Section one sports policy risk
I reviewed an insurance policy for sports related industry that is touted as catering towards mental health. The policy whilst unique in itself and being one of the first insurance policy types that claims to cover development of mental health related illness. I cannot name the policy for legal reasons, in review, this insurance company charge fees not only to the team/player/club monthly they also charge the union body £25000.00 per month on retainer to continuing to reuse their services. This is the main leading sports insurer for the sporting profession.
The policy in itself for an athlete offering protections is not fit for purpose, due to the connection between CTE evidencing behaviour disorder, there is no cover that offers protections specifically for and or against CTE or dementia related disease. Consider these ridiculous exclusions that I found under the exclusion sections:
1-Being a professional footballer. •2- Any claim attributable either to arthritic or other degenerative conditions in joints, bones, muscles, tendons or ligaments. •3- Repetitive stress (strain) injury or syndrome. 4-• Naturally occurring condition or gradually operating cause. •5- Illness or sickness.
Subject to point 1, this from a professional review suggests if you are a professional footballer you are actually excluded on that ground for even making a claim, this is such an absurd notion that it actually creates legal issue for an unfair contract term subject to the UK legislation Unfair contract terms act 1977. You then observe the further wording under point 2 and I do take issue with the wording here “any claim attributable either to arthritic or other degenerative condition”, now this specifically excludes ANY degenerative condition which CTE and or dementia fall in this bracket. Under section 3 repetitive stress (strain) injury or syndrome indicates yet another major factor for excluding CTE and associated degenerative and or stressful condition that we now know is already scientifically proven and further than that, any stress related injury or syndrome that formulates as a result of the CTE condition. If you have seen my research and observed the blogs you will understand the devastating impact this disease will have, if you have taken a single step towards fighting back as suggested within my blogs you can actually advise an insurer if you are taking steps to fight back, which in essence should lower premiums if you are seeking an individual based additional protection policy.
Subject to two clauses contained within the Unfair Contract Terms Act 1977 :
- Section 2(1) provides ‘a person cannot by reference to any contract term … exclude or restrict his liability for death or personal injury resulting from negligence.’
- Section 2(2) provides ‘in the case of other loss or damage (i.e. other than death or personal injury), a person cannot so exclude or restrict his liability for negligence except in so far as satisfies the requirement of reasonableness.’
The contract as agreed between you and the insurer would be sufficient grounds to raise dispute on grounds of breach of contract especially on high value cases.
The vague ambiguity covered under number 4 worded as naturally occurring condition or gradually operating cause does in the very legal sense create ambiguous wording. This is further evidence for you in raising dispute if you find the exclusion term is thrown at you as a means by which to exclude or prevent you from claiming. In my professional experience in dealing with many insurance companies internationally I found you have every right to raise a dispute to the exclusion clause as rendering the policy not fit for purpose. This means you would in essence have to jump through insurance complaint hoops before you end up being able to escalate your dispute legally or attempt at mediation for resolution. One question I would advise you to consider, why should you be forced into having to go down those channels for an insurance policy that you pay for, regardless of standing as an athlete or actor you are still a consumer and afforded all the available protections under the regulations and the law.
The final insult is the section 5 wording which spans such a huge area it covers everything else in stating illness or sickness. This in my professional view is so wide and vague it effectively mops up every other potential area for illness or sickness that could form and further reinforces the insurer position that you are excluded under this for every other ailment. This in my view renders the fit for purpose aspect of this cover as void and wholly inadequate in offering any protections, so why pay the premium which more than likely costs your club/or individual athlete thousands if not millions. The insurance policy is effectively void in every way, offers no protections in any way.
The manner in which CTE actually evidenced degenerative brain disease and leads to development of other conditions is quite critical in how insurers need to adapt and review their policies. I offer a confidential review of your insurance policy on an impartial basis.
When I see insurance policy contracts claim they offer cover for development of mental illness, I thought to myself that would be a huge leap forward in adapting to change. In considering your own review you should check the wording of the actual policy and specifically look for any of those vague and legally ambiguous sections as listed above. Then cross reference that with the exclusion section of your contract, you may very well find it not being fit for purpose.
I know you may ask, well what do I do to ensure my insurance is fit for purpose, one simple step is to check as stated above. You have every legal right as part of any contract negotiation to put forward your own caveats to add to your insurance policy, it is a two way negotiation you must not forget that. If they simply tell you what they want you to accept and you just go with the flow you will more than likely end up with an insurance policy that does not protect you.
One suggestion for your consideration is to ask this question:
Does this cover protect me from degenerative conditions now and in the future,
They may say what do you mean, so lay it out their directly as possible. If I develop a degenerative disease that leads to further diagnosis of mental health related disease will I be protected. You will know from their response if you will be covered or not.
