Anatomy of a home healthcare claim

February 03, 2015

We are very proud of our claims handling and broad policy language. Here is an example of a claim we recently settled for one of our insureds. I’m sure they did not expect to get a claim as soon as they bound coverage, but were happy they had the coverage they need and a claims team that was on their side.

May 2013: Hiscox writes a policy, covering home healthcare services performed on or after May 6, 2012, effective May 6, 2013 – May 6, 2014. Coverage included professional and general liability with limits of $1M each claim and $3M aggregate for each.

May 30, 2013: our insured receives a letter from an attorney stating that a patient was injured in their care and demanding their insurance company’s information.

June 2013: a lawsuit is filed against our insured by the mother of a disabled adult, on his behalf, for bathtub burns allegedly caused by negligent care by the insured’s staff on April 15, 2013.

July 2013: our coverage analysis determined that coverage would apply under the Professional Liability coverage part since the allegations were for negligence in the course of professional services, performed after our retroactive date, causing bodily injury, and the claim was made during the current policy period.

October 2013: through discovery, we received photos that show a burn pattern that is inconsistent with injuries from scalding bathtub water. We suspect that the client’s mother is not being forthcoming about the true nature of the injuries and continue to gather information.

February 2014: following favorable depositions of the insured’s staff and the patient’s mother we were able successfully settle this claim at mediation for a fraction of the initial demand, helping the insured maintain their good name in the process.

Hiscox rolled out a new Home Healthcare professional liability form December 2014, which aims to meet more of the needs of our insureds and brokers by including necessary coverage in the base form as well as some useful add-on coverage by endorsement.