1/9 What’s Causing Athletic Injuries? Lessons From Claims EduRiskSolutions.org

Risk Research Bulletin

What’s Causing Athletic Injuries? Lessons From Claims

Whether conditioning, practicing, or competing,

student athletes often test their physical limits or place

themselves in harm’s way. From 2007–2011, United

Educators (UE) received 209 claims involving injured

intercollegiate and club athletes that generated a total

of more than $15.5 million in monetary losses to UE

and its member institutions.

A review of UE’s claims shows that deficiencies in

coaching, facilities, equipment, and medical care held

institutions responsible for player injuries.

UE Claims Data

Intercollegiate vs. Club

In UE’s five-year claims study, nearly 20 percent of the 209 claims resulted in losses—both legal fees and payments to claimants—with the average claim costing more than $420,000. Intercollegiate or varsity athletes filed almost three-quarters of the injured player claims and were responsible for 63 percent of the losses. The remaining claims and losses arose from club sports.

Figure 1: Percent of Claims and Losses by Sport Type

0%

10%

20%

30%

40%

50%

60%

70%

80%

73%

27%

63%

31%

Varsity Sports

Club Sports

Percent of Claims Percent of Losses

Sports With Injuries

Contact sports generated the most claims with the following sports accounting for 67 percent of the study’s injured athletes: football (19 percent), basketball (16 percent), softball (13 percent), soccer (11 percent), and baseball (8 percent). Slightly more than half of these injuries, 51 percent, occurred in competition, although athletes spend more time practicing than competing.

Figure 2: Sports with Injuries

33%Other

19%Football16%Basketball

13%Softball

11%Soccer 8%Baseball

Common Causes of Injuries

Coaching errors were the top cause of player injuries and cited in 40 percent of the claims with losses. At 31 percent, defects with the athletic facility were the second most frequent. Other common causes of player injuries include improper medical care (20 percent) and problems with athletic equipment (9 percent).

Figure 3: Common Causes of Injuries

40%Coaching Error

31%Facility Defect

20%ImproperMedical Care

9%

EquipmentProblems

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3/9 What’s Causing Athletic Injuries? Lessons From Claims EduRiskSolutions.org

Claims Lessons

While risk is inherent in all college sports, an institution can be liable if it does not use reasonable care to prevent foreseeable player injuries. The following claims lessons suggest risk management measures to improve coaching, facilities, equipment, and medical care to prevent and respond to athlete injuries.

Lesson #1 Train athletics staff on safety and liability issues

As the study shows, sports present significant safety and liability risks for institutions. Yet many institutions fail to educate their athletics staff on safety and liability issues. To properly educate staff, consider the following ideas:

❚ Start from the top down. To ensure that staff take the institution’s training efforts seriously, intercollegiate athletic directors and heads of club sports should make clear that they support the training and that athlete safety is a top priority. For example, Princeton University’s athletic department has identified the goal of athlete well-being in the mission statement of its Student Athlete Handbook.

❚ Involve the institution’s risk manager. Risk managers study the college’s liability exposures, claims, and insurance coverage and often have valuable safety and liability expertise. While many institutions involve the risk manager in club sports, they are often not involved in intercollegiate athletics. Risk managers can assist in training athletics staff or identifying training resources.

❚ Train all new employees. At the very least, an institution’s education program should target new hires. Many newly hired coaches and trainers are recent college graduates. While knowledgeable of their sport or field, they may not fully understand the risks and liability issues associated with their positions.

❚ Learn from athlete injuries and near misses. Prior injuries or situations in which athletes narrowly avoid injury are great learning opportunities. Athletic programs should regularly review causes of athletic injuries and how they can be avoided. Additionally, review media articles about injuries occurring at other institutions and discuss how your college would handle a similar situation.

Lesson #2 Prioritize player safety and well-being over competition

In more than half of the claims caused by coaching errors—the top cause of athlete injuries—coaches appeared to place competition ahead of safety and showed a lack of empathy for injured players. Consider the following example from an actual claim:

Due to rain, a college softball game is delayed and moved to a new field. On the new field, the coach notices patches of ice in the team’s dugout, but she does not point them out to her players. During warm-ups, a player slips and falls on the ice and breaks her arm. The coach appears annoyed with how the injury disrupts her line-up and she does not check on the player following the game. The player sues the college, claiming the coach was negligent for not warning her players about the ice in the dugout or trying to correct the dangerous condition.

The coach appears more concerned with trying to complete the game than about player safety. Despite the game delay, the coach or other athletic personnel should have warned players about the ice and alerted facilities or grounds personnel to correct the condition. Under tort law, if an institution employee fails to warn of or correct a dangerous condition, the institution may be held responsible for injuries arising out of that hazard.

