Citing Costs, N.H.L. Injury Study Urges More Safety An author of a new medical study said the high cost of paying injured N.H.L. players should push the league to stiffen what he described as inadequate measures to prevent brain trauma, including rules that still allow fighting. "N.H.L. owners need to do a better job of protecting their athletes - if not for their players, then for their own pocketbooks," said the author, Dr. Michael Cusimano, a neurosurgeon at St. Michael's Hospital in Toronto. N.H.L. teams and their insurers paid about $653 million in salary to players sidelined by concussions and other injuries over three recent seasons, according to estimates in the study, to be published Monday by Injury Prevention, a British medical journal. The study was conducted by researchers from the hospital and the University of Toronto. It estimated that teams and their insurers paid injured players an average of $218 million during the 2009-10, 2010-11 and 2011-12 seasons. On average, 50.9 percent of N.H.L. players missed at least one game to injury over each of those three seasons, the researchers said. Of the 1,307 players who appeared in at least one game over those three seasons, 63 percent missed time to injury, according to the study. Concussions were among the most financially costly injuries, the researchers determined, amounting to $42.8 million of the $218 million in annual wages paid to sidelined players. Head and neck injuries, as well as leg and foot injuries, were found to be the most expensive in overall cost. Insurance companies compensate teams 80 percent of salary costs for players sidelined more than 30 games because of a single injury. Until that 30-game threshold is reached, a team pays an injured player's full salary. "It was time to show a different perspective on the whole injury side of sport, and specifically hockey," said Cusimano, a leading advocate for concussion prevention in hockey and the study's corresponding author. We've all heard a lot about the medical and personal side of this over the last little while. This is another perspective, the financial perspective. An N.H.L. spokesman said the league had no comment because it had not seen the study. In recent seasons, the N.H.L. has largely outlawed hits to the head and other dangerous checks, and established a Department of Player Safety. The department, led by the Hall of Famer Brendan Shanahan, has overseen a sharp increase in fines and suspensions for contact causing injuries. On-ice behavior has changed noticeably, with players often declining to make heavy checks on opponents in vulnerable positions. Teams have also followed concussion protocols far more strictly in recent seasons. But Cusimano called the league's measures "giving lip service" to player safety. The report noted that the N.H.L. had taken no significant steps to ban fighting, even though league-endorsed research shows that fights account for 8 percent to 9 percent of players" concussions. The new study also noted relatively recent instances in which N.H.L. sponsors had pressured the league to address injury risks, and it cited reports that insurance companies had expressed reluctance to continue to provide compensation. "Despite this, N.H.L. management and players are resistant to making changes that could decrease speed and physical play," the study said. The N.H.L. has reported record revenue in recent seasons, but Cusimano said the league could be hurt long term by falling participation rates for youth hockey in Canada. The decline has been attributed in large part to parents" fears of injuries. "Despite current injury prevention strategies, professional hockey is seen as a particularly risky sport," the study said, "and 31 percent of Canadian parents report that they would discourage their children from participating." The researchers drew their injury and salary data from published reports, including those on concussions or suspected concussions. Cranial injuries and non-nasal facial fractures were included in concussion counts. Cusimano said he hoped the financial burden of paying injured players would spur the league to do more to reduce injuries. The N.H.L. also faces a lawsuit from a small group of former players who say they are living with the long-term effects of concussion-related brain trauma sustained during their careers. A federal judge recently rejected the N.F.L."s proposed $765 million settlement of a class-action concussion lawsuit brought by about 4,500 former players, ruling that the figure could be inadequate to compensate all potential future recipients.