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Per Diem Information

Per diem work is one of the fastest-growing ways athletic trainers practice in Connecticut. Tournaments, showcases, camps, club programs, and secondary schools without full-time coverage all hire ATs on a single-event or short-term basis. The work is legitimate and often well-compensated. It also shifts a set of responsibilities onto you that a full-time employer would normally carry: your standing orders, your liability coverage, your tax withholding, your contract terms, and your emergency plan. This page covers what Connecticut law requires, where per diem ATs most often get exposed, and how to negotiate terms that protect you.

Standing Orders
This is the single most common gap in per diem work. An AT shows up to cover a weekend tournament, provides care all day, and has no idea whose standing orders authorized any of it.
 
What Connecticut law actually requires


Under C.G.S. § 20-65f(1), athletic training in Connecticut is practiced "with the consent and under the direction of a health care provider." That phrase is defined in § 20-65f(6). It means one of two things:

  • A written prescription from a health care provider specifying the plan of care for a specific musculoskeletal injury or illness, or
  • A standing order, when the patient is participating with a professional, amateur, school, collegiate, or other sports organization.
Per diem event coverage almost always falls into the second category. That means you need standing orders in place before you provide care.
 
The five required elements
 
C.G.S. § 20-65f(7) defines standing orders as written protocols, recommendations, or guidelines that:
  1. Are furnished and signed by a health care provider
  2. Are followed by the athletic trainer while practicing under that provider's direction
  3. Are annually reviewed and renewed by both the health care provider and the athletic trainer
  4. Require ongoing communication to be available between the provider and the AT
  5. Include all five of the following:
    • A plan for emergency situations
    • Appropriate treatments for specific injuries or illnesses
    • Instructions for the treatment and management of concussions
    • A list of conditions requiring immediate referral under § 20-65h
    • A list of conditions beyond your scope of practice, education, or training
A one-page signature on generic language does not satisfy this. If any of the five content elements is missing, the document is incomplete.

Who can sign
 
C.G.S. § 20-65f(8) defines "health care provider" as a person licensed in Connecticut to practice:
  • Medicine or surgery (Ch. 370)
  • Chiropractic (Ch. 372)
  • Podiatry (Ch. 375)
  • Naturopathy (Ch. 373)
  • Nursing under § 20-94a (APRN)
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A sample standing orders document is provided here

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Professional Liability Insurance
 
Connecticut has a statutory minimum

 

Under C.G.S. § 20-65k(d), for registration periods beginning on or after October 1, 2017, a licensee who provides direct patient care and is renewing a license must maintain professional liability insurance or other indemnity against professional malpractice of at least:

  • $500,000 per person, per occurrence

  • $1,500,000 aggregate

The statute contains one exception: the requirement does not apply if the insurance or indemnity is provided by the licensee's employer.

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Why does that exception usually not help per diem ATs

 

Per diem work creates two problems:

  • If you are an independent contractor, you have no employer. The exception does not apply. The obligation is yours.

  • If you have a full-time employer, that policy almost certainly covers you only while acting within the scope of your employment. Weekend coverage for an unrelated organization is outside that scope. You are likely uninsured for that work, even though you carry employer coverage the other five days.

Do not assume. Ask your employer's risk manager, in writing, whether your policy covers outside per diem work. Keep the answer.

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What to check in a policy

 

NATA's Best Practice Guidelines for Per Diem Work recommends confirming that your policy includes:

  • License defense. Coverage for attorney fees if you have to defend your license before the Department of Public Health. This is a separate exposure from a malpractice suit and is often the more likely of the two.

  • Sexual misconduct/abuse allegations. Frequently excluded or sublimited. Read the endorsement.

  • General liability, including coverage for your own injury.

  • Occurrence vs. claims-made. An occurrence policy covers incidents that happen during the policy period, regardless of when the claim is filed. A claims-made policy only covers claims filed while the policy is active, which means you need tail coverage if you let it lapse. For episodic per diem work, occurrence coverage is generally the safer structure.

  • Portability. Confirm the policy follows you across settings and employers rather than being tied to one worksite.

 

NATA's guidance notes that policies commonly carry $1 million per occurrence and $3 million aggregate, which exceeds Connecticut's statutory floor. Given how inexpensive the incremental coverage is, most per diem ATs should carry the higher limits rather than the statutory minimum.

