Liability insurance is there to financially protect a business should something go wrong, and nursing homes are no different. A few forms of insurance for nursing home care are required when operating a nursing home in order to safeguard both the facility and its inhabitants. Liability, property, and workers’ compensation insurance are a few examples of these coverage alternatives.
This article will guide you through how does nursing home insurance work, how it covers care homes, and the potential impact of claims on patient care. If you need more information, you can contact us at our offices, conveniently located in Chandler, Peoria, and North Phoenix. We can meet in person at our nearby offices, over the phone, or via video call.
The injury attorneys at Nursing Abuse Injury Law Firm have significant experience in helping clients who have been nursing home abuse victims and need to use the home’s liability insurance. You can contact us for a free consultation or read on to find out more.
Nursing Homes & Insurance Background
Over the years, the United States government has made substantial efforts to improve the quality of nursing home care.
Federal laws detail the standards nursing homes must adhere to. For example, The Nursing Home Reform Act, introduced in 1987, protects residents’ rights, and the Ombudsmen monitor, mediate and educate residents on how to improve their care.
However, even at the best nursing homes, sometimes things go wrong.
In an environment where staff are responsible for vulnerable and fragile patients, even the smallest oversight could have severe consequences. Therefore, nursing homes have various liability insurances in place to help cover the cost of any legal action they may face.
What Is Nursing Home Insurance and What Does It Cover?
Liability insurance is essential for small businesses in the U.S., including nursing homes. In Arizona, it’s particularly important as the state imposes no limits on non-economic damages like pain and suffering. How much does nursing home insurance costs vary, with inexperienced nursing homeowners typically facing higher premiums.
Other factors influencing liability insurance for nursing home care are:
- Amount of employees
- Size of business premises
- Nature of business
- Location
- Past claim history
- Turnover
- Associated risks
- Required coverage levels
- Previous health and safety record
Is nursing home insurance worth it? Yes, since it covers legal expenses and potential settlements or judgments related to claims of liability.
How Does Nursing Home Insurance Work?
Like any other business, care homes have a range of policies in place to guard them against legal claims.
As with most insurance for nursing home care policies, the nursing home owner pays an insurance premium every month. In return, the nursing home gets insurance coverage they can turn to if a legal claim is made against them.
If a resident wins a claim against their nursing home, the business owners can use their insurance policy to pay damages. In such cases, people often ask: will insurance pay for nursing home costs related to harm or injury? The answer depends on the policy coverage — some policies may fully or partially pay legal settlements.
What Are the Minimum Liability Insurance Requirements for Nursing Homes by State?
Meeting insurance requirements offers residents and their families peace of mind while also protecting the nursing home from potential financial losses. Reliable nursing homes should assume that their residents have the necessary insurance, but unfortunately, this is not always the case.
While some jurisdictions may mandate higher limits, generally speaking, general liability insurance should have a minimum coverage level of at least $1 million. This includes the State of Arizona.
Insurance for nursing home care shields the facility from legal responsibility for mishaps, injuries, or property damage that occurs on their property. This insurance covers legal bills and settlement costs and protects the care home from expensive lawsuits.
Long-Term Care Insurance and Nursing Homes
Nursing homes and various care options such as assisted living and in-home care may be covered by long-term care (LTC) insurance, which addresses services not typically included in standard health insurance.
How much does long-term nursing home insurance cost? The average cost of long-term nursing home insurance, which can be used to pay for nursing home care, varies depending on age, gender, coverage amount, and other factors.
In 2024, the average annual premium for a $165,000 policy was $950 for a 55-year-old man and $1,500 for a 55-year-old woman
For a 60-year-old man, the average annual premium was $1,200, and for a 60-year-old woman, it was $1,900 varies based on factors like age at enrollment (younger enrollees pay lower premiums), coverage amount, health status, and policy type.
Annual premiums typically range from $1,500 to $7,000 and can increase with age or care needs.
Is long-term nursing home insurance worth it? Consider it if you have significant assets to protect, a family history of long-term care needs, and can afford the premiums. It might not be worth it if you qualify for Medicaid if premiums strain your budget or if viable alternatives exist, such as self-funding or family care.
What Does Long-Term Care Insurance Cover?
Long-term Insurance for nursing home care covers several services that help with daily care in the facility. This may include daily and personal care, transportation, and therapy, among others.
It covers expenses related to care services, not liability for injuries or negligence
How much is long-term nursing home insurance cover? It will depends of some of the variables such as age, health, and the scope of the policy. For example, for a 55-year-old man, the average annual premium for $165,000 of coverage in 2023 was $900.
How Does It Differ From Nursing Home Liability Insurance?
How does nursing home insurance and long-term care insurance work? How do they differ from each other? To answer these questions, we have to take into consideration several things, since they serve different purposes.
