1. Chapter 3: Legal Liability and Insurance

2. Legal Concerns
Negligence suits involving coaches, athletic trainers, school officials and physicians have increased in frequency and amount of damages awarded
Liability
Being legally responsible for the harm one causes another person
Must be certain you are aware of all rules and regulations relative to healthcare in a given state

3. Standard of Reasonable Care
Negligence: the failure to use ordinary or reasonable care.
Standards of reasonable care
Assumes that a person is of ordinary and reasonable prudence
Bring commonsense approach to the situation
Must operate within the appropriate limitations of ones educational background

4. Torts Legal wrongs committed against a person (liability results)
May emanate from
Nonfeasance
Fail to perform legal duty, i.e. fail to refer
Malfeasance
Performs action that is not his/hers to legally perform, i.e. perform advanced treatment leading to complications
Misfeasance
Improperly perform something the person has a legal right to do

5. Negligence
Care giver does something a reasonably prudent individual would not.
Care giver fails to do something a reasonably prudent individual would not.
Athletic trainer has a duty to provide coverage to athletes (obligation)

6. Obligation to provide services vs. Scope of employment
Individual possessing higher level of training will possess higher level of competence
Once the individual assumes duty of caring for athlete that person has an obligation to provide appropriate care
Obligation to provide services vs. Scope of employment
Good Samaritan Law
Provides limited protection against legal liability to one that provides care should something go wrong

7. Statutes of Limitation
Specific length of time an individual can sue for injury resulting from negligence.
Varies by state but generally ranges from one to three years
Clock begins at the time the negligent act results in suit or from the time injury is discovered following negligent act
Minors generally have an extension

8. Assumption of Risk
Athlete is made aware of inherent risks involved in sport and voluntarily decides to continue participating
Expressed in written waiver or implied from conduct of athlete once participation begins
Can be used as defense against an athlete’s negligence suit

9. Does not excuse overseers from exhibiting reasonable care and prudence in regards to conduct of activities or foreseeing potential hazards
Many and varied interpretations (particularly with minors)
Often a waiver will stand in court except in incidents of fraud, misrepresentation or duress

10. Product Liability
Liability of any or all parties involved in manufactured product for damages caused by product
Includes manufacturer of components, assemblers, wholesaler, and retail store owner
Products with inherent defects are subject to liability suits
May be based on negligence, strict liability or breach of warranty fitness

11. Equipment warning labels
Manufacturer of equipment has duty to design and produce equipment that will not cause injury
Express warranty
Manufacturer’s written guarantee – product safety
Equipment warning labels
Informs athlete of possible dangers inherent with product use
National Operating Committee on Standards for Athletic Equipment (NOCSAE)
Minimum standards for equipment to ensure safety

12. Insurance
Major changes in insurance have occurred in light of managed care
Major increases in the number of lawsuits and cost of insurance
Medical insurance is a contract between the company and policyholder
Company agrees to pay portion of medical bills following payment of a deductible

13. General Health Insurance
Policy that covers illnesses, hospitalization and emergency care
Sometimes offered through academic institutions for students (athletics)
Secondary insurance provided through institutions to cover costs above primary insurance coverage
Schools and universities must ensure that athletes have primary insurance coverage (in place or arranged for)

14. Reimbursement
Primary mechanism of payment for medical services in the U.S.
Policyholder insurance company reimburses health care providers for services rendered
Number of different options
Pre-arranged systems
Payment for preventive care
Other systems developed to contain costs

15. Health Maintenance Organization
Provide preventive measures and dictate where individual can receive care
Permission must be gained to see someone outside of the plan (except in emergencies)
HMO will pay 100% of costs if care rendered within the HMO plan providers
Athletic trainers must have working knowledge of HMO limits and restrictions

16. Preferred Providers Organization
Provide discount health care and also limit where treatment can be obtained
Must be aware of what facilities are approved for the program in order have cost completely covered
May include additional types of coverage (physical therapy)
PPO pay on a fee-for-service basis

17. Point of Service Combination of HMO and PPO
Based on HMO model but allows for care outside of the plan
Flexibility is allowed for certain conditions and circumstances

18. Indemnity Plan Most traditional form of billing for health care
Fee-for-service plan that allows insured party to seek care without restrictions
Provider charges patient or third-party payer
Charges are set on fee schedule

19. Capitation
Form of reimbursement where members make standard payment monthly regardless of services rendered
Managed care plans utilize this practice

20. Accident Insurance
Low cost plan to cover accident on school grounds to student
Protects student against financial loss from medical and hospital bills
Provides for additional protection for institution above regular policy
Will cover costs associated with hospital care, surgery, and catastrophic injuries

21. Catastrophic Insurance
Catastrophic injuries in athletics are relatively rare, but are staggering to all involved
Organizations (NCAA, NAIA, NFSHSA) provide additional coverage to deal with lifetime extensive care
Ensuring that all athletes and faculty/staff coverage is in place is critically important

22. Filing of claims, at times, is the responsibility of the athletic trainer
Can be very time consuming taking the athletic trainer away from other responsibilities
Additional staff may be necessary to deal with added responsibilities

23. Insurance to Protect the Professional
Protect against damages that may arise from injuries occurring on school property
Covers against claims of negligence on part of individuals
Because of rise in lawsuits, professionals must be fully protected, particularly in regards to negligence
Will cover negligence in civil case – not criminal complaint

24. Insurance to Protect the Professional (continued)
Errors and omissions liability insurance has evolved to protect individuals against suits claiming malpractice, negligence, errors and omissions (each person should still have personal liability insurance)

25. Insurance Billing Must file claims immediately and correctly
To facilitate, collect insurance information at the start of the academic year
Letters should be sent home to fully explain the coverage available and necessary procedures
Standard forms are the norm, but accurate and thorough completion is critical