the law firm Reed Smith, said that the insurer had denied his client’s claim even though the N.F.L. had determined Nakamura was unfit to play in the league. He added that the insurer was aware that the growing spotlight on concussions and chronic traumatic encephalopathy, or C.T.E., a chronic brain condition linked to repeated head hits, might lead to more claims.
“It may turn out based on the recent C.T.E. studies that they may prove to be the most common career-ending injury,” Schryber said.
Dan Burns, chief executive of Pro Financial Services, which underwrites insurance for players and teams, said that football players were most at risk because they had short careers on average and because most contracts were not guaranteed. As a result, they should be protected against concussions and degenerative brain disease.
“It’s gotten a lot more attention, and I think the leagues have made progress in diagnosing them properly, but it’s a risk we’ve been aware of for decades,” he said.
Nakamura’s wife, Jamie, is living with the effects of those risks. Her husband, she said, became a different person after he sustained the concussion in 2013, and the more than 50 visits to the doctor since then, on top of the insurer’s denial of his claim, have added to his stress.
“We have lives that have to continue, and we’ve been waiting for this, so what else does he have to do to get what we deserve?” she said.