Pro Athletes Should Watch For Insurance Companies Claiming “Cumulative Trauma”
Practically every professional athlete is likely to suffer some cumulative wear and tear to their bodies over the course of a playing career. However, some disability insurance policies may use that cumulative trauma as a basis to deny disability benefits when a serious injury ends a player’s career.
Gordon Gordon & Centracchio recently litigated a claim on behalf of an NHL player whose career ended due to a serious concussion. That player had a disability insurance policy that should have provided $1 million in disability benefits to the player, but the insurance company denied the claim. According to the insurance company, the “disability” wasn’t the one concussion – but rather – the accumulation of all the concussions the player had sustained over the course of his career. We didn’t see it that way and successfully took on the insurance company.
Rarely do professional athletes retire from old age. It’s almost certainly an injury – or multiple injuries – that lead to hanging up the skates or cleats. Disability insurance is a practical and effective way for a professional athlete to protect himself from that inevitable retirement day.
Is It A Cumulative Injury or Not?
Insurance companies are quick to sell professional athletes disability insurance at very high premiums. It should come as no shock that the insurance company often denies the claim – usually relying on an exclusion that precludes coverage for the effects of cumulative trauma.
“Cumulative” means the effect of excessive wear and tear over time on joints, tendons, etc. We all have cumulative wear and tear on our bodies – athletes and non-athletes alike. But when is a career-ending injury the result of “cumulative” trauma vs. an acute traumatic event? What if both can be argued?
That was the question we faced in this NHL disability concussion claim. The insurance company claimed the player’s career ended due to the cumulative effects of multiple concussions over the player’s career. We argued that it was this last concussion – the one from which the player never returned – that acutely ended his career and thereby triggered insurance coverage. We won the argument. But why?
Who Assumes the Burden of Proof – the Player or the Insurance Company?
In order for the insurance company to deny disability benefits based on a cumulative trauma endorsement, the insurance company (not the player) must prove that it is more likely than not (greater than 50% likelihood) that the career-ending event was cumulative. In our recent NHL concussion case, the insurance company was unable to meet this burden of proof. Therefore, under the law, we forced them to pay the policy benefits to our client.
We’ve won similar cases for players dealing with knee, wrist, back and shoulder injuries.
The insurance companies will always make you fight for your benefits. That’s why you need to engage attorneys like Gordon Gordon & Centracchio to fight for your rights.
Even when an insurance company has the burden of proof, it’s the professional athlete’s burden to fight for your rights to coverage. The insurance company bets that you’ll cave in and walk away from the claim. Don’t. Turn to Gordon Gordon & Centracchio instead. The outstanding reputation of our attorneys in representing professional athletes is precisely the type of counsel you need. Contact us today for a free consultation.
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