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CTE: What Lies Ahead for Workers’ Comp?

As CTE increasingly becomes an emerging issue for other professions, workers' comp stakeholders should start thinking about how to prepare for future CTE claims.
By: | November 1, 2017 • 5 min read

The summer of 2017 saw the first claims paid out to retired NFL players from the $1 billion settlement fund created in the wake of the class-action lawsuit brought by former athletes against the league. In the suit, retired players alleged that the NFL covered up evidence of the damaging neurological effects caused by repeated hits to the head.

At the root of that neurological damage lies Chronic Traumatic Encephalopathy, or CTE.

CTE may cause a host of cognitive and behavioral problems, including depression, aggression and violence, paranoia and impulse control, impaired judgment, confusion, progressive dementia, Parkinson’s and Alzheimer’s disease.

But those symptoms may not manifest until someone reaches their 40s or 50s. The brain damage can begin decades earlier and builds over time through repeated sub-concussive hits to the head. The type that linemen can sustain dozens of times within a single game.

Linking the symptoms to CTE is difficult, though, because the condition currently can only be diagnosed after death.

The NFL controversy might have swiveled the spotlight onto CTE and raised public awareness, but it has also raised questions and concerns in other industries. There’s no telling how many other professions are at risk of sustaining head trauma and developing the disease.

“As we learn more about CTE, it opens the door to other types of professions where it’s not an emerging issue yet because they are not as high-profile as professional sports,” said Danielle Jaffee, Manager of Government Affairs, IWP.

As research sheds more light on this neurodegenerative disease, proactive discussions about the risk of CTE can help the workers’ comp industry stay ahead of the curve.

Researchers Take on CTE

Danielle Jaffee, Manager of Government Affairs

The NFL settlement compensates former players experiencing CTE symptoms for medical testing and further care, but freed the NFL from admitting fault or disclosing what it knew and when about the link between repetitive head trauma and CTE.

But others are quickly filling in the gaps.

Boston University’s CTE Center has identified markers in brain tissue that indicate CTE, and researchers are moving toward the goal of developing a method to diagnose CTE in living people, as well as potential treatments. It draws on a bank of 425 donated brains, 270 of which have been diagnosed with CTE.

Other entities like the Brain Injury Research Institute and Stanford University are also studying ways to identify CTE in a living brain, and what sources and types of trauma may lead to degeneration of brain tissue.

But they remain a long way off from understanding how to diagnose or effectively treat the condition.

Workers’ Comp Implications

“We don’t yet have a test in place that could indicate if a living person has CTE,” said Jaffee. “And you can’t have a workers’ comp claim without a diagnosis. So while CTE hasn’t impacted our industry yet, it certainly has the potential to do so.”

The NFL lawsuit could provide a rough blueprint for how claims may be handled in the future, but challenges emerge in variations among states’ classification of professional athletes.

Many states bar professional athletes from filing workers’ comp claims or set caps on payout amounts, so claims filed in the NFL settlement won’t translate directly to a workers’ comp scenario.

“There are states like Kansas that define professional athletes as employees, but other states like Florida specifically exclude them. And then there are states that defer to labor union contracts,” Jaffee said. “If there were less restrictions on professional athletes, you might have greater likelihood of them filing claims.”

Thirty-eight former players involved in the NFL lawsuit did opt out of the settlement, preferring to pursue their own claims individually in state court.

“They’re trying to force the NFL to cover CTE as a workers’ comp claim, but the court system is slow and we haven’t seen yet how that will play out,” Jaffee said.

Even if the courts allow athletes to file a works’ comp claim, it’s uncertain whether they’ll recognize CTE as a compensable injury due to its cumulative nature. State laws again vary in whether cumulative trauma qualifies as a workers’ comp injury, and claimants will bear the burden of proving a direct link between their symptoms and their tenure as pro football players.

Despite these challenges, “I think a professional athlete making a workers’ comp claim for CTE is how we’re going to figure out how it works – if it works – and how we should respond as an industry,” Jaffee said.

Getting the Conversation Going

In the face of so many unanswered questions, how can stakeholders in the workers’ comp industry prepare for future CTE claims?

“At IWP, our goal is start a conversation around this topic with all stakeholders: the insurers who would cover claims, the PBMs that would handle the medications, the pharmacies and doctors treating the injury, and the legislators and policymakers crafting state law. Even the lawyers who could represent claimants, whether they are professional athletes or not,” Jaffee said.

