When insurers walk away from concussion risk, who protects athletes?

A recent move from a leading insurance provider has made it more difficult for AFL and AFLW players to access brain injury insurance.

In March, Zurich Australia announced concussion and head trauma exclusions^[1] for professional players who held total and permanent disablement (TPD) insurance as part of the AFL Players Association superannuation fund, the trustee for which is AMP.

This means no TPD benefit will be payable for football-related brain injury including concussion and chronic traumatic encephalopathy^[2].

Read more: I’ve seen the brain damage contact sports can cause – we all need to take concussion and CTE more seriously^[3]

The change comes into effect on May 1.

So why did Zurich make this move and how may the decision impact sports leagues and athletes?

A rapidly escalating risk landscape

Zurich has stated^[4] it is the only insurer offering this type of coverage to AFL and AFLW players, reflecting a reduced appetite from insurers and underwriters to cover these types of injuries.

Media reports^[5] suggest Zurich is worried by a higher-than-expected volume of claims paid since it commenced coverage in 2020, with several seven-figure payouts to athletes.

Another reason given was the high levels of uncertainty^[6] associated with brain injuries and attempts to limit liability for high-contact sports.

Unlike their AFL counterparts, NRL players don’t appear to have access to a single default insurance arrangement. Instead, the league and its players association have two funds^[7]: a “past player medical support fund” and the “player hardship fund”.

There is limited publicly available information about the nature and scope of these funds.

Limited options for athletes

Millions of Australian workers are covered by state-based workers compensation schemes such as WorkCover. These provide no-fault insurance that pays medical costs and replaces part of a worker’s income when they are injured because of their job.

Most professional athletes are excluded. This exclusion was a focus^[8] of a 2023 Senate inquiry^[9] into concussions and repeated head trauma in contact sports.

From May 1, unless an AFL or AFLW player has their own private TPD insurance, they will need to look to the league and its players association for support.

The AFL, via its players association, does offer a “severe injury benefit” which provides financial support up to $600,000 to eligible AFL and AFLW players who suffer cognitive impairment caused by their playing career. This includes the impacts of traumatic brain injuries^[10].

But this capped payment is not comparable to the financial security previously offered by Zurich.

There are also concerns about the discretionary nature of these private schemes and whether the level of funding available is sufficient to cover the number and amount of claims.

For now, privately funded arrangements such as the AFL’s act as a stopgap.

More sustainable solutions are needed.

One sport, differing approaches

How countries organise responsibility for the long-term impact of head injury risk varies significantly.

A useful comparison can be found in the three rugby heartlands of the southern hemisphere: Australia, New Zealand and South Africa.

In Australia, registered rugby players at all levels are covered by a national risk management and insurance program^[11]. Injury cover is basic and capped.

This insurance does not cover long-term head injury risk.

Instead, the future costs of concussion tend to fall across a mix of private insurance, public health systems and increasingly for professional players, the courts. Litigation related to concussion and head trauma is rising and is widely viewed by insurers as an accelerating legal risk^[12].

Insurers have responded by withdrawing or excluding head injury cover from their TPD insurance. In effect, concussion risk is being treated as uninsurable, rather than governable.

New Zealand takes a fundamentally different approach.

Through its no-fault Accident Compensation Corporation, head injuries are treated as a publicly pooled social risk – coverage is automatic and universal.

The compensation corporation works alongside sport through SportSmart^[13], a national injury prevention program developed by academics, clinicians and sporting organisations.

In this system, litigation is largely replaced with guaranteed medical care, rehabilitation and income support, while prevention becomes a direct tool for protecting the sustainability of the insurance pool.

South Africa sits somewhere between these models.

While the system does not rely on a public insurer, it operates in partnership with a private insurer and incorporates BokSmart^[14], a national safety program which mandates education, enforces evidence based laws and applies strict return-to-play protocols across all levels.

Litigation is possible in South Africa but remains uncommon.

Rather than adopting an initiative such as SportSmart or BokSmart, Australia’s concussion governance is largely decentralised. Individual codes have responsibility for concussion protocols within their competitions and pathways.

Stronger partnerships are needed

While a lack of TPD insurance does not directly threaten the viability of sports, Zurich’s decision does require alternative solutions to protect athletes.

Better partnerships between sporting organisations, insurers and governments should create an opportunity to improve how head injury risk is understood.

By pooling more injury surveillance data, stakeholders could gain a clearer picture of long-term exposure and emerging trends. This would support better decisions about preventing harm, designing policy, and managing risks.

This approach will likely be most effective if it extends down to community and junior sport.

Concussion and head injuries often first occur in youth participation^[15], and early mismanagement can increase the risk of long-term health consequences^[16].

A serious concern

The Zurich decision only impacts the specific TPD cover of elite AFL and AFLW players. However, any decision to reduce or exclude sport-related concussion cover could lead other insurers to review their coverage, including community or junior sport insurances.

This will be a serious concern, because as the Insurance Council of Australia cautioned in its 2023 submission to the Senate inquiry: “no insurance means no sport^[17]”.

References

1. ^{^} head trauma exclusions (www.theaustralian.com.au)
2. ^{^} chronic traumatic encephalopathy (theconversation.com)
3. ^{^} I’ve seen the brain damage contact sports can cause – we all need to take concussion and CTE more seriously (theconversation.com)
4. ^{^} has stated (www.abc.net.au)
5. ^{^} Media reports (www.theaustralian.com.au)
6. ^{^} high levels of uncertainty (www.abc.net.au)
7. ^{^} two funds (www.rlpa.com.au)
8. ^{^} exclusion was a focus (doi.org)
9. ^{^} 2023 Senate inquiry (www.aph.gov.au)
10. ^{^} traumatic brain injuries (www.afl.com.au)
11. ^{^} national risk management and insurance program (australia.rugby)
12. ^{^} accelerating legal risk (www.insurancebusinessmag.com)
13. ^{^} SportSmart (www.acc.co.nz)
14. ^{^} BokSmart (www.springboks.rugby)
15. ^{^} often first occur in youth participation (theconversation.com)
16. ^{^} long-term health consequences (www.mayoclinic.org)
17. ^{^} no insurance means no sport (www.aph.gov.au)