waiver of all claims [form]

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RAILS advises libraries not to complete Affordable Care Act forms or advise customers about which
insurance options are best for them, unless the library has staff who have completed certified
training, such as certified application counselors. Providing such assistance without certified training
exposes the library to liability. If a library chooses to do so anyway, use of a liability waiver is advised.
RAILS attorney Phil Lenzini has provided the following model waiver, but consult your library attorney
as well.
HEALTH INSURANCE MARKETPLACE
WAIVER OF CLAIMS AND HOLD HARMLESS
Starting October 1, 2013, under Federal law, consumers in all
states will be able to research, investigate and apply for new
affordable health coverage options through the Health Insurance
Marketplace for coverage beginning as soon as January 1, 2014. While
XYZ LIBRARY
, is not directly involved in providing assistance in
these applications and enrollments in the Health Insurance Marketplace,
and has no relationships with the health insurance products or coverages
involved, as a local community resource available for all residents and
patrons, particularly with the Library’s Internet access, available
computers and equipment, we have been enlisted to make those resources
available as needed for our citizens.
IN CONSIDERATION of the beneficial public services performed by
and to be performed by the
XYZ LIBRARY
, the undersigned citizen
hereby waives all claims for damage or injury to my person and property
which may be caused by an act or omission of the
XYZ LIBRARY
, its
officers, agents, employees, volunteers, or any other person or persons
performing any service or assistance in respect to the Affordable Care
Act whatsoever. As an interested patron or library user, I understand
that there may be exposure of my personal information, privacy or
confidences, or activities which pose a substantial risk of such, as
well as aspects of my investigation or application or enrollment in the
Health Insurance Marketplace for health care coverage.
I assume the risk of all such dangers and conditions included in
or incidental to any assistance requested by me of the Library or
provided thereby, and I hereby waive any and all specific notice of such
conditions. I understand that the
XYZ LIBRARY
shall not be liable
for any damages or injuries I might sustain. I hereby fully and forever
release and discharge
XYZ LIBRARY
from any and all claims,
demands, damages, rights of action or causes of action, present or
future, whether the same be known, anticipated or unanticipated,
resulting from or arising out of my requests for assistance from the
XYZ LIBRARY
.
_____________________________
Dated
___________________________
Signature
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