Legal Concerns and Insurance Issues

Liability

being legally responsible for harm caused

Standard of Reasonable Care

act as a careful, prudent person with YOUR training would (do NOT do more than you can)

Negligence

failure to use reasonable care (must operate within the appropriate limitations of ones educational background)

BE THOUGHTFUL

Torts

legal wrongs

Nonfeasance

fail to perform legal duty (fail to refer)

NO ACTION TAKEN, should have helped but didn’t

Malfeasance

doing something you’re not legally allowed to (advanced treatment without certification)

Misfeasance

doing right thing INCORRECTLY (“up to date way”)

Proving Negligence

Higher training = higher expected competence

Duty to provide care once you take responsibility

Sovereign Immunity

govt. employees often protected from negligence lawsuits

Good Samaritan Law

limited protection if you voluntarily give emergency care

Statute of Limitations

time limit to sue (1-5 years; longer for minors)

Assumption of Risk

-athlete understands risks and still participates

-written waiver

-waivers hold up unless fraud, misrepresentation, or duress

-does NOT excuse caregivers from reasonable care

Reducing Risk of Litigation

-build good relationships with coworkers, parents, athletes

-have policies + emergency action plan

-be familiar with medical history/records

-get consent before treatment

-maintain confidentiality

-stay within scope of practice

-carry liability insurance

-use common sense

Product Liability

everyone in product chain can be liable for defective equipment

Manufacturer duties

safe design, warnings, labels

National Operating Committee on Standards for Athletic Equipment(NOCSAE)

sets minimum safety standards for sports equipment

Trainers should NOT alter equipment

General Health Insurance

covers illness, hospitalization, emergency care

colleges may offer secondary coverage for athletes

Copay

what you pay out of pocket at doctor visits etc.

Deductible

amount you pay before insurance can pay anything

Premium

how much you pay monthly

Accident Insurance

Low-cost, covers, accidents on school/work grounds

protects against hospital bills + catastrophic injuries

Catastrophic Insurance

For RARE but severe sports injuries

Professional Liability Insurance

protects professionals (like AT) from negligence lawsuits

Third Party Reimbursement

how health providers get paid in US

insurance reimburses providers

We pay insurance…

insurance pays provider

HMO

preventive care, must stay in network, pays 100% if within plan

PPO

discount care, some flexibility, pays fee-for-service (do not care what doctor)

POS

HMO + PPO combo, allows out-of-plan in some cases

EPO

strict like HMO, very limited network (few doctors)

PHO

Hospital + physicians contract with employers/organizations

Medicare

for elderly & disabled

Medicaid

for low-income individuals (varies by state)

Worker’s Compensation

state-mandated insurance for workplace injuries

High Premium

Low deductible

Low Premium

High deductible