Long-term care facilities are among the most complex and high-exposure accounts in commercial insurance. The residents are among the most vulnerable members of society. The staff perform physically demanding work with one of the highest injury rates of any occupation. The regulatory environment is intense — state surveys, CMS certification, and staffing mandates all create compliance exposure. And the legal environment for nursing home claims has become increasingly plaintiff-friendly, with large jury verdicts for resident falls, pressure ulcers, and neglect. Writing this class correctly requires specialty markets, specialty forms, and a thorough understanding of the actual exposures.
Professional Liability (Long-Term Care / Nursing Home Liability)The primary specialty coverage for nursing homes, skilled nursing facilities, and assisted living communities. Covers claims arising from professional care services — resident falls, pressure ulcer development, medication errors, elopement (a resident wandering and leaving the facility unsupervised), inadequate supervision, failure to follow a physician's orders, and wrongful death from neglect. Long-term care professional liability is a specialty market with limited admitted carriers. Prior loss history for 5–7 years is typically required.
Abuse and Molestation LiabilityNursing home residents are among the most vulnerable individuals in society — elderly, often cognitively impaired, physically dependent on staff, and unable to advocate for themselves. Abuse and molestation by staff members — physical, sexual, or emotional — is one of the most damaging and highly publicized claim categories in long-term care. Standard GL excludes this coverage. It must be specifically added, and the underwriting scrutiny on abuse history, background check protocols, and staff supervision policies is significant.
Workers' CompensationNursing home employees have one of the highest WC injury rates of any industry. Patient handling — transfers, repositioning, lifting, and ambulation assistance — causes chronic musculoskeletal injuries to nursing aides and licensed nurses. Violence from cognitively impaired residents (dementia, TBI) creates a significant assault risk for floor staff. Needlestick and bloodborne pathogen exposure is also elevated. WC is the single highest ongoing insurance cost for most long-term care facilities after professional liability.
Commercial General LiabilityCovers premises liability for residents, visitors, and vendors — a family member who falls in the parking lot, a vendor injured in a delivery area, or property damage to resident personal property caused by facility operations. GL must be coordinated with the professional liability policy to ensure no gap exists between premises liability and professional liability claims.
Commercial PropertyCovers the nursing home building, resident common areas, furniture and equipment, medical equipment, kitchen and laundry equipment, and administrative office contents. Long-term care facilities often have significant building values with specialized HVAC, plumbing, and fire suppression systems that must be valued at replacement cost. Business interruption coverage for the loss of resident revenue if the facility must be evacuated or temporarily closed is also critical.
Crime / Employee DishonestyNursing home staff have access to residents' personal belongings, cash, valuables, medications, and in some cases power of attorney over financial accounts. Theft from residents — cash, jewelry, credit cards, prescription medications — is a recurring and underreported crime in long-term care facilities. Crime coverage with employee dishonesty and resident personal property theft protection is essential.
Directors and Officers (D&O)Nursing home operators face regulatory investigations, state health department actions, CMS certification disputes, and shareholder or ownership disputes that create D&O exposure for facility leadership. A regulatory action that threatens Medicare or Medicaid certification affects the facility's core revenue — and the defense of that action is a D&O claim, not a GL claim.
ACORD 125 — Commercial Insurance ApplicationPrimary submission document for nursing home and assisted living accounts. Capture facility type (skilled nursing facility, assisted living, memory care, continuing care retirement community), licensed bed count, current occupancy rate, Medicare/Medicaid certification status, and state licensing information.
ACORD 126 — Commercial General Liability SectionRequired for GL. Must describe all facility services — skilled nursing, rehabilitation, memory care, independent living, adult day services. Each level of care creates different liability exposure. Memory care and dementia units require specific underwriting consideration for elopement and resident-to-resident violence.
ACORD 130 — Workers Compensation ApplicationRequired for WC. Nursing home employee classifications include RNs (8833), LPNs (8833), CNAs (8833 or 8835), dietary staff (9058), maintenance (5183), and administrative staff (8810). The high-exposure classifications — nursing aides who perform direct patient care — must be accurately identified and separated from lower-risk administrative and ancillary staff.
ACORD 140 — Property SectionRequired for commercial property. Nursing home buildings require careful valuation — specialized HVAC systems, fire suppression systems, elevator equipment, commercial kitchen and laundry equipment, and resident room furniture all add replacement cost beyond the basic structure. Business income coverage based on lost resident revenue during restoration must also be calculated.
→What type of facility — skilled nursing facility (SNF), assisted living, memory care, CCRC, or a combination?
→How many licensed beds does the facility have? What is the current occupancy rate?
→Is the facility Medicare-certified? Medicaid-certified?
→What is the staffing ratio — nurses and CNAs per resident per shift?
→Does the facility have a dedicated memory care / dementia unit?
→What is the resident acuity mix — what percentage of residents require skilled nursing vs assisted living level care?
→Does the facility offer rehabilitation services — PT, OT, speech therapy?
→What is the facility's most recent state survey result — any deficiencies, immediate jeopardy findings, or civil monetary penalties?
→Has the facility been cited for any resident abuse, neglect, or exploitation incidents in the last 5 years?
→Has the facility had any elopement incidents in the last 5 years?
→What is the facility's fall rate and pressure ulcer incidence rate?
→What background check and screening process is used for all new hires?
→What is the building year of construction and date of last major renovation?
→What is the total building replacement cost value?
→Does the facility have a patient safety committee and formal incident reporting protocol?
→Has the facility had any professional liability claims or lawsuits in the last 7 years?