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Carriers

 

Several carriers write individual professional liability policies for athletic trainers. CATA does not endorse a specific carrier. Get multiple quotes and compare the exclusions, not just the premium. Commonly used options include:

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Certificates of insurance

 

Expect hiring organizations to ask for a certificate of insurance, and expect to sometimes be asked to name them as an additional insured. Both are normal. Know how to request a COI from your carrier and build the lead time into your scheduling.

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Negotiating A Fair Rate

There is no reliable published benchmark for per diem athletic training rates in Connecticut. Online salary aggregators report figures for full-time employed ATs, which are not the right comparison. A per diem rate has to absorb costs a salary does not.

Rather than anchoring to someone else's number, calculate what the job actually costs you:

 

Ask yourself

 

Contact hours: Scheduled event time

Uncompensated time: Travel, setup, breakdown, documentation after the event

Mileage: Round-trip at the current IRS rate

Supplies: What are you expected to bring and consume

Self-employment tax: Roughly 15.3% off the top before income tax

No benefits: No health insurance, retirement match, paid leave, or workers' comp

Opportunity cost: This is your Saturday

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Divide total cost by contact hours to find your break-even. Your rate is that number plus margin. That is a defensible floor you can hold in a negotiation because it is arithmetic rather than a preference.​

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Negotiate more than the hourly number​

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An extra dollar an hour is worth less than most of these:

  • Minimum call. A four-hour minimum means a rain-shortened event does not turn into ninety minutes of pay.

  • Cancellation policy. Full pay for cancellations inside 48 hours, half pay for 48 to 72 hours. Write it down. Late cancellation is the most common way per diem ATs lose money.

  • Overtime trigger. Games run long. Define when the clock keeps running and at what rate.

  • Travel and mileage. Reimbursed separately, at the IRS rate, or built into the day rate. Either is fine as long as it is stated.

  • Supplies and equipment. Get specific: tape, ice, coolers, AED, splints, crutches, treatment table, tent, shelter. Who brings each item. If you are supplying, price it.

  • Payment terms. Payment on site or within 14 days is customary. Net 60 is not. State the terms and the invoice process.

  • Scope limits. You are covering athletic injuries within your scope. You are not the event's medical director, you are not covering spectators, and you are not making decisions outside your scope. Say so in writing.

  • Coverage ratio. How many fields or courts, how many simultaneous events, how many other ATs. One AT for six fields is not coverage, and accepting it is a liability decision.

 
Get it in writing

 

A written contract is best. If the arrangement was made by phone, send a confirming email the same day listing date, times, location, rate, minimum, cancellation terms, supplies, and who holds the standing orders. That email is your record.

NATA's per diem guidance recommends a written agreement addressing: description of services, who develops and provides the EAP, supplies and equipment responsibility, classification (contractor or employee), tax handling, scope of practice consistent with your standing orders, rate and payment timing, expense reimbursement, required insurance and licenses, contract length, termination and dispute resolution, and the cancellation policy.

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Red flags

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  • No one can tell you whose standing orders you are working under

  • No written EAP for the venue

  • No access to participant emergency contact or medical information

  • Payment terms are vague or "we'll figure it out"

  • You are asked to work outside your scope, or to be the sole medical presence for a coverage load that is not clinically reasonable

  • The organization insists on a rate below your break-even point and characterizes it as good exposure

Resources
 
Connecticut Law

C.G.S. Chapter 375a, Athletic Training (§§ 20-65f through 20-65m): https://www.cga.ct.gov/current/pub/chap_375a.htm

§ 20-65f: definitions, including standing orders and health care providers

§ 20-65h: referral obligations

§ 20-65k(d): professional liability insurance requirement

 

C.G.S. § 31-222: worker classification, ABC test

 

CT DOL Employer/Employee Relationship for CT Unemployment Taxes

 

CT DPH Athletic Trainer Licensure

 

NATA

Best Practice Guidelines for Per Diem Work 

NATA Risk and Liability resources

Best Practice Guidelines for Athletic Training Documentation

NATA Position Statement: Emergency Planning in Athletics

 

CATA

Athletic Training Practice Guidelines

Concussion Information

AED Information

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This page is provided by the Connecticut Athletic Trainers' Association for the education of its members. It is not legal, tax, or insurance advice, and it does not create an attorney-client or advisory relationship. Statutory citations reflect Connecticut law as of the date of publication. Verify current statutory language and consult your own counsel, tax professional, or insurance broker regarding your specific circumstances.

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