Is a resident fall covered by my care home or assisted living insurance?

General liability covers injuries caused by your premises: a wet floor, a broken step, a visitor who trips. Professional liability covers injuries caused by the care you give or fail to give. A resident fall is almost always argued as a care failure: the fall risk was known, the care plan called for help with transfers or regular checks, and it did not happen.

That is why the policy type decides the outcome. A home carrying only general liability can have a certificate, a premium and a policy, and still receive a denial letter after a fall, because the claim is about care.

Falls are the most common cause of injury among older adults, and residents of care homes are older and frailer than average. For a small home they are the most likely serious claim you will face, which makes this the first thing to confirm on any policy.

First, look for a professional liability coverage part on the declarations page, sometimes called healthcare professional liability or resident care liability. If you cannot find it, ask your agent in writing whether you have it.

Second, check whether defense costs are inside or outside the limit. If they are inside, the lawyers defending the fall claim are paid out of the same limit that pays the family.

Third, check the limit itself. A fall that leads to a hip fracture and a death is valued on the injury, not on the size of your home.

Report the incident to your insurer promptly, even if no one has threatened a claim. Most care liability policies are claims-made and have reporting requirements, and late notice is one of the most common reasons a covered claim becomes a coverage dispute. Keep the incident report, the care plan and the charting together and unchanged.