A former professional football has sued Lloyds of London in North Carolina state court, claiming it wrongly rejected a claim for coverage on a policy that was designed to cover career-ending injuries, such as the debilitating concussion that he suffered.
Plaintiff Haruki Nakamura, who was a safety for the Baltimore Ravens and Carolina Panthers, alleged in a complaint that he took a blow to the side of the head during an August 2013 preseason game, which was ultimately diagnosed as a concussion. Nakamura was placed on the “injured reserve” list, and five days later, was released from the team through a “Settlement and Release” due to “concussion,” according to the complaint.
Nakamura is seeking $3 million, or triple the value of the $1 million policy, to account for damages, as well as costs, interest and lawyer fees.
In his lawsuit, he noted that the defendant’s denial “comes down to the opinion of one self-selected medical examiner whose ‘all clear’ diagnosis conflicts with determinations” made by Nakamura’s treating physician and a physician designated by the NFL Retirement Board, who both found that Nakamura is “totally and permanently disabled” due to chronic post-concussion syndrome.
Elaborating on this, he noted that Lloyds “added insult to injury by subjecting (him) to virtually impossible, hair-trigger notice ‘procedures; voluminous and duplicative paperwork; no fewer than three layers of administrative bureaucracy (including, in addition to Underwriters itself, Underwriters’ insurance agent/representative and a third party claims handler); and interminable delays in its ‘investigation’ of (his) claim. In total, Underwriters, by and through its agents, strung Nakamura along for more than two years, only to deny Nakamura’s claim.”
Equal to the alleged obfuscation of his claim, Nakamura also took issue with the findings of the defendant’s chosen “medical examiner.”
According to the plaintiff, has claim was denied on the grounds that he does not satisfy “the Policy’s requirement of sustaining a Bodily Injury caused in and of itself by an Accident occurring during the Certificate period and which, solely and independently of any other cause, results in Total Disablement directly culminating in Permanent Total Disability.
“Underwriters’ denial called into question (1) whether Nakamura even was suffering from post-concussive syndrome, (2) but if so, whether his condition was solely attributable to the August 29, 2013 injury, as opposed to prior documented (and speculated) concussions; and (3) whether, notwithstanding Nakamura’s post-concussive syndrome, Nakamura could return to the NFL.”
In contrast, the plaintiff noted the aforementioned finding of the NFL-designated physician, neurologist Dr. Barry Jordan, M.D., and his treating physician, Dr. Michael Collins, Ph.D. Dr. Jordan, in particular, concluded in his report that the “constellation of symptoms, including cognitive impairment, debilitating headaches, dizziness/vertigo, and behavioral changes characterized by irritability, depression, anxiety and outbursts, is consistent with a chronic post-concussion syndrome. Accordingly, he fulfils criteria for total and permanent disability considering that his concussion occurred two years ago and has not resolved.”
Nakamura is being represented by John Schryber of Reed Smith LLP in Washington, D.C., and David Wright, of Robinson, Bradshaw & Hinson PA in Charlotte.
