It is crucial that healthcare providers and risk managers be aware of and understand what coverage is available to respond to liability claims. A healthcare provider typically has, as part of its insurance portfolio, a professional liability policy and a general liability policy.
Federal and state nursing home regulations govern the rights of nursing home and assisted living residents. These regulations, designed to protect patients from abuse and/or neglect, address privacy, security and participation in care concerns.
Among these regulations are the laws created by the Nursing Home Reform Act. Claims of abuse and neglect are still prevalent, and this is a primary reason to carry professional liability coverage and to provide clients with reasonable nursing home insurance rates.
Nursing homes strive to provide care in a safe environment, but must make reasonable efforts to ensure that no harm comes to those in their care, be that from workers or outside forces.
What is covered under PL policy?
A professional liability policy typically covers damages because of a medical incident resulting from professional healthcare services. A medical incident may be typically defined as any act or omission in the rendering or failure to render professional healthcare services. Although some policies further define what is meant by “professional services,” the term professional services as defined by case law generally means work “requiring knowledge of an advanced type in a field of learning or science customarily acquired by a prolonged course of study of specialized intellectual instruction”.
This includes “services that require specialized skill, knowledge, learning, or attainments”. On the other hand, services requiring training in the performance of routine, manual, or physical processes are not considered “professional services” and will not be covered under a professional liability policy. This means that every facility must factor in a general liability policy into their nursing home insurance rates.
Claims of abuse, neglect, or failure to provide proper care, whether unfounded or not, are unfortunately part and parcel of running a nursing facility. Protection, in the form of nursing home professional liability insurance, is perhaps the best defense any time that a claim is filed and must be defended.