Legal Liability and Insurance

1. Legal Liability and Insurance Chapter 3

2. Chapter Objectives • Explain the legal considerations for the coach acting as a health care provider. • Define the legal concepts of liability, negligence, torts, assumption of risk. • Identify measures that can be taken by both the coach and athletic trainer to minimize chances of litigation. • Describe product liability. • Identify the essential insurance requirements for protection of the athlete. • Describe the types of insurance necessary to protect the coach acting as a health care provider.

3. Objective: Explain the legal considerations for the coach acting as a health care provider. Legal Concerns of the Coach and Athletic Trainer • What risk factors are present in physical activities? • What isliability? • How can liability be reduced?

4. Objective: Define the legal concepts of liability, negligence, torts, assumption of risk. Standard of Reasonable Care • Definition of terms • Negligence • Standard of Reasonable Care

5. Torts • Definition of terms • Torts • Act of Omission • Act of Commission

6. Statute of Limitations • Defined • How long does a plaintiff have to file suit? • State laws

7. Assumption of Risk • Defined • What are waivers?

8. Warn the athlete of the potential dangers inherent in the sport. Supervise constantly and attentively. Properly prepare and condition the athlete. Properly instruct the athlete in the skills of the sport. Ensure that proper and safe equipment and facilities are used by the athletes at all times Work to establish good personal relationships with the athletes. Parents, and coworkers Establish good policies and procedures of operation of an athletic training facility Develop and carefully follow an emergency plan Familiarize yourself with the health status and medical history of the athletes Keep good records that document injuries and the rehabilitation Document efforts to create a safe playing environment Have a detailed job description in writing Obtain written consent for providing health care to minors Maintain confidentiality of medical records. Objective: Identify measures that can be taken by both the coach and athletic trainer to minimize chances of litigation. Reducing the Risks of Litigation for Negligence For Coaches

9. Do not dispense prescription drugs, and if allowed by law exercise extreme caution in administering nonprescription medications. Use only those therapeutic methods that one is qualified to use that the law states may be used. Do not permit or use faulty or hazardous general and protective equipment. Develop an understanding that an injured athlete will not be able to return until cleared by the team physician or the athletic trainer Follow the express orders of the team physician at all times. Purchase liability insurance to protect against litigation and be aware of the limitations. Know the limitations of your expertise and the applicable state regulations and restrictions Use common sense in making decisions about the athlete’s health and safety. Reducing the Risks of Litigation for Negligence For Coaches

10. Objective: Describe product liability. Product Liability • Manufacturers have a responsibility to design and produce equipment that will not harm or cause injury as long as it is used for as intended. • Manufacturers written guarantee that the product is safe. • Warning labels placed on the helmets informing players of the inherent dangers using this piece of equipment. • National Operating Committee on Standards for Athletic Equipment (NOCSAE) label must be on helmets. • NOCSAE establishes minimum standards for equipment must meet to ensure its safety.

11. Insurance to Protect the Athlete • Every athlete should be covered by appropriate insurance policies to maximize benefits if injury occurs. • Since 1990 health care has reformed to where MANAGED CARE provided by the health care personnel is closely monitored by insurance companies • Since 1971 there has been a significant number of law suits filed due to the increase of individuals becoming more physically active.

12. Objective: Identify the essential insurance requirements for protection of the athlete. Insurance to Protect the Athlete • With managed care and increase in lawsuits insurance cost have elevated dramatically. • The major types of health insurance that coaches must be aware of are • General health insurance • Catastrophic insurance • Accident insurance • Liability insurance (covering errors and omissions)

13. General Health Insurance • Every athlete should have general health insurance: • Covering • Illness • Hospitalization • Emergency care • Institutions who provide the primary insurance coverage pay a very high premium • Most institutions provide secondary coverage once the athlete’s personal coverage has paid. • The coach or athletic trainer need to require athletes to complete a insurance information card and put information on file

14. General Health Insurance • Third Party Reimbursement • The primary mechanism of payment of medical services in the United States. • Health care professionals are reimbursed by policy holders insurance company. • Insurance companies have begun to pay for preventative care to reduce to high cost of hospital care (i.e. pay fees for health club)

15. General Health Insurance • HMO: Health Maintenance Organization • An athlete cannot receive medical treatment insurance coverage from a specialist with prior consent of their primary care doctor; emergencies are the only exception. • Athletic trainers and coaches need to understand the limitations and restrictions of the HMO coverage at their institution.

16. General Health Insurance • Preferred Provider Organizations (PPO) • Provide discount health care but also limited where a person can receive treatment for an illness. • Coaches and athletic trainers must be apprised where the athlete should be sent based on the PPO. • Point of Service Plan (PPO) • A combination of a HMO and a PPO • Based on a HMO structure but allows athletes to go outside the HMO to obtain services • Flexibility is allowed with certain conditions

17. General Health Insurance • Capitation: reimbursement process in which members make a standard payment each month regardless of how much medical treatment is rendered. • Third party reimbursement for athletic training services has been difficult to obtain through state licensing. Such difficulty has not been the case for physical therapy.

18. Other Insurance Information • Accident Insurance: • Utilized to protect the student while on school grounds while they in attendance. • Schools general insurance might be limited and accident insurance can assist when a student sustains an injury that provides additional coverage. • This type of coverage is limited and does not require knowledge of fault and the amount it pays is limited • Does not cover catastrophic injuries

19. Objective: Describe the types of insurance necessary to protect the coach acting as a health care provider. Insurance to Protect the Coach • Personal Liability Insurance • Covers the claims of negligence on the part of individual • Catastrophic Insurance • Covers medical and rehabilitative services for athletes who are permanently disable.

20. For More Information • Legal Information Institute at Cornell: http://www.law.cornell.edu/topics/sports.html • Cramer First Aider: http://www.ccse.k12.wy.us/CCHS_web_sptmed/fstaider.htm • Sports Lawyers Journal: http://law.tulane.edu/journals/slj/abstracts.htm • Catastrophic Insurance http://www.hiaa.org