Insurance Claims Report Spotlights Risks To Assisted Living Facility Operators


Late last year CNA, one of the nation’s largest commercial insurance companies, issued a report summarizing professional liability insurance claims for senior living facilities that it closed between 2011 and 2015. Although the vast majority of the closed claims (80.7%) were from skilled nursing facilities, some of the findings in the report are of significance to assisted living facility operators.

*The leading causes of claims paid regardless of facility were resident falls (42.7%), pressure ulcers (18.6%), and improper care (excluding falls) (14.7%).

*The highest average paid claims for all facility types were elopement ($325,561) followed by failure to follow physician orders ($323,325), and delays in seeking medical treatment ($245,783).

*The average paid per closed claim for assisted living facilities ($221,496) was higher than the average paid for skilled nursing facilities ($212,766).

*More than one half of elopement claims (54.3%) were from assisted living facilities.

*Assisted living facility elopement claims were very costly, averaging $388,048 per claim, and they were more costly than elopement claims for skilled nursing facilities ($251,172).

*Although 94% of pressure ulcer related claims arose from skilled nursing facility residents, the average claim paid for pressure ulcer related claims for assisted living facilities ($236,562) exceeded the average pressure ulcer claim paid for skilled nursing facilities ($231,732).

*Almost 76% of the fall related claims involved skilled nursing facility residents, but the average claim paid for fall related claims for assisted living facility residents ($196,571) exceeded the average claim paid for fall related claims involving skilled nursing facility residents ($188,009).

The complete CNA report can be found here.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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