The response to this question alone will help you or your representative assess/decide if you are covered during your career and after. The reason behind that question is to determine if you are diagnosed with a degenerative condition during your career, they may very well decide to end your career or offer alterative roles other than playing, this will mean you should be able to make a claim if they take any and or all action that leads to end of career decision and the policy will mean pay out until your retirement age. Do not forget that CTE develops in much the same way asbestosis forms, it can span over a forty year development period.
Currently and further delving into the review, there is a section that offers financial reward for dealing with a concussion and that figure was quoted as £10000.00 pounds, this figure is stark in value, it is legally questionable to whether you should accept it for the legal reason as follows. If you accept the insurance figure on such a small value and go on to develop CTE after the concussion you may find that you have inadvertently waived your rights to making claim at a later date in being retired due to the disease.
I would seriously advise athletes of all ages involved in sports or other associated professions to consider the routes towards ensuring you have the right insurance policy in place for protections. This means protections for development of a “degenerative disease”, key on using those words when asking for renewal or your insurance policy. In addition to stating what future protections does it offer, again key on wording when negotiating with an insurer for a policy and or renewal.
I hope that helps you understand one avenue available to you and hope it helps you address the issue now rather than later. I have as part of my negotiations approached Lloyds of London with the ambition to motivate the insurance profession to taking those leaps in modifying archaic contract terms, words used themselves by Lloyds of London was that” it was refreshing to see people thinking outside of the box, in proposing changes to age old historic insurance policy wording that in most cases was drafted in the 1800 hundreds if not before. I have also made contact with some amazing forward thinking insurers who do think outside the box in hope of creation of a new style product never realised in this country to date. Time for changes.
Section 2 – Acting /performer insurance policy risk and review
I conducted a review of the insurance policy that I would assume most performers/actors/actresses within the UK take out when they go into their chosen profession. I also conducted a review of a Hollywood based insurance policy, so this blog will break into two sections covering acting insurance policy risk and review.
I would start with the review of the UK based insurance policy with specific focus on offering CTE based degenerative protections to include Mental health conditions. I found one such policy that is widely recommended when signing up to obtain a certain acting card. I will not name the company for legal reasons. The policy I reviewed had sections contained below:
The policy pays the following benefits in the event of an accident covered by the policy: > loss of life — £20,000; > loss of one or more limbs — £20,000; > permanent total disablement — £20,000; > facial disfigurement — up to £5,000; > temporary total disablement — £150 per week payable for up to 52 weeks excluding the first 2 weeks; > medical expenses — up to £6,625; > coma benefit — £50 per day to a max 52 weeks; > hospital benefit — £50 per day to a max 52 weeks; > disability assistance — up to £20,000; > funeral benefit — £10,000; > dental benefit — £500; > optical benefit — £500;
The benefits of this insurance policy seem to be a low ball figure that has never been reviewed in line with the rates of inflation. If you consider some actors/presenters/performers would earn millions if not hundreds of thousands a year in performance of their role, this kind of insurance policy is very basic and offers zero protections in a way that caters for CTE, degenerative disease and or development of dementia related condition that may lead to other associated mental health condition. I looked once more for those key words permanent total disablement which creates yet again the vague and ambiguous wording that serves no specific term for the condition, and also raises questions as to whether the insurer would actually classify CTE, degenerative brain disease and mental health degradation as a permanent disablement. It would be highly likely the insurer would not classify such a specific degenerative condition under this bracket and would in all fairness try and sell you some form of additional insurance policy claiming it does a lot more but you have to pay more.
Given the extent of my research evidencing what occurs and how, to include what forms in the brain you will understand the kind of behaviour issue that forms as a direct result of the CTE condition. I cross referenced the above with the exclusion clauses :
Injury arising from or contributed by: > any aerial activity (other than as an acrobat) such as hang-gliding, parachuting, paragliding, kite surfing, bungee jumping and the like: > involvement in the armed forces/services; > emotional or psychiatric conditions; > the use of un-prescribed drugs; > self-harm and suicide;
Know Bear Grylls may find interest in reviewing his insurance policy for all the amazing work he puts in around the globe to keeping people inspired and motivated whilst performing those death defying acts. I notice this week the amazingly talented Holly Willoughby had a scare when she thought a light had fallen from the ceiling in the studio, it only takes one impact and could lead to development of the disease.
You will observe there is zero cover from alleged financial rewards from any diagnosis of those conditions. Based on those exclusions you will see the emotional or psychiatric condition which is so far reaching and vague it is what I would construe as a generic clause of exclusion. The exclusion clause caters for any and or all stress related conditions and further than that any mental health related disorder, you would have zero chance of being able to make any kind of successful claim on any basis with these insurance policies.