Long-term Insurance for nursing home care is purchased by individuals to cover costs associated with extended care services, like nursing home stays or home care, protecting them from financial burdens. It benefits those in need of care and their families.
In contrast, liability insurance for nursing home care is bought by the facilities to shield themselves from financial losses due to lawsuits. It covers claims of negligence or malpractice, including injuries to residents, abuse, or neglect, and it handles legal costs and settlements.
Incidents That Lead to Insurance Claims Against Nursing Homes
Nursing homes are responsible for protecting residents’ health and safety, but accidents can occur due to negligence, neglect, abuse, or other misconduct. These incidents often lead to insurance claims—how does nursing home insurance work in such cases? Typically, the facility’s liability coverage may compensate victims, but policies vary in scope and limits.
Accidents Due to Negligence
Accidents brought on by negligence or carelessness in nursing homes might involve a variety of circumstances. Falls, medication mistakes, a lack of supervision, a lack of staff, a failure to provide essential medical treatment, or a failure to avoid bedsores are a few examples of this. These situations can seriously injure the residents of a nursing home when it breaches its duty of care.Nursing Home Neglect
Neglect in nursing homes is another severe problem that may result in insurance for nursing home care claims. Inadequate hydration and nourishment, poor personal hygiene and care, a failure to keep the living space safe and sanitary, or a general disregard for the needs of the residents are just a few examples of how neglect can appear. Residents may experience severe health issues and a lower quality of life as a result of these types of neglect.Nursing Home Abuse
Abuse in nursing homes is a distressing issue that can manifest in various forms, including physical, emotional, sexual, and financial abuse. Physical abuse involves intentional harm, such as hitting or improper use of restraints. Emotional abuse includes verbal threats and humiliation, causing psychological distress. Sexual abuse refers to any non-consensual contact, while financial abuse involves unauthorized use of a resident's financial resources.Knowing how nursing home insurance works can help to get the proper compensation for the incident suffered.
Common Lawsuits Against Nursing Homes and How Insurance for Nursing Home Care Covers Them
Victims and their families can file insurance for nursing home care claims against nursing homes to seek compensation for harm suffered, which holds the facilities accountable and helps recover damages for medical bills, pain, suffering, or wrongful death. These claims can also highlight systemic issues, prompting necessary improvements in resident safety. Understanding your rights and how nursing home insurance coverage can help is critical during such claims.
Understanding what does nursing home insurance cover in these cases is key to ensuring fair compensation and adequate legal support. Navigating this process can be complicated, so it’s essential to consult with an experienced attorney who specializes in nursing home negligence. They can assist you throughout the legal process, collect evidence, and advocate for your rights, ensuring your claim is valued and negotiated fairly.
When Liability Insurance Isn’t Enough
Does insurance cover nursing home claim amounts in full? Not always. As with any other policy, liability insurance for nursing home care won’t always pay, and the claim may exceed the policy limitations. Understanding how does nursing home insurance works is critical when claims are denied or underpaid.
There are several reasons why an insurance company might reject a claim from a care home, these include:
- The care home didn’t provide accurate information
- A change of circumstances
- An eligibility clause
- The care home owner didn’t abide by the terms and conditions
- The policyholder may have been deliberately reckless, which could void the policy.
In another common scenario, the insurance company will pay, but the payment won’t cover the resident’s full costs.
If this happens, the resident can sue for the excess. The care homeowner would then use their own financial assets to settle the remainder of the claim.
Nursing Home Insurance Won’t Cover Everything?
Get Legal Help for Your Loved One Today!
Which Insurance Policies Are Compulsory?
Workers’ Compensation
Whether an employee is full-time or part-time, a business owner must purchase workers’ comp. However, there may be exceptions if the employee is an independent contractor or a casual worker. The nature of the job means nursing home injuries are common. For example, lifting a patient can cause back injuries, or managing a dementia patient prone to violence can lead to injury. Additionally, form filling and typing can cause RSI and upper limb pain. In these circumstances, an employer may need to claim Workers’ Compensation.Commercial Auto Insurance
- This relates to business-owned vehicles. If a business owner or their staff use their car for work purposes, they must have a minimum of:$15,000 bodily injury insurance for each person
- $30,000 bodily insurance for each accident
- $10,000 property damage
Employee Benefits Liability Insurance
This is another essential requirement. An employee who’s injured at work can sue their employer. If they’re successful, the home is responsible for lost income, pain and suffering, medical expenses, and other losses.Knowing how nursing home insurance works can help to get the proper compensation for the incident suffered.
Additional Insurance Policies
- Nurses’ insurance: individual staff members may have individual insurance to protect themselves financially.
- Business owner’s insurance: This is an insurance package that covers a mix of liabilities. This insurance makes coverage more affordable.
- Sexual misconduct insurance: unfortunately, assaults from residents and abuse from care workers sometimes occur. Therefore, a nursing home may decide to invest in this type of insurance.
