College athletes are unpaid. What if injury ruins their chance of turning pro?

It was founded in 1906 to improve player safety but resisting accountability for injuries has long been at the heart of the NCAA’s insistence that college athletes are amateurs.

US college sports’ major governing body began using the term “student athlete” as a legal strategy when the widow of a man named Ray Dennison unsuccessfully sought benefits after he died in 1955 as a result of a head injury suffered while playing football for a college team in Colorado. The institution, a court declared, was “not in the football business”.

By defining players as amateurs rather than employees, students not staffers, the NCAA swerved the obligation to offer typical entitlements such as workers’ compensation. Sure, they were dedicated athletes playing at a high level - but the field was not their workplace, the gym not their office, a football scholarship not a hiring contract. Somehow, for a student athlete, sports were at once fundamental and extracurricular.

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Yet as professional sports grew ever more lucrative, the risk of sustaining a serious injury and losing out on a fortune became a threat to the credibility of the avowed amateur ethos. If athletes were not sticking around to complete their degrees, how could they be seriously viewed as students? And why should they continue to accept the dangers of their sports without being paid a salary?

In 2014, as quarterback Johnny Manziel left Texas A&M after his sophomore season and entered the NFL draft, the university took a decision that would reverberate through college sports more deeply than the ephemeral brilliance of the 2012 Heisman Trophy winner.

Cedric Ogbuehi, an offensive tackle and likely first-round draft pick, was eyeing the professional ranks. But A&M persuaded him to remain at Kyle Field for his senior year, largely because the university paid more than $50,000 for a loss-of-value insurance policy designed to provide compensation should injury threaten his NFL hopes and diminish his future earnings potential.

Despite an ACL injury, Ogbuehi, now 29, was selected 21st overall by the Cincinnati Bengals in the 2015 draft and currently plays for the Seattle Seahawks. Among the 500,000 or so college athletes who compete annually under the auspices of the NCAA there are more than 210,000 injuries per year, according to one estimate, ranging from minor to catastrophic and fatal.

Inevitably, some highly promising players are forced to quit, like Stanley Doughty, a top defensive lineman at the University of South Carolina in the mid-2000s who suffered a serious spinal injury. Or another Gamecocks football star, Marcus Lattimore, whose knee injuries saw him taken in the fourth round of the 2013 draft by the San Francisco 49ers, though he never played and retired the next year.

Others slip down the pecking order, like Kevin Ware, who has pursued a career in Europe after his NBA hopes were dashed by a horrific broken leg while playing for the University of Louisville in 2013.

But coverage that goes beyond ordinary campus and primary healthcare policies and pays out in the event of permanent disability or reduced appeal to prospective employers can offer reassurance and financial security.

A&M realised that swallowing the huge cost of bespoke private athlete insurance, which is often too expensive for individuals to purchase on their own, could be a recruiting tool: a way to narrow the gap between the $0 salaries of college stars and the millions of dollars from professional teams that could vanish with one mistimed tackle.

And colleges are allowed to pay for it by tapping into a multimillion dollar fund known as the SAF that the NCAA disburses to institutions to assist Division I athletes. It has a wide range of allowed uses, such as paying for academic support services, educational supplies and travel. And health expenses. “I don’t think many schools know about [paying for insurance that way],” A&M associate athletic director Justin Moore told Fox Sports in 2014. “It’s a game-changer.”

Others followed. Later that year it was revealed that Florida State University would cover the reported $60,000 cost of a $10m insurance package for its star quarterback, 2013 Heisman winner Jameis Winston, today in the NFL with the New Orleans Saints.

While at Duke University, Zion Williamson suffered a bizarre injury from a shoe “explosion” during a 2019 game that drew attention to an $8m policy to be triggered if he fell below 16th in the NBA draft (he was later selected first overall by the New Orleans Pelicans).