Moreover, the coach should have gone out of her way to show concern for the injured player and refrained from appearing inconvenienced. In UE’s experience, when athletics personnel strike the right balance of empathy and professionalism, injured players are more likely to feel goodwill toward the team and less likely to sue the college and its employees. UE calls this balance the “Cool Head, Warm Heart™” approach and recommends taking these steps when an athlete is injured:

❚ Appoint a liaison from the coaching staff and a team member to periodically check on the student’s status and offer support

❚ Promptly report the injury to parents and the relevant campus department that can provide support, such as the dean of students’ office

❚ Contact the risk manager or financial officer to see if there are funds or insurance to cover the student’s medical expenses

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Lesson #3 Consistently require or encourage the use of protective equipment

A significant coaching error that drove claims was the failure to consistently require or encourage players to use protective equipment. Consider the following example:

A college baseball pitcher is pitching batting practice at a close range without a protective screen also known as an “L screen.” While the team has some L screens, the pitcher is reluctant to request one for fear of seeming weak to the coach and teammates—particularly because the coach never encourages players to use these protective screens. A ball strikes the pitcher in the face, causing severe facial injuries. The player sues the institution and the coach, alleging the coach was negligent for failing to provide protective equipment to players.

While it is not clear whether the coach forgot about the protective equipment or purposefully decided it was unnecessary, coaches set the tone for use of this equipment. When coaching staff do not consistently instruct players to use protective equipment, those employees and the institution can be liable for resulting player injuries. Lack of equipment is a hazard and, as previously noted, athletics staff have a duty to warn about or correct any hazards observed. To ensure players use protective equipment, coaching staff should:

❚ Require players to use all safety equipment identified as mandatory by authoritative sources. From a liability perspective, consider equipment recommended for use by a trustworthy source, such as the NCAA Sports Medicine Handbook.

❚ Require players to use all safety equipment owned by the institution. If the athletic program owns the protective equipment, then use it or be prepared to explain why a piece of equipment was purchased but not used.

❚ Encourage players to police each other and report issues with equipment. Athletics staff can place some of the onus on athletes by teaching them the importance of safety equipment and encouraging them to correct each other and report any problems with equipment.

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Lesson #4 Check for hazards adjacent to locations of play and practice

Facility defects caused almost one-third of the study’s injuries. Coaches and trainers often focus on the area of play, but the majority of these claims occurred adjacent to the area. Consider the following examples:

❚ A football player was severely injured when he ran out of bounds and tripped on mats covering concrete areas surrounding the college’s football field.

❚ A pole vaulter was killed when he landed in an unpadded area to the side of the landing pit.

❚ A basketball player suffered severe lacerations to his hand when he ran into an unpadded window near the court.

❚ A ski team member was severely injured when he collided into an unpadded pole near the ski course.

In the above cases, the claimants argued that the institution should have inspected these adjacent locations since it is foreseeable that an athlete might encounter hazards near the area of competition. Moreover, authoritative sources, such as the NCAA’s Sports Medicine Handbook, recommend that an institution’s inspection of athletic facilities “include not only the competitive area, but also warm-up and adjacent areas.”

Lesson #5 Document the evaluation and treatment of all student athlete injuries

Improper medical treatment by the institution’s trainer or physician was alleged to have caused 20 percent of the claims and, in most of these cases, documentation of the athlete’s treatment was poor. The lack of documentation made it difficult to determine whether the institution’s medical treatment was negligent or if the institution simply could not prove the care it gave to athletes. Consider this example:

A college football player suffered a concussion during a game. The institution’s return-to-play policy for head injuries required that, over a seven-day period, the athlete avoid contact and gradually increase his physical activity. The institution kept no records of whether its policy was followed. Three weeks after the first concussion the player received another concussion, which left him severely disabled. He sued the institution claiming its medical care was negligent because the college did not follow its return-to-play policy.

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Given the lack of documentation, the institution is in a weak position to defend itself against a serious student injury. Good documentation practices by team trainers, physicians, and physical therapists provide credible proof in the event of litigation, and improve treatment by facilitating coordination between providers. Consider the following practices:

❚ Invest in an electronic documentation system. An electronic documentation system makes it easier for medical providers to access and input player health information when they need it, such as at a competition or practice. It also facilitates the sharing of information about an athlete’s treatment between trainers, doctors, and other medical professionals. Many vendors of these systems will back up the treatment records to ensure record retention.