“We’re trying to stay on top of things that will impact our industry and make sure that these discussions are happening now so that no one is caught off guard.”

It will take time for further research to illuminate the details of how CTE develops and progresses, and what could be done to treat the disease before it’s too late. But there is enough understanding to drive preventative measures and find ways to reduce repeated head trauma.

Even the NFL has encouraged safer tackling techniques and flag football as an alternative for younger players.

CTE might not have an impact on worker’s comp in the next year or even five years, but planning ahead will yield less confusion and better outcomes for providers, payers and claimants alike.

“Through these conversations, and as we learn more about CTE, we’ll be looking at our workers’ comp systems and questioning if those systems are the best avenue to handle these claims. And if not, do we need to figure out a better way?” Jaffee said.

“We’re here to start and facilitate that conversation so that states can effectively serve their communities in this area as it emerges.”

To learn more, visit https://www.iwpharmacy.com/.



This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with IWP. The editorial staff of Risk & Insurance had no role in its preparation.

IWP is a national home delivery pharmacy service working as an advocate for injured individuals. Fully licensed in 48 states, IWP enhances patient access and alleviates administrative and financial burdens.

High Net Worth

High Net Worth Clients Live in CAT Zones. Here’s What Their Resiliency Plan Should Include

Having a resiliency plan and practicing it can make all the difference in a disaster.
By: | September 14, 2018 • 7 min read

Packed with state-of-the-art electronics, priceless collections and high-end furnishings, and situated in scenic, often remote locations, the dwellings of high net worth individuals and families pose particular challenges when it comes to disaster resiliency. But help is on the way.


Armed with loss data, innovative new programs, technological advances, and a growing army of niche service-providers aimed at addressing an astonishingly diverse set of risks, insurers are increasingly determined to not just insure against their high net worth clients’ losses, but to prevent them.

Insurers have long been proactive in risk mitigation, but increasingly, after the recent surge in wildfire and storm losses, insureds are now, too.

“Before, insurance was considered the only step in risk management. Now, our client families realize it is one of the many imperative steps in an effective risk management strategy,” said Laura Sherman, founding partner at Baldwin Krystyn Sherman Partners.

And especially in the high net worth space, preventing that loss is vastly preferable to a payout, for insurers and insureds alike.

“If insurers can preserve even one house that’s 10 or 20 or 40 million dollars … whatever they have spent in a year is money well spent. Plus they’ve saved this important asset for the client,” said Bruce Gendelman, chairman and founder Bruce Gendelman Insurance Services.

High Net Worth Vulnerabilities

Laura Sherman, founding partner, Baldwin Krystyn Sherman Partners

As the number and size of luxury homes built in vulnerable areas has increased, so has the frequency and magnitude of extreme weather events, including hurricanes, harsh cold and winter storms, and wildfires.

“There is a growing desire to inhabit this riskier terrain,” said Jason Metzger, SVP Risk Management, PURE group of insurance companies. “In the western states alone, a little over a million homes are highly vulnerable to wildfires because of their proximity to forests that are fuller of fuel than they have been in years past.”

Such homes are often filled with expensive artwork and collections, from fine wine to rare books to couture to automobiles, each presenting unique challenges. The homes themselves present other vulnerabilities.

“Larger, more sophisticated homes are bristling with more technology than ever,” said Stephen Poux, SVP and head of Risk Management Services and Loss Prevention for AIG’s Private Client Group.

“A lightning strike can trash every electronic in the home.”

Niche Service Providers

A variety of niche service providers are stepping forward to help.

Secure facilities provide hurricane-proof, wildfire-proof off-site storage for artwork, antiques, and all manner of collectibles for seasonal or rotating storage, as well as ahead of impending disasters.

Other companies help manage such collections — a substantial challenge anytime, but especially during a crisis.

“Knowing where it is, is a huge part of mitigating the risk,” said Eric Kahan, founder of Collector Systems, a cloud-based collection management company that allows collectors to monitor their collections during loans to museums, transit between homes, or evacuation to secure storage.

“Before, insurance was considered the only step in risk management. Now, our client families realize it is one of the many imperative steps in an effective risk management strategy.” — Laura Sherman, founding partner, Baldwin Krystyn Sherman Partners

Insurers also employ specialists in-house. AIG employs four art curators who advise clients on how to protect and preserve their art collections.

Perhaps the best known and most striking example of this kind of direct insurer involvement are the fire teams insurers retain or employ to monitor fires and even spray retardant or water on threatened properties.

