ASKING THE RIGHT QUESTIONS

An important place for retail agents to start, when clients are facing insurance market shifts is to gather information on what has changed in the client’s business. Retail agents should discuss the following questions with senior living care facility operators:

What changes have you made in the past 12 to 36 months that would impact operations and potential risk exposures?

Examples of such changes could include:

• New Facility Leadership
• Capital Improvements
• Installation or replacement of technology that reduces risk or improves patient care. Some examples of such technology may include electronic medical records and elopement prevention devices.
• Change in Patient Mix, Such as by Age, Gender and Acuity

What steps have you taken in response to a prior claim or loss to mitigate the likelihood of a future recurrence?

Steps that facility operators might note for insurance underwriters include, for example:

• In-Service Training in Response to a Claim
• Changes in Facility Policies or Procedures as a Result of a Claim
• Improvement of a Facility’s Physical Condition
• Hiring of a Wound Care Team

What information should underwriters know about your facility’s operations?

Specific items to discuss with a senior living care facility operator include:

• Why is your facility less likely to incur a loss than it was 12 to 24 months ago?
• What factors that contributed to prior claims have changed for the better or may no longer apply?

Above all, insured’s should be introspective and accountable when providing underwriters with written responses to claims and improvements. Too frequently, insured’s feel the need to defend themselves regarding claims which does not help achieve the desired impact. Encourage the insured to acknowledge the shortcomings or issues that led to the claim and describe steps taken to reduce the likelihood of recurrence. Underwriters will respond more favorably to that approach.

BEHIND THE NUMBERS

The market correction in the senior living facility segment is based on long-term trends in loss drivers. Three types of allegations form the majority of closed claims in senior living, across skilled nursing, assisted living and independent living facilities, according to the CNA Aging Services 2018 Claim Report (source). These are: resident falls, accounting for 40.5%; pressure injuries, 22.6%; and improper care excluding falls, 17.0%. CNA’s 2016 Claim Report, which analyzed a four-year period dating back to 2011, found similar results: resident falls accounted for 42.7% of closed claims; pressure injuries, 18.6%; and improper care excluding falls, 14.7%.

CNA’s 2018 report found that the overall average total paid for a resident fall was $193,236. The overall average total paid for a pressure injury was $234,243. These are up from the 2016 findings, where CNA found the average claim payment for a resident fall was $186,589 and a pressure injury was $232,398.

BOTTOM LINE

Retail agents have an important role to play. As the insurance marketplace hardens for senior living facility operators, retailers can help their clients by: setting and managing expectations, communicating actions that enhance the client’s risk profile, and working with an wholesale specialist who can provide insights and creative insurance solutions.

Contact your CRC Group Producer for more information.

Contributors:

• Jason Lewis is President of CRC’s Denver office and National Healthcare Practice Leader.
• Lee McClure is a Healthcare Liability Broker at CRC based in Birmingham, AL.