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Liability insurance is there to financially protect a business should something go wrong, and nursing homes are no different. This article will talk you through how these policies work, how they cover care homes, and the potential impact of claims on patient care.

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 Ombudsmen monitor, mediate and educate residents to improve their care.

However, even in 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 cover the cost of any legal action they may face.

What is nursing home liability insurance?

Liability insurance is standard no matter the type of business.

In the United States, all small businesses (businesses with 500 employees or less) should have liability insurance.

This is especially imperative in Arizona as the state doesn’t place a limit on non-economic damages (pain and suffering, depression, anxiety).

The cost of liability insurance for each nursing home is variable and depends on multiple factors. For example, a nursing home owner with limited experience may be charged more than an experienced owner.

Other factors influencing liability insurance premiums 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

How liability insurance works

Like any other business, care homes have a range of policies in place to guard them against legal claims.

As with most insurance 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 against them.

If a resident wins a claim against their nursing home, the business owners can use their insurance policy to pay damages.

However, there are some occasions when a policy won’t pay out or provide full cover.

When liability insurance isn’t enough

As with any other policy, liability insurance won’t always pay, or the claim may exceed the policy limitations.

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 payout, but the payment won’t cover the resident’s full costs.

If this happens, the resident can sue for the excess. The care home owner would then use their own financial assets to settle the remainder of the claim.

Which insurance policies are compulsory?

Arizona state law dictates which insurance policy types are compulsory for all businesses across Arizona. These insurance policies must provide a fixed level of coverage.

In addition, there are many extra insurance policies available. While they’re not obligatory, these policies could save a nursing home needing to fund a lawsuit from their own assets. Arizona’s compulsory insurances are:

Worker’ 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

Please note the above limits may be subject to change.

Employee benefits liability insurance

This is another essential requirement. An employer 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 any other losses.

Additional Insurance Policies

There are many additional insurances a nursing home may have to protect themselves against various liabilities.

Although these aren’t always necessary, business owners and staff may choose to take out:

  • 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, one on one 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.

Will legal action affect the quality of care?

A major concern among residents is 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 reoccurring and resulting in another lawsuit.

Finally, it’s important you’re 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 staff treat 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

How do I start a claim against a nursing home?

Contact a lawyer. They’ll negotiate with insurance companies for you, and if needed, file suit against the nursing home.

Do cases take long to settle?

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.

Is there a time limitation to make a claim?

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.

Can I prove negligence against a nursing home?

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.

What about cases of malpractice in nursing homes?

These cases are more difficult to prove. Finding fault requires calling on expert witnesses. You must then demonstrate the care you or your loved one received was below standard, caused injury, and has associated losses.

How a Lawyer can help you

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

Seek expert help from Thompson Law Firm

For most residents, their nursing home provides a safe, welcoming atmosphere. However, not every resident will be as fortunate. Should you or your loved one’s care fall below standard, you might want to consider legal action.

At the Thompson Law Firm, we’ll use our expertise in nursing home abuse and negligence to help you fight for the compensation you deserve.

For further information, contact us today.

Our experienced attorneys offer comprehensive guidance on all personal injury matters by phone or video conference call.

Our team of lawyers work closely with their injury clients across Arizona, communicating clearly whilst offering reassurance and empathy through an often very difficult and emotional process. During the free consultation, our lawyers will discuss your concerns before creating a comprehensive plan for you, while also assessing the strength of your claim.

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