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CHAPTER 3
Legal Liability and Insurance
OVERVIEW
LEARNING OBJECTIVES
After studying Chapter 3, the student will be able to:
Describe the steps that can be taken to decrease the chance of litigation.
Define and explain the legal concepts of liability, negligence, assumption of risk,
and torts including nonfeasance, malfeasance, and misfeasance.
Describe product liability and explain the function of the NOCSAE.
Describe the statue of limitations.
Explain the Good Samaritan Law.
Describe the different types of medical insurance plans including: HMOs, PPOs,
Point of Service, and Indemnity plans.
Describe the types of insurance that are necessary to protect individuals acting
as health care providers (personal liability insurance and error and omission
liability insurance).
KEY TERMINOLOGY
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
DISCUSSION QUESTIONS
1. What are the legal concerns in athletic health care?
2. Discuss strategies for avoiding litigation.
3. What are the different types of health insurance and what are the benefits and
limitations of each type?
4. How can an individual protect themselves from litigation?
5. What kinds of insurance do you need in order to protect yourself?
CLASS ACTIVITIES
1. Have students investigate personal liability insurance and discuss what kind of
policies they were able to locate. Include details of each policy.
2. Locate several case studies on legal issues in the athletic arena and have a class
discussion on the legal implications of each case.
3. Have students act out several types of situations in which they have to provide
health care and identify the potential areas of negligence.
WORKSHEET ANSWERS
Matching
1.
2.
3.
4.
c
b
a
g
5.
6.
7.
8.
e
h
f
d
Short Answer
9. Liability is the state of being legal responsible for the harm that one causes
another person.
IM-3 | 2
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
10.Complaint must establish three things: That a duty of care existed between the
person injured and the person responsible for that injury, that conduct of the
defendant fell short of that duty of care, and that damages resulted.
11.NOCSAE The National Operating Committee on Standards for Athletic
Equipment.
12.Malfeasance: An individual performs a medical treatment not within his/her
legal province and from which serious medical complications developed
Nonfeasance: An individual fails to refer a seriously injured athlete for proper
medical attention
Misfeasance: An individual incorrectly administers a first aid procedure that
they have been trained to perform
Listing
13.Personal liability insurance
14.Errors and Omissions liability insurance
15-18. Any of the strategies listed in the Athletic Injury Management Checklist on
decreasing risk of litigation.
Essay
19-25. Managed Care: A prearranged system for delivering health care that is
designed to control costs while continuing to provide quality care
Health Maintenance Organizations: (HMOs) Provide preventive measures and
limit where individuals can receive care. HMOs generally pay 100% of medical
costs as long as care is rendered at an HMO facility. Many HMOs use a
capitation system that limits the amount that is reimbursed for a specific service.
Preferred Provider Organizations: (PPOs) Provide discount health care but also
limit where a person can go for treatment of an illness. If receiving treatment at
an approved facility all costs are paid. Individuals treated at a facility not on the
approved list may be required to pay for care. PPOs pay on a fee-for-service
basis.
Point of Service Plan: Combination of HMO and PPO plans. Based on HMO
structure, yet it allows members to go outside the HMO to obtain services.
Flexibility is allowed only with certain conditions and under special
circumstances
Indemnity Plan: Provider charges the patient or a third party payer a fee for
services provided. Charges are based on a set fee schedule.
IM-3 | 3
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
NAME ________________________
SECTION _____________________
CHAPTER 3 WORKSHEET
Legal Liability and Insurance
MATCHING: Match the following terms with their definition
_________ 1.
_________ 2.
_________ 3.
risk
_________ 4.
limitations
_________ 5.
_________ 6.
_________ 7.
Insurance
_________ 8.
Tort
Negligence
Assumption of
Statute of
Product liability
HMO
Medical
Act of Omission
IM-3 | 4
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
IM-3 | 5
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.