Legal concerns and insurance issues'

1
Legal concerns and insurance issues.

• Chapter 3

2
Legal concerns for coaches ATCs

• Negligence lawsuits from athletic injuries have
  increased in both frequency and
• Liability being legally responsible for the
  harm one causes another person
• Negligence failure to use ordinary or
  reasonable care
• Standard of reasonable care assumes you use
  common sense and exercise due care
• Torts legal wrongs committed against person or
  property
• Nonfeasance (act of omission) failure to
  perform a legal duty
• Malfeasance (act of commission) commit an act
  that isnt yours to perform
• Misfeasance do something incorrectly

3
Legal concerns continued

• Consent
• Actual
• Implied
• Minors
• Mentally ill
• Duty to act Legal obligation to give aid or
  perform emergency care
• Pre-existing obligation
• Employment requires it
• When first aid has begun

• Negligence must prove
• Victim was injured
• You had a duty to act
• You acted imprudently and/or your actions caused
  or contributed to the injury
• Sovereign immunity
• Protects government and its workers from
  negligence
• Good Samaritin laws

4
Legal concerns continued

• Assumption of risk
• Sports are dangerous!
• Usually expressed by signing a waiver
• Doesnt negate the need for exercising reasonable
  care and preventing accidents
• Product liability
• Manufacturers have duty to design equipment that
  wont cause injury
• Athletes must sign a form acknowledging they
  understand the warning in football/lacrosse
  helmets
• NOCSAE, ASTM, CSA establish minimum standards for
  equipment
• Statute of limitations
• Specific length of time to sue for damages
• Varies by state (1-3 years usual)

5
Reducing risk of litigation

• Good personal relationships
• Policies and procedures EAPs
• Monitor equipment for hazards
• Athlete medical history and conditions
• Accurate and timely records
• Safe rehabilitation/training environment
• Detailed job description
• Written consent to treat
• Maintain confidentiality
• Caution administering medications
• Only use methods within your training
• Follow all MD instructions
• Use common sense

6
Insurance issues

• Era of managed care
• General medical or health insurance
• Contract between policy holder and company
• Can be primary or secondary
• Supplemental policies continue where it stops
• Usually pay a portion of the medical bill
• Accident insurance
• Professional liability insurance
• Shotgun approach
• Catastrophic insurance
• Errors and omissions liability insurance

7
Types of medical insurance

• HMO Health maintenance organization
• PPO Preferred provider organizaiton
• POS Point of service plan
• EPO Exclusive provider organizaiton
• PHO Physician hospital organization
• TPA Third party administration
• Medicare (parts A, B, C, D)
• Medicaid
• Workers compensation
• Indemnity plan
• Capitation

8
Insurance reimbursement

• Third-party reimbursement
• Health care professionals are reimbursed by the
  insurance company for services rendered
• IDC-9 and CPT codes
• Difficult for ATCs to obtain from insurers
  unless also a PT, OT, or SLP
• Future??