Section 2 of Acting Insurance policy and review Hollywood
It was a real task in trying to source a Hollywood celebrity insurance policy, in the first instance I was able to find an article of celebs actually insuring their bodies and other associated body parts. This was an interesting issue to the extent the celebs have insured everything ranging from legs, bottoms through to the actual body, however in every case not one person actually insured their brain. This led me to considering if celebs can insure their bodies in all their splendour, then why not the brain, is there some clause or issue that insurers claim they cannot cover. Unfortunately if it is the case you can insure anything if you throw enough money at it then it solely comes down to standing in life and an actor who may be just starting out may not be given the same opportunity to do the same.
It makes legal and protective sense to have an insurance policy for ensuring your brain in its amazing function is protected against damage and or harm. Is there an insurer in the UK or internationally that could actually cater for creating a policy that is specifically designed for this purpose. You may ask why, if you consider the above insurance policies and their respective exclusions that render the policy not fit for purpose, why could we not simply bypass the standard insurance policy in protecting the one function that governs all decision making. I believe if you insure the brain against harm, degradation and or dementia would be a far better direct route to assess medically when a person is affected by CTE and goes on to develop further associated symptoms. It bypasses all need for a policy that covers specifically an event-based trigger and further, the need for any exclusion-based assessment.
I ventured across one insurance policy which offered an A list celeb a 50 million insurance protection against sustaining injury during filming an event, choreography or other activity associated within their capability. If the insurer are offering that kind of protection it makes me wonder what kind of fees are being charged, so why not simply request insurance that protects the brain from the offset. The cover did not factor in degenerative disease or cater towards developing mental health trauma as a result of performance of a given event or role. In my view despite all the amount offered it does not adequately protect as it should do, the disheartening issue here is the amount celebrity’s must be spending on these kinds of insurance policies. Contained within the exclusion section it used wording as follows:
Self-inflicted injury or suicide, pregnancy and childbirth, existing illness or disease prior to the insurance being affected, aids or aids related complex, intoxication by alcohol, narcotics or drugs not prescribed by a registered medical practitioner and injury, sickness or accident sustained or medical treatment received outside of lawful jurisdiction.
In assessing the fitness if such a hugely complex statement does indirectly invalidate itself, with comments like self-inflicted injury, this means if you take part in an event where you may be asked to perform a specific role and you consent to conducting that role, if you at any point hurt yourself you would actually be excluded from making a claim for such things as CTE and or dementia related disease. We see the further words as injury, sickness or accident which again raises serious vague ambiguity on wording that caters for such a wide-ranging exclusion meaning any and or all illness, sickness could potentially be argued as having different meaning to that of sickness, so you may have a slight chance of making a claim here.
The accident wording is another example of whether you may have grounds to argue legally if you went on to develop the disease because you could potentially state it was through no accident or fault of your own that you took part in a role that you were not made aware of had inherent risks. I see two potential avenues here in what I would say is precatory wording.
The US market for insurance are in fact industry leaders in their respective fields, you would assume they have policy that caters for everything, so it is quite alarming to see some policy documents really are not worth the paper they are printed on. We in the UK have insurance giants like Lloyds of London who have their own set of brokers that cater for assessing such need, and so , when I approached Lloyds innovation team they welcomed the thoughts behind the reason to create a new style insurance policy. It becomes clear that insurers on both sides of the pond do not offer the legally necessary protections.
There has to be a direct link medically between symptoms or variants of CTE that do lead to other associated variants, for example, the case of the hugely talented and sorely missed Robin Williams where he was originally misdiagnosed with Parkinsons. How was that achieved in the assessment phase, did he manage to make a claim on his insurance policy?. Unfortunately, after he passed away he was able to correctly receive a diagnosis, this is one reason why we need to continue to develop research in these dementia related and CTE fields. I was not able to find a single instance where Mr Williams had occurred a head trauma through a physical act, this in my view would suggest there has to be a direct medical connection between stress and or trauma. What I classify as the fight or flight response could have further connection in the chemical release in the body and brain and a singular event may have triggered a possible underlying genetic issue which led to the dissassociative disorder and ultimately him sadly taking his own life. There was one article accredited here Lewy body dementia: The life-changing disease that devastated Robin Williams – Boston News, Weather, Sports | WHDH 7News. In much the same way the tau protein forms in the brain from repetitive injury, the lewy body forms as an accumulation of a similar form of protein strand. The symptoms that occur in this process are an exact match to how the tau protein build up affects motor function, and behaviour change. It is therefore reasonable to assume the process as to how it forms must be created from a singular stressful event occurring rather than an accumulation of physical traumas.
I would state with certainty there is a very live legal need for all respective people in these fields to review their policy of insurance for the reasons as mentioned earlier. We simply cannot allow the same thing to occur again through a failure of insurance not standing up to what it is designed to do, this includes possible contract negotiations where you could add caveats to your contract which give you added piece of mind before you take up a role, you will see such clauses within the provisioning clauses section of my site for your consideration.
Each time we face our fear, we gain strength, courage, and confidence in the doing. -Theodore Roosevelt
Investigate for yourself the insurance policy, check the wording and then if necessary, apply the changes.
Credit to Scott Graham for image