High-Level Service for High Net Worth

All high net worth carriers have programs that leverage expertise, loss data, and relationships with vendors to help clients avoid and recover from losses, employing the highest levels of customer service to accomplish this as unobtrusively as possible.

“What allows you to do your job best is when you develop that relationship with a client, where it’s the same people that are interacting with them on every front for their risk management,” said Steve Bitterman, chief risk services officer for Vault Insurance.

Site visits are an essential first step, allowing insurers to assess risks, make recommendations to reduce them, and establish plans in the event of a disaster.

“When you’re in a catastrophic situation, it’s high stress, time is of the essence, and people forget things,” said Sherman. “Having a written plan in place is paramount to success.”


Another important component is knowing who will execute that plan in homes that are often unoccupied.

Domestic staff may lack the knowledge or authority to protect the homeowner’s assets, and during a disaster may be distracted dealing with threats to their own homes and families. Adequate planning includes ensuring that whoever is responsible has the training and authority to execute the plan.

Evaluating New Technology

Insurers use technologies like GPS and satellite imagery to determine which homes are directly threatened by storms or wildfires. They also assess and vet technologies that can be implemented by homeowners, from impact glass to alarm and monitoring systems, to more obscure but potentially more important options.

AIG’s Poux recommends two types of vents that mitigate important, and unexpected risks.

“There’s a fantastic technology called Smart Vent, which allows water to flow in and out of the foundation,” Poux said. “… The weight of water outside a foundation can push a foundation wall in. If you equalize that water inside and out at the same level, you negate that.”

Another wildfire risk — embers getting sucked into the attic — is, according to Poux, “typically the greatest cause of the destruction of homes.” But, he said, “Special ember-resisting venting, like Brandguard Vents, can remove that exposure altogether.”

Building Smart

Many disaster resiliency technologies can be applied at any time, but often the cost is fractional if implemented during initial construction. AIG’s Smart Build is a free program for new or remodeled homes that evolved out of AIG’s construction insurance programs.

Previously available only to homes valued at $5 million and up, Smart Build recently expanded to include homes of $1 million and up. Roughly 100 homes are enrolled, with an average value of $13 million.

“In the high net worth space, sometimes it takes longer potentially to recover, simply because there are limited contractors available to do specialty work.” — Curt Goetsch, head of underwriting, Private Client Group, Ironshore

“We know what goes wrong in high net worth homes,” said Poux, citing AIG’s decades of loss data.

“We’re incenting our client and by proxy their builder, their architects and their broker, to give us a seat at the design table. … That enables us to help tweak the architectural plans in ways that are very easy to do with a pencil, as opposed to after a home is built.”

Poux cites a remote ranch property in Texas.

Curt Goetsch, head of underwriting, Private Client Group, Ironshore

“The client was rebuilding a home but also installing new roads and grading and driveways. … The property was very far from the fire department and there wasn’t any available water on the property.”

Poux’s team was able to recommend underground water storage tanks, something that would have been prohibitively expensive after construction.

“But if the ground is open and you’ve got heavy equipment, it’s a relatively minor additional expense.”

Homes that graduate from the Smart Build program may be eligible for preferred pricing due to their added resilience, Poux said.

Recovery from Loss

A major component of disaster resiliency is still recovery from loss, and preparation is key to the prompt service expected by homeowners paying six- or seven-figure premiums.

Before Irma, PURE sent contact information for pre-assigned claim adjusters to insureds in the storm’s direct path.

“In the high net worth space, sometimes it takes longer potentially to recover, simply because there are limited contractors available to do specialty work,” said Curt Goetsch, head of underwriting for Ironshore’s Private Client Group.


“If you’ve got custom construction or imported materials in your house, you’re not going to go down the street and just find somebody that can do that kind of work, or has those materials in stock.”

In the wake of disaster, even basic services can be scarce.

“Our claims and risk management departments have to work together in advance of the storm,” said Bitterman, “to have contractors and restoration companies and tarp and board services that are going to respond to our company’s clients, that will commit resources to us.”

And while local agents’ connections can be invaluable, Goetsch sees insurers taking more of that responsibility from the agent, to at least get the claim started.

“When there is a disaster, the agency’s staff may have to deal with personal losses,” Goetsch said. &

Jon McGoran is a novelist and magazine editor based outside of Philadelphia. He can be reached at [email protected]