TL;DR
Claim type
Ask an administrator about a fall and you get an incident narrative: where it happened, what the floor was like, whether anyone saw it. Ask plaintiff counsel about the same fall and you get a different document entirely, one that starts weeks before the fall with the admission assessment.
That difference is the whole claim. A visitor who slips in the lobby has a premises case. A resident who falls in the same lobby has a care case, because the resident was someone the community had already assessed, already planned for, and already agreed to supervise.
Last updated
01
The complaint will allege that the resident had a documented fall risk, that the care plan required specific interventions, and that on the day in question those interventions were not delivered. Physical conditions appear too, but usually as a secondary count rather than the theory of the case.
The reason is value. A premises claim is worth what the injury is worth. A care claim reaches assessment, staffing and supervision, which supports a corporate negligence theory, which supports discovery into budgets and staffing models, which supports a much larger number. Counsel who does this work chooses the second framing every time.
Expect the complaint to name more than the operating entity. Where the staffing model was set above the building, the management company and the parent get named on the same theory.
02
The fall risk assessment at admission and at each change of condition, with the score and the tool that produced it. An assessment that was never repeated after a medication change or a decline is the gap counsel looks for first.
The care plan, and critically its revision history. A care plan that names an intervention is only useful if the record shows the intervention was performed. A plan that was never revised after the first fall is worse than no plan, because it establishes the risk was known and the response did not change.
The staffing and assignment record for the shift. If the shift ran below what your own acuity tool called for, that comparison is the most damaging document in the file, more damaging than a shortfall against a state minimum, because it is your own assessment of your own residents.
Post-fall documentation: neurological checks where indicated, the physician notification, the family notification, and the post-fall assessment that should have changed the care plan. The most common failure is a thorough incident report followed by no change to the plan.
Video, which overwrites on a cycle measured in days. It is the single most commonly lost piece of evidence in this claim type and its loss is not neutral: a court may permit the jury to infer what it would have shown.
03
Professional liability responds to the assessment, care planning and supervision theories, which carry the value. General liability responds to the physical condition theories. On a combined general and professional form this distinction is academic. On a split program it decides which limit and which retention applies, and the allocation argument runs alongside the case.
The first failure point is defense treatment. Fall cases are document-intensive: the chart, the staffing records, the care plan history and competing clinical experts all have to be worked up. On a policy where defense erodes the limit, that spend is consuming the money available to settle, and it is consuming it on cases that are frequently defensible.
The second is the abuse and neglect sublimit. In states with a statutory neglect definition, a fall following a documented and unaddressed risk can be pled as neglect rather than negligence, which on many forms moves the claim to a sublimit well below the policy limit.
The third is the entity schedule. If the management company is named and is not a named insured, it funds its own defense and the carrier is entitled to allocate defense costs between covered and uncovered parties.
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Preserve the video before the retention cycle overwrites it, and confirm in writing that the system has been suspended. This is the single most time-critical action and it is routinely missed.
Issue a litigation hold covering the clinical record, the incident file, staffing and assignment records for the shift, equipment maintenance records, the training file for the staff involved, and internal communications about the resident.
Record the names and contact details of every person on duty, including agency staff. Turnover will make them unreachable within months and they are the witnesses.
Report it. On a claims-made program, an incident meeting your notice standard should be noticed as a circumstance, which fixes the responding policy year even if the demand arrives three years later.
Do not alter or supplement the chart. Late entries are permissible when made and dated properly, but any change after a demand letter will be characterised as fabrication regardless of intent, and electronic records carry audit trails that make the timing visible.
Talk to the family, promptly and in person. The most common reason a family retains counsel is that nobody explained what happened.
Follow-up questions
Almost always professional liability in substance, because it is pled as a failure of assessment, care planning and supervision rather than as a defect in the floor. General liability responds to the physical condition allegations that usually accompany it. On a split program the allocation between the two is a live argument; on a combined form it disappears.
Not meaningfully. A resident or family cannot generally waive the facility duty to deliver the care it assessed as necessary, and a waiver in the admission packet tends to be read as evidence the risk was known rather than as a release. The documented assessment and the documented intervention are what protect you.
That is the harder case and it is the common one. With no witness and a resident who may not be able to describe what happened, the only account is your record, and any gap in it is filled by the plaintiff narrative rather than by testimony. Unwitnessed falls are the reason contemporaneous charting is a financial control rather than a clinical formality.
Go deeper
Other claim types
The highest-severity routine claim in skilled nursing. It has no single incident to defend, so the case is decided by whether repositioning, nutrition, hydration and skin assessment were documented continuously.
The highest-severity single event in memory care and assisted living. Pled as a failure of wandering assessment and supervision, and frequently characterised as neglect, which on many policies moves it to the abuse sublimit.
High frequency, variable severity, and unusually complicated on the coverage side because the pharmacy, the prescriber, the agency nurse and the facility can each be responsible for a different link in the chain.
The highest-severity category in senior care and the one most often capped by a sublimit far below the policy limit. The claim against the operator is negligent hiring, supervision and reporting, not the act itself.
Not a claim type so much as a multiplier on every other one. It runs on a separate limitations clock, is frequently outside any arbitration agreement the resident signed, and in some states carries damages of a different character entirely.
Fast, frequently fatal, and unusually defensible or indefensible depending on two documents: the swallow evaluation and the diet order, and whether what was served matched them.
Predictable in dementia care and structurally awkward on the coverage side, because many abuse endorsements only reach acts by employees while an assault and battery exclusion can still catch the injury.
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Send the declarations page and the demand letter if there is one. A specialist reads which policy part responds, what the limit actually is after defense, and what to preserve, within one business day.