That's exactly what she did so that Steve-O could do what he is famous for—shock. To assuage the expected fear of an insurer to cover such an act, McNaught consulted a doctor to find out just where Steve-O could staple his leg without hitting anything important, like a blood vessel.

“After the doctor and I shared a laugh, he actually told me the place [Steve-O] could do it without seriously injuring himself,” McNaught says.

With more than 15 years working with networks and reality TV producers, McNaught fields numerous calls every day—each presenting insurance dilemmas.

“It's challenging, and it can be nerve-wracking,” she says. “There can be a lot of people waiting. A crew can be on a Tarmac, waiting to get on a helicopter. Obtaining insurance is always the last call.”

The popularity of reality shows has ballooned and the wide-range of types keep McNaught on her toes and her negotiating skills sharp.

“A lot of these shows are seeking to make the audience gasp,” McNaught says. “That can get risky and, in order to get coverage, part of my job is convincing underwriters the risk is worth taking.”

For the most part, it is. The loss ratio is less than 3 percent, McNaught says. And coverage is mostly affordable. As reality television has evolved, brokers have forced producers to tighten liability releases contestants sign, and to fully explain the contract to them.

However, there are cases in which no insurer can be found—at least not for the stunt as it was originally drawn up. McNaught says one show wanted contestants to pass a baton to each other while sitting on a chair on top of separate biplanes.

“That one got a little crazy,” she explains. “They would have to be really close, the pilots' would need to be perfect and the weather needed to be right.”

The show, fully insured, wound up doing the stunt—just without the passing of a baton.

When you watch a show such as “Fear Factor,” the risks are obvious. Contestants, for example, are asked to gather flags while climbing on the outside of a car that is dangling from helicopters 100 feet in the air. McNaught has worked with “Fear Factor” and other popular reality shows, such as “Survivor,” and sometimes, the biggest risks are the ones behind the scenes.

For instance, kidnap and ransom coverage is essential for any show leaving the country. Coverage for the confiscation of equipment is important as well, she says.

Location also plays a role. If you're filming in Iceland, maybe insurance for a volcano eruption wouldn't hurt. Taping in Florida during hurricane season definitely carries more risk. A remote spot away from medical services can be tricky too, McNaught says.

“These are all things I bring up that they may or may not have thought about,” she says. “But that's what a good broker does.”

In fact, McNaught says she's been presented with so many risk scenarios for so many different types of shows, she can normally predict what the show is going to do next.

But for all the talk about the risks associated with reality shows, the most claims are generated by a standard set of stairs.

“The walk-and-talk shows—the game shows,” answers McNaught when asked about the shows that produce the most claims. “Walking up and down a staircase.”