The NCAA created a permanent total disability policy option for certain elite athletes in 1990 and provides excess catastrophic injury coverage for the most serious and costly-to-treat sports injuries. In 2014 it began allowing athletes to pay for loss-of-value insurance coverage through loans secured against their potential future earnings. That niche market, centered on first- or second-round prospects in the most popular college sports, flourished.

“Now it’s very, very rare to find a school that doesn’t utilise the SAF budget to purchase these policies for student athletes,” says Eric Chenowith, a former basketball player who runs a leading brokerage, California-based Leverage Disability and Life Insurance Services. “I work with over 60 universities nationwide. I would say 58 out of 60 are all utilising the SAF to a certain extent to purchase disability insurance for student athletes.”

Their popularity and the sums involved was noted by the supreme court before it unanimously ruled in June that the NCAA’s caps on education-related benefits violate antitrust law, paving the way for future challenges on other restrictions, such as the ban on player wages.

“The one limitation that is the most troublesome is … that schools can pay up to $50,000 for a $10m insurance policy to protect student-athletes for future earnings. Now that sounds very much like pay for play,” chief justice John Roberts remarked during oral arguments in the Alston case. “You’re paying the insurance premium so that they will play at college and not in the pros. Doesn’t that undermine the amateur status theory you have?”

Seth Waxman, the NCAA attorney, replied: “It is a cost of participating in athletics that permits athletes who want to receive an education instead of pay for their play [to] continue to do so.”

Regardless of whether insurance is a form of remuneration or an educational expense, the current system invites dilemmas over the most appropriate use of limited SAF funds. For example, if a college allocates $100,000 annually for insurance, should it decide to pay $50,000 each for generous policies for its best two football players, or purchase 20 $5,000 policies to cover more athletes, albeit less extensively? Or would that sum be better deployed to buy computers for a hundred students?

The June ruling may allow universities to spend more freely on insurance, Sportico reported, perhaps allowing for greater and more enduring support to players who suffer life-altering injuries, regardless of whether or not they have the potential to reach the big-time. And ultimately, if amateurism falls, college players should be entitled to the superior benefits currently available to professionals.

Chenowith, 42, played basketball for the University of Kansas. In his last two years at college he took out a bank loan to pay for an insurance policy that would have entitled him to $1m in the event of career-ending illness or injury. He was selected in the second round of the 2001 NBA draft by the New York Knicks but endured persistent back problems and went on to appear professionally in Europe and for minor-league teams in the US.

Research on the long-term health effects of college sports is limited and findings are mixed. Some research suggests that athletes may have a lower risk of depression later in life compared with non-athletes but a higher risk of lingering physical damage. Growing awareness of the prevalence and long-term consequences of concussions has led to a flurry of lawsuits and disrupted the insurance business.

“I still carry pain with me, and I’ll have it for the rest of my life. I should probably have a major surgery coming up at some point in my life but for me personally the trade-off was well worth it, having a college degree completely paid for by a scholarship,” Chenowith says. “It’s been worth it in the end for me to sacrifice my body so I could find a successful path in life.”

Jason Stahl, founder and executive director of a newly-formed organisation, the College Football Players Association, says he once talked to a 65-year-old “who was showing me how he can’t raise his arms above shoulder height. He said ‘this is because of two surgeries I had because of injuries I sustained in college football’.”

Among the challenges players face, Stahl says, are accessing adequate long-term treatment and navigating bureaucracy, to ensure healthcare costs are covered and expected payouts are not denied. Given the frequency of injuries such as concussions in training sessions and preseason games, let alone competitive fixtures, he would like to see reforms to an “out-of-control practice culture”.

Some 66 years after Dennison’s death, the continued injury risks, the spectre of widespread and slowly emerging brain damage caused by concussions and advent of a de facto pay-to-play reward in the form of loss-of-value insurance look like key flash points for the legal battles ahead as the landscape reshapes in the wake of the Alston decision and permission for players to profit from their name, image and likeness rights.

“Change is here and change is coming and I think it could move much more rapidly than people think,” Stahl believes.