Claims-Made versus Occurrence Coverage
What this clause says
This Policy applies only to Claims first made against the Insured and reported to the Company during the Policy Period or any applicable Extended Reporting Period.
What this actually means
An occurrence policy responds to injuries that happen during the policy period, whenever the claim is eventually made. A claims-made policy responds only to claims first made and reported while the policy is in force, and only for incidents that happened after its retroactive date. Senior care professional liability is commonly written claims-made because the gap between an incident and a lawsuit in this class can be long.
What it means for an operator
The distinction only bites at transitions. As long as you renew with the same structure and an unbroken retro date, claims-made behaves much like occurrence. The damage happens when a program switches carriers, switches from claims-made to occurrence or back, or lapses. Each of those moments creates the possibility of a year of operations with no policy that will answer for it. In a hard market where operators change markets more often, this is no longer a theoretical exposure. Treat any carrier change as a coverage-continuity project rather than a pricing exercise.
Program notes
Occurrence coverage is scarcer and generally more expensive in senior care than claims-made, and in the hardest segments it may not be offered at all. Claims-made with a clean, continuous retro date and a funded tail plan is a defensible structure; claims-made with neither is not.
How this evaluates
The Policy Checker applies these rules in order; the first match wins.
coverage trigger equals occurrence -> Compliant: Occurrence coverage responds to incidents during the policy period regardless of when the claim is eventually made, which removes retro-date and tail exposure entirely. coverage trigger equals claims-made -> Borderline: Claims-made is normal in this class, but it makes the retroactive date and the tail into live issues. Both are checked separately below.
See this in your policy
Check this term against your own program.
Run the Policy CheckerRelated clauses
Common questions about this clause
- What happens if the retroactive date on my nursing home policy is wrong?
- Should we switch from claims-made to occurrence coverage?
- What is the difference between neglect and negligence in a senior care claim?
- What happens to insurance at a senior care change of ownership?
- What happens to our insurance when we acquire a senior living building?