❚ Carefully document all head and time loss injuries. When an athlete’s injury is to the head or will cause him or her to be out from practice or competition, medical providers should pay particular attention to documenting treatment.

❚ Show that an institution followed its written policy. If an institution has a policy regarding the treatment of injuries, such as a concussion treatment plan, the college should sufficiently document adherence to the policy.

❚ Maintain treatment records. The length of time that treatment records should be kept varies by state, so athletic programs should consult with the institution’s attorney to determine local requirements.

Lesson #6 Refrain from excessively pressuring or teasing athletes

More than 10 percent of the claims in the study arose from athletes alleging they were injured when they trained or competed in a dangerous way in response to pressure or teasing by the coaching or medical staff. While part of a coach’s job is to push and develop athletes to their potential, sometimes coaches and their staff cross the line and endanger rather than motivate athletes. Consider these claims examples:

❚ A football player recovering from an injury lifted a dangerous amount of weight when the training staff teased him about his light workouts.

❚ A female basketball player alleged she developed an eating disorder in response to her coaches’ repeated comments that she was a fat, slow, and weak player.

❚ A female basketball player with an injured knee claimed her coach pressured her to play injured, which led to a more a significant knee injury.

To avoid these types of claims, athletics staff should refrain from:

❚ Teasing injured athletes about their workouts or prescribed rehabilitative program.

❚ Pressuring team doctors or trainers to clear an athlete to participate in a sport or return to play following an injury.

❚ Harassing or belittling players; a coach may be liable for any emotional injuries that occur from such harassment.

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Lesson #7 Take precautions when outside sports are practiced indoors

Many of the claims occurred when an outside sport was practiced indoors because of inclement weather. Consider these claims that occurred while practicing in a campus gym:

❚ While hitting golf balls into a canvas mat, a golfer was injured when a ball ricocheted and hit him the eye.

❚ A baseball player suffered a serious head injury when part of an outdoor batting cage that was being used indoors fell on the player.

❚ A soccer player suffered a broken nose and facial injuries when she was hit by a ball from a nearby softball practice

❚ A baseball coach demonstrating a hitting technique misjudged his distance and hit a player in the head.

Many of these scenarios could have been avoided with better planning. When bringing an outdoor sport indoors, athletics staff should consider:

❚ Using a softer ball. To reduce the chance of injuries and property damage, softer-than-regulation balls should be used for sports such as baseball, softball, lacrosse, soccer, and golf.

❚ Scheduling indoor practices for both in- and out-of-season sports. Indoor spacing is limited and, to avoid overcrowding, institutions need to carefully schedule and communicate which teams have priority for using indoor facilities during different athletic seasons.

❚ Wearing appropriate footwear. Many outdoor sports require the use of cleats, which are generally inappropriate for indoor surfaces. Remind players to wear footwear suitable for the indoor surface.

❚ Using indoor-specific equipment. When possible, institutions should seek to provide players with specific versions of their equipment for use indoors.

❚ Planning appropriate practice drills. Given the differences in spacing, flooring, and lighting between outside and inside play, coaches need to modify their practice plans accordingly.

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Lesson #8 Ensure all varsity and club athletes sign a release

In almost 30 percent of the claims reviewed, the injured athlete had signed a release, a document in which athletes acknowledge the risks associated with their sport and promise not to hold the institution responsible for injuries arising out of those risks. When there was a signed a release, the costs or value of the claim were often significantly reduced. While a court never decided whether any of the study’s releases were enforceable, the perception that a release might be enforced was helpful for negotiating a lower claim settlement. A release may also deter athletes from bringing claims.

Since a release has the potential to significantly impact an institution’s liability exposure, sports programs should work with the college’s attorney to draft releases for each intercollegiate and club sport and require players to sign them. For more information on drafting releases, please reference the EduRisk resource, Checklist for Drafting Effective Releases.

ConclusionSome athletic risks are unavoidable. However, when an institution fails to properly manage foreseeable hazards in its athletic programs, the institution may be held responsible for related player injuries. By applying lessons from this claims study, colleges can reduce the injuries and liability arising from problems with coaching, facilities, equipment, and medical care.

Resources

Club and Intramural Athlete Policies and Procedures

Princeton UniversityStudent Athlete Handbook

Slippery Rock UniversityDepartment of Athletics Policy and Procedures Manual

Moravian CollegeClub Sports Policy and Procedures at Moravian College

Athletics Risk Management

EduRiskChecklist for Drafting Effective Releases

NCAANCAA Sports Medicine Handbook

AcknowledgementBy Alyssa S. Keehan, director of risk research

9/9 What’s Causing Athletic Injuries? Lessons From Claims EduRiskSolutions.org

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