Claims-made insurance policies are a vital component of risk management for the senior living industry, where professional liability and specialized coverages are common. Unlike occurrence-based policies, claims-made coverage depends on when a claim is reported and what defines a claim. In claims-made policies, a claim is typically any written demand for damages or remedy from an alleged wrongful act. However, it is very common for these policies to be structured to include incident triggers, where reporting a suspected incident that could lead to a claim before it’s actually made, also triggers coverage. Some incidents that might lead to claims include items like resident injuries, medical record requests, or complaints. Early reporting helps insurers manage risks, while failing to report on time can lead to denied coverage, even if no formal claim is made.
Variations across policies
Claims-made triggers, reporting rules, and timelines vary by insurer and policy. For senior living organizations, these differences affect coverage for resident care and operational risks.
Given the variability in policy language and the sensitive nature of senior care risks, proactive management and clear communication with insurers are critical to safeguarding coverage and protecting your community.
What defines a claim
Understanding the definition of a “claim” with a policy that includes incident triggers is critical in a claims-made policy. A misunderstanding of the policy’s definition of a claim along with timely reporting can lead to forfeited coverage, potentially leaving the insured unprotected if an insurer argues the claim was made before the policy began or reported too late.
Timeline requirements for reporting
Timely communication with your insurer is essential and knowing and meeting these deadlines is essential to maintain protection and avoid coverage gaps. Policies set strict deadlines for reporting claims or incidents, often during the policy or extended reporting period.
For more ways our specialized brokers can minimize your risk while maximizing the health of your communities, check out our senior living practice.
