| Falls and Transfer Injuries |
The most common source of nursing home claims. Hip fractures, head injuries, and death from falls — especially during transfers, toileting, or ambulation. |
High claim frequency; premiums +10–30% based on fall rates. Carriers require documented risk assessments and fall prevention programs. |
| Pressure Ulcers (Bedsores) |
Stage III and IV pressure injuries are often cited as evidence of neglect. Poor turning schedules, inadequate nutrition, and documentation gaps drive claims. |
Premium increase; carriers scrutinize wound care protocols, turning schedules, and Braden scale documentation. |
| Medication Errors |
Wrong drug, wrong dose, wrong time, or missed doses — especially with polypharmacy in elderly populations. Controlled substance diversion adds exposure. |
+15–35% PL surcharge; higher if no eMAR system or pharmacy partnership. |
| Abuse and Neglect Allegations |
Physical, emotional, sexual, or financial abuse claims carry the highest severity. Even unfounded allegations trigger costly investigations and defense. |
+25–50% surcharge or exclusions; SAM endorsement essential. Non-renewal possible after substantiated incidents. |
| Elopement (Memory Care / Dementia) |
Residents with dementia who wander off premises face injury, exposure, or death. Elopement claims carry catastrophic severity. |
Major underwriting concern; carriers require documented alarm systems, delayed egress, staffing ratios, and wander prevention protocols. |
| Infection Outbreaks |
COVID-19, MRSA, C. diff, and influenza outbreaks in congregate settings. Regulatory scrutiny is intense; wrongful death class actions possible. |
Post-COVID, infection control is a top underwriting concern. Carriers require documented sanitation, isolation, and outbreak response protocols. |
| Staffing Shortages / High Turnover |
Understaffing correlates directly with claim frequency and severity. CNA turnover disrupts continuity of care and training documentation. |
Up to +50% in severe cases; non-renewal possible. Carriers evaluate staff-to-resident ratios, training programs, and retention metrics. |
| Restraint Use (Physical or Chemical) |
Improper restraint use can cause injury, asphyxiation, or abuse allegations. CMS regulations heavily restrict restraint use. |
Surcharge; carriers require documented restraint reduction programs and staff training. |