Prentice Ch. 3 - Legal Concerns and Insurance Issues Flashcards Preview

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Flashcards in Prentice Ch. 3 - Legal Concerns and Insurance Issues Deck (32):


the state of being legally responsible for the harm one causes another person



the failure to use ordinary or reasonable care


The standard of reasonable care

assumes that an individual is neither exceptionally skillful nor extraordinarily cautious but is a person of reasonable and ordinary prudence
- common sense approach


duty of care

part of an official job description


to est. negligence you need 4 things

1. duty of care existed between person injured and person responsible for injury
2. conduct of the defendant fell short of the standard of care
3. the defendant caused the injury to occur
4. personal, property, or punitive damages occured



legal wrongs committed against the person or property of another



when an individual fails to perform a legal duty
- ATC fails to refer a seriously injured pt. for proper medical attention



an individual commits an act that is not legally his or hers to perform
- ATC may perform a therapeutic treatment that violates the practice of another licensed health care professional



an individual improperly does something he or she has the legal right to do
- ATC may incorrectly administer a treatment technique procedure he or she has been trained to perform


a successful negligence case against an ATC needs

1. ATC had a duty to exercise reasonable care
2. ATC breached that duty by failing to use reasonable care
3. that there is a reasonable connection between the failure to use reasonable care and the injury the individual suffered or that the ATCs actions made the injury worse


Sovereign immunity

neither the government nor any individual who is employed by the government can be held liable for negligence
- once the ATC assumes the duty of caring for a patient the ATC has an obligation to make sure that appropriate care is given


Good samaritan law

provides limited protection against legal liability to any person who chooses to provide first aid. however, it does not apply to someone who has a duty to act as dictated by the nature of his or her job


Statues of Limitation

sets a specific length of time that individuals may sue for damages from negligence
- between 1 and 5 years to file suit
- some states permit an injured minor to file suit up to three years after the minor reaches the age of 18


Assumption of risk

The individual through express or implied agreement assumes that some risk or danger is involved in the particular undertaking. In other words a person takes his or her own chances


How to reduce litigation

- est. good personal relationships
- specific policies and guidelines
- record keeping


Product liability

if the product is not used correctly by the consumer, the manufacturer cannot be held liable
- does not excuse ATC who misuses the equipment, only equipment that is faulty


General health insurance

policy that covers illness, hospitalization, and emergency care


Primary insurance

all medical expenses are paid for by the institution
- institutions pay an extremely high premium for this


Secondary insurance

pays the remaining medical bills once the personal insurance company has made its payment
- always includes a deductible that is not covered by plan


Health maintenance organizations (HMOs)

- provide preventive measures and limit where the individual can receive care
- generally pay 100% of the medical costs as long as care is at one of the HMO facilities
- most use capitation systems


Preferred Provider organizations (PPOs)

- discount health care but also limit where a person can go for treatment of an illness
- pay for fee service basis
- can provide PT etc. more easily and cheaper


Point of service plan

- combination of HMO and PPO plans.
- based on an HMO structure yet allows members to go outside the HMO to obtain services but only under certain conditions and circumstances


Exclusive Provider Organizations (EPOs)

- combo of HMO and PPO
- restrictive of the number and types of providers the have
- will most likely not pay anything if you use out of network providers


Physician Hospital organization (PHOs)

involve a major hospital or hospital chain
- contacts directly with employers to provide services


Third-Party Administrators

- used to administer services and to pay claims for self-insured group plans and thus function as pseudo insurance companies



federal health insurance program for the aged and disabled


Medicare parts

Part A: Hospital. normally premium-free and retirement to beneficiary
Part B: Physician. mostly premium charge to the beneficiary
Part C: allows person to choose among several types of health care plans
Part D: federal program to subsidize the costs of prescription drugs for medicare beneficiaries



health insurance program for people with low incomes and limited resources
- funded by both the federal government and individual states


Workers comp

- employers pay premiums


indemnity plans

-fee for service plan that allows the insured party to seek medical care without restriction on utilization or cost



form of reimbursement used by managed care providers in which members make a standard payment each month regardless of how much service is rendered to the meter by the provider


National Provider Identifier (NPI)

government issued identification number for individual health care providers and provider organizations