- Property liability insurance: covers a business if a visitor injures themselves and for property damage.
- Medical malpractice insurance: if a nursing home provides medical care, this type of insurance covers the cost of a negligence claim against them
- General liability insurance: sometimes referred to as commercial general insurance. It protects a nursing home if someone is injured on its premises. It also covers third-party property damage, libel, slander, and some copyright disputes.
- Business interruption insurance: this pays for ongoing financial commitments, payroll, taxes, and other costs.
- Content insurance: in the event of robberies or property damage.
- Umbrella insurance: Another consideration is an umbrella insurance policy. This insurance covers the excess that a nursing home’s other policies might not provide.
What Happens If a Nursing Home Lacks Proper Insurance?
Choosing a nursing home covered by insurance gives you peace of mind, knowing that any legal or medical issues will be addressed without risking the home’s financial stability. Without adequate insurance, a nursing home may be unable to pay residents for accidents they suffer, which could result in a decline in the quality of care. This can lead to lawsuits, financial problems, and closures. Therefore, it’s always important to check if you have adequate insurance for nursing home care.
How to Check if a Nursing Home Has Enough Insurance Coverage?
To understand how nursing home insurance works and if a facility has sufficient coverage, consider the following:
Will Legal Action Affect the Quality of Care?
A primary concern among residents is that their legal action may lead to poorer care for other residents. This is a legitimate worry. Funding that may have gone into improving patient care could instead fund a legal settlement.
However, as claims are largely paid out through insurance policies, this shouldn’t be the case, and nursing homes cannot justify poor care under any circumstances. Further, studies regarding Tort cases and whether litigation influences care show there’s no impact. One concluded that: “tort litigation has no substantial association—positive or negative—with quality of care in the nursing home sector.”
Your legal case may actually help improve care standards. Sometimes courts rule that homes must implement changes to make it safer, or homes address their failings to prevent the same problem from reoccurring and resulting in another lawsuit.
Finally, you must be aware of your rights. If you make a successful claim against the nursing home and remain a resident there, it shouldn’t make any difference to the way the staff treats you. If you fear this is the case, you have the right to make a complaint and speak to an Ombudsman. Consulting with your lawyer is also advisable.
Care Home Liability FAQs
Contact a lawyer. They’ll negotiate with insurance companies for you and, if needed, file suit against the nursing home.
The more complicated a case is, the longer it’s likely to last. It’s not untypical for cases to last 18 months or longer. However, relatively simple cases may be finished much sooner by settling with the insurance company.
Time limitations are detailed in Arizona’s state law under what’s called the statute of limitations. In Arizona, you have two years to make a personal injury claim.
The legal process isn’t one you should undertake on your own. By calling on their vast expertise and understanding of the laws, a lawyer is the person best placed to work alongside you.
These cases are more difficult to prove. Finding fault requires calling on expert witnesses. You must then demonstrate that the care you or your loved one received was below standard, caused injury, and has associated losses.
Seek Expert Help From a Nursing Abuse Injury Law Firm
Nursing home residents have the right to receive high-quality care, and a home should also allow residents the same level of dignity as anyone else. However, if a resident or their loved one feels this isn’t happening, they should explore the options open to them.
This could be following the formal complaints procedure, contacting the Ombudsman office, or speaking to a lawyer. In cases of personal injury or medical negligence, a lawyer can help by:
- Assessing your case
- Gathering documents, facts, and evidence to support your case
- Writing legal letters and sending a letter before action to the defendant
- Working with you for the best outcome and negotiating on your behalf
Legal assistance is crucial when dealing with liability coverage claims with insurance for nursing home care. For claims that often involve negligence, abuse, wrongful death, or inadequate care, a lawyer can help navigate complex legal and insurance issues.
Denied Coverage? Underpaid Claim?
Our Attorneys Fight for Nursing Home Victims!
More Ways We Can Assist You
Our team of abuse attorneys is dedicated to seeking damages on behalf of those family members who are being abused and helping you find better accommodations for them in the nearby area. We’ve worked on several nursing home abuse cases previously in your area and take the time to understand the family’s concerns as well as the situation they believe their loved one is in.
At the Nursing Abuse Injury Law Firm near you, we have more than 15 years of experience helping clients obtain compensation for their and their loved ones’ personal injuries, including those from nursing home abuse in the Phoenix area. When you’re ready to talk, please contact our office to arrange a free initial consultation by phone or at our Chandler office, conveniently located near you.
Contact Us Today!
If you or a loved one has been the victim of nursing home abuse, contact the Nursing Abuse Injury Law Firm in nearby Chandler, AZ, to speak with an experienced personal injury attorney. We provide personal injury legal services to clients in your area, including Chandler, Mesa, Scottsdale, Tempe, and Peoria.
