Do we need abuse coverage if we have never had a claim?

Yes, and a clean history is the argument for negotiating a better limit rather than for skipping the coverage. Abuse allegations produce the largest verdicts and the most publicity in senior care, and they are almost never covered at the full policy limit.

Read three things: the sublimit amount relative to your main limit, whether abuse has its own aggregate or shares the general one, and whether the endorsement applies to any claim arising out of abuse regardless of how it is pleaded. That last phrase is what pulls negligent hiring and supervision counts into the sublimit alongside the abuse count.

Then check whether the excess layers follow form over abuse. Many excess markets decline to follow a sublimited abuse grant, which means coverage that exists at the primary can vanish above it.