Insurance Claims Report Spotlights Risks To Assisted Living Facility Operators

By: I. Paul Mandelkern:  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.

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