KIMBERLY MARSELAS
@KIMMARSELAS
KIMBERLY BONVISSUTO
JUNE 14, 2025
Falls continue to be the most frequent source of liability claims in senior care facilities. (Photo: Getty Images)
The average payment for senior care liability claims doubled in the decade ending in 2024, with skilled nursing and other higher-acuity settings facing the highest increases.
Liberty Mutual highlighted courtroom tactics as one reason for the steep rise in its recent 2025 senior care claims study.
“Factors contributing to the increase in average indemnity payments include legal system abuse and plaintiffs’ counsel use of reptile theory courtroom tactics to inflame the jury,” the report noted. “By focusing on the providers’ chronic understaffing and payment of low employee wages, plaintiffs claim gross negligence in an effort to circumvent damage caps.”
While some states are targeting tort reform as a result, the insurance company offered other insights about the current market and where providers can make improvements to protect themselves from incidents, claims and liability.
Its study analyzed 2,500 closed claims reported under Liberty Mutual/Ironshore policies resolved within the past 12 years.
Overall, the average claim rose to $226,028 across senior care sectors by the end of 2024.
Falls drive claim volumes
Falls-related injuries (45% of all claims, the biggest percentage by far) consistently drove the overall volume of claims, pressure ulcers and abuse — although less frequent — led to higher claims costs.
“Although fall-related injuries generate more claims overall, the financial severity (average gross incurred) is notably greater for pressure ulcers, abuse, and elopements,” the study found. “These categories, while fewer in number compared to falls, present significant financial consequences, particularly in skilled nursing facilities, where residents’ mobility is often limited due to comorbidities.”
In addition, 40% of closed claims contained wrongful death allegations, a large drive of claim frequency.
The average payment for senior care liability claims doubled in the decade ending in 2024, with skilled nursing and other higher-acuity settings facing the highest increases.
Liberty Mutual highlighted courtroom tactics as one reason for the steep rise in its recent 2025 senior care claims study.
“Factors contributing to the increase in average indemnity payments include legal system abuse and plaintiffs’ counsel use of reptile theory courtroom tactics to inflame the jury,” the report noted. “By focusing on the providers’ chronic understaffing and payment of low employee wages, plaintiffs claim gross negligence in an effort to circumvent damage caps.”
While some states are targeting tort reform as a result, the insurance company offered other insights about the current market and where providers can make improvements to protect themselves from incidents, claims and liability.
Its study analyzed 2,500 closed claims reported under Liberty Mutual/Ironshore policies resolved within the past 12 years.
Overall, the average claim rose to $226,028 across senior care sectors by the end of 2024.
Falls drive claim volumes
Falls-related injuries (45% of all claims, the biggest percentage by far) consistently drove the overall volume of claims, pressure ulcers and abuse — although less frequent — led to higher claims costs.
“Although fall-related injuries generate more claims overall, the financial severity (average gross incurred) is notably greater for pressure ulcers, abuse, and elopements,” the study found. “These categories, while fewer in number compared to falls, present significant financial consequences, particularly in skilled nursing facilities, where residents’ mobility is often limited due to comorbidities.”
In addition, 40% of closed claims contained wrongful death allegations, a large drive of claim frequency.
(Source: Liberty Mutual 2025 Senior care claims study)
Failure to treat/prevent pressure ulcers resulted in 331 claims in skilled nursing, 30 claims in assisted living, and just one claim in independent living.
For falls, nursing homes experienced 557 claims, with 209 in assisted living and 75 in independent living.
The report authors said that the data underscore the need for “consistent and meticulous” documentation regarding resident assessments for care plans, falls risks and wound care management, as well as the “critical” need for comprehensive safety plans. The report also emphasized the importance of implementing resident monitoring systems, employee training on safety protocols and comprehensive care plan interventions to prevent elopements.
Costs vary by care level
Skilled nursing providers saw the highest average claims cost at $210,000 per incident, followed by assisted living communities at $159,000 and independent living settings at $74,000.
Those costs often were doubled when indemnity was involved, due to the associated expenses to launch a “robust defense.”
Failure to treat/prevent pressure ulcers resulted in 331 claims in skilled nursing, 30 claims in assisted living, and just one claim in independent living.
For falls, nursing homes experienced 557 claims, with 209 in assisted living and 75 in independent living.
The report authors said that the data underscore the need for “consistent and meticulous” documentation regarding resident assessments for care plans, falls risks and wound care management, as well as the “critical” need for comprehensive safety plans. The report also emphasized the importance of implementing resident monitoring systems, employee training on safety protocols and comprehensive care plan interventions to prevent elopements.
Costs vary by care level
Skilled nursing providers saw the highest average claims cost at $210,000 per incident, followed by assisted living communities at $159,000 and independent living settings at $74,000.
Those costs often were doubled when indemnity was involved, due to the associated expenses to launch a “robust defense.”
(Source: Liberty Mutual 2025 Senior care claims study)
The report authors attributed the cost disparities to the inherent vulnerabilities of residents in higher levels of care. In addition, as the level of care escalated, so did the complexity and expense of defending and settling claims, including the need for specialized expert witnesses, extensive medical records reviews and in-depth analysis of comorbidities.
Failure to protect residents from abuse led to the highest claims costs. Four claims in independent living had an average cost of $568,000, compared with 23 claims in assisted living at an average cost of $227,000 and 28 claims in skilled nursing settings costing an average of $286,000.
“The financial liabilities linked to allegations of abuse and elopement are viewed through a lens of perceived preventability, particularly in settings with vulnerable populations,” the report read. “This emphasizes the critical importance of regular staff training on the facility’s abuse policies, safety protocols, de-escalation techniques and thorough pre-employment screening to mitigate risks.”
The report authors attributed the cost disparities to the inherent vulnerabilities of residents in higher levels of care. In addition, as the level of care escalated, so did the complexity and expense of defending and settling claims, including the need for specialized expert witnesses, extensive medical records reviews and in-depth analysis of comorbidities.
Failure to protect residents from abuse led to the highest claims costs. Four claims in independent living had an average cost of $568,000, compared with 23 claims in assisted living at an average cost of $227,000 and 28 claims in skilled nursing settings costing an average of $286,000.
“The financial liabilities linked to allegations of abuse and elopement are viewed through a lens of perceived preventability, particularly in settings with vulnerable populations,” the report read. “This emphasizes the critical importance of regular staff training on the facility’s abuse policies, safety protocols, de-escalation techniques and thorough pre-employment screening to mitigate risks.”
No comments:
Post a Comment