A large liability insurer of skilled nursing facilities (SNF) compared its closed claims experience for the five-year period from January 1, 2007 through December 31, 2011 (“Group A”) with its closed claims experience between January 1, 2012 and December 31, 2013 (“Group B”) and found that “resident safety remains an abiding challenge for aging services organizations.” Group A consisted of 1,558 closed claims and Group B consisted of 843 closed claims.
The Group A closed claims had an average total paid (indemnity plus expense costs divided by the number of closed claims) in the amount of $211,477 while the Group B closed claims had an average total paid of $211,159. In 2012, the average total paid for closed professional liability claims involving for-profit facilities was $9,502 higher than the average paid for not-for-profit facilities.
For Group B, the average total paid for closed claims involving for-profits facilities was $26,713 higher than the average paid for not-for-profit facilities, due to higher expenses for managing the claims and higher average indemnity payments made (indemnity payments are monies paid for the settlement or judgment of a claim).
The insurer reported that 29.4% of the total paid closed claims for both groups combined involved payments for high severity, which was defined as total payments in excess of $250,000.
The insurer also found the following:
The average total paid for SNF decreased from $218,072 for Group A to $200,837 for Group B.
The average total paid for assisted living facilities increased from $205,370 for Group A to $225,542 for Group B.
The average total paid for continuing care retirement communities increased from $168,422 for Group A to $317,741 for Group B.
The insurer found that the four most frequent allegations in closed claims for both groups were resident falls, pressure ulcers (bed sores), improper care, and failure to monitor. The highest average payments involved allegations of elopement ($368,789 in Group A and $339,658 in Group B, with 43 of the 49 elopement claims involving cognitive impairment), failure to follow a physician’s order, failure to inform a physician, and gross improper care (egregious deviation from standards).
Approximately 82% of closed claims in both groups involved the most frequently claimed injuries: death, fractures, and pressure ulcers. The highest average total payments were made for injury claims involving loss of limb or amputation, and death.
Of the 2,401 total closed claims in both groups, 991 involved resident falls (of which 452 involved allegations of failure to monitor), most of which involved falls at the resident’s bedside, in the resident’s bathroom, or in other areas of the resident’s room.
Closed claims primarily alleging resident abuse increased from 3.9% of the closed claims for Group A to 4.3% for Group B. Abuse claims almost always involved allegations of abuse committed by another resident or by an employee.
Closed claims involving medication error allegations decreased from 4.2% of the closed claims for Group A to 2.6% for Group B.
If you or a loved one were injured (or worse) as a result of nursing home neglect, nursing home abuse, or nursing home negligence in the United States, you should promptly seek the legal advice of a local nursing home claim attorney in your state who may investigate your claim against a nursing home for you and represent you or your loved one in a nursing home case, if appropriate.
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