Concussions among high school athletes and schools' concussion protocols have been a frequent topic of discussion between school districts and their insurers during summer renewals, and some brokers say the discussions will intensify.

With the National Football League's settlement of a group of concussion-related suits and the National Collegiate Athletic Association facing concussion suits by former players, the risk that concussions might impair brain function later in life could be the next asbestos, one insurance broker said.

If insurers pay a significant portion of the NFL settlement, it “could set off a firestorm” of insurers looking to include concussion exclusions in schools' insurance policies, said Michael McHugh, area senior executive vice president at Arthur J. Gallagher & Co. in Itasca, Ill. “I think concussion is going to be what asbestos was 30 years ago in our world,” he said.

“It was definitely an active topic of discussion at renewals, and I would suspect it would become a more active topic,” said Daniel Howell, senior executive vice president and managing director of the public entity practice at Alliant Insurance Services Inc. in San Francisco.

One major underwriter “was leaning toward mandating concussive injury exclusions at July (renewals)” for NCAA Division I accounts, Mr. Howell said. “We did not see that from other markets.”

Both brokers said that football is at the top of many people's minds when thinking of concussion risks. But the risk of concussion “can come from any sport a child plays,” Mr. McHugh said.

Across the country, there's great diversity in the way high schools approach concussion risks. “So much has changed in the last few years that now we have a very wide disparity in how well protected athletes are in two schools that are down the block from each other,” said Christopher Nowinski, co-founder and executive director of the Sports Legacy Institute Inc., Waltham, Mass., and co-director of the Boston University Center for the Study of Traumatic Encephalopathy.

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“The reality is there's no single step that schools can take to keep their athletes safe. It's a long list, and the reality is very few are doing everything,” Mr. Nowinski said.

The institute provides its own list of steps that schools should take to reduce concussion risks at www.concussionchecklist.org. But schools also should be training coaches, teachers, athletes and parents about concussion issues, Mr. Nowinski said.

Schools also need to have return-to-play and return-to-school policies, he said, and should have an athletic trainer on the sidelines and, better still, a doctor.

“We have to recognize the value of a medical infrastructure,” Mr. Nowinski said. “If you could have a physician on the sidelines, you'd diagnose even more concussions.”

Mr. Nowinski said he hopes the insurance issue might help promote a more thorough approach to addressing student athletes' concussion risks, though it hasn't thus far.

“We've tried to push the insurance argument to try to motivate folks to upgrade policies for years,” he said. “It hasn't worked historically. We do think it's a great carrot for people to implement standards.”

Connie Telfeyan, risk/safety manager at Omaha Public Schools in Omaha, Neb., said the district's concussion protocols are shaped largely by guidance provided by its insurer, United Educators Insurance, a Reciprocal Risk Retention Group. In addition, “We have a state law that we have to follow, and it's very similar to what United Educators asks us to do.”

The Omaha district's student athletes take cognitive ability tests before participating in sports to provide a comparative baseline should they suffer an injury. “Our schools even follow the concussion protocol in (seventh- and eighth-grade) flag football,” she said.

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Michael Fox, risk analyst at Miami-Dade County Public Schools, said the Florida district has an extensive approach to addressing concussion risk. Student athletes in impact sports are given a cognitive ability baseline test prior to participation through KiDZ Neuroscience Center at the University of Miami, which also does testing after an injury.

Each school has a licensed athletic trainer, and the district has a doctor on-site at every football game. The district also has a relationship with a concussion specialist at the University of Miami and refers students to her if needed.

Once a student is treated for a concussion, none is cleared to participate in a sport until they've been cleared by the cognitive test.

The district also has a football helmet reconditioning program under which the head gear can be reconditioned, if needed, each year for five years before being retired.

Kurt Gibson, associate executive director of the Illinois High School Association, said that under IHSA rules, athletes displaying signs of a concussion must be removed from a practice or competition and may not return until cleared by a medical professional. Under the Illinois rules, either a licensed physician or certified athletic trainer must clear the athlete to return to play.

“We ask our officials in Illinois any time they are working a game and they send a player out for a head injury to write a special report for us,” Mr. Gibson said. The report, providing a brief description of the incident and indicating whether the athlete returned to competition, is forwarded to the athlete's school to follow up on the student's condition and any necessary treatment.

Mr. Gibson said the IHSA's sports medicine advisory committee has discussed requiring baseline cognitive tests for all student athletes, but decided not to do so.

“We would certainly tell anyone if the school district has the resources to do that, certainly do so,” he said, but the district IHSA has sought to avoid mandates that not all schools would have the resources to meet.