What documents should we send with our submission?

Application, signed and complete, with no blanks left for the underwriter to interpret. Five years of loss runs valued within the last thirty days, from every carrier, including years with no losses, since a missing year is read as a hidden year.

Schedule of locations: address, care setting, licensed beds, occupied beds, year built, construction, protection, replacement cost, and the licensing status of each.

Current policy specimens rather than certificates, so the incoming market can see the defense treatment, the abuse sublimit, the retroactive date and the aggregate basis it is being asked to match.

Survey history for the last three years with statements of deficiency and plans of correction, and an explanation of any immediate jeopardy finding. Sending it is better than withholding it, because it is public and the underwriter will find it.

Staffing: hours per resident day by discipline, agency percentage and its trend, turnover rate, and the acuity tool you use.

Clinical program summary: falls program, wound care capability and protocol, medication management, behavioral health support, and infection prevention.

Abuse prevention packet: background screening policy and frequency, reference verification practice, training records, reporting mechanism, and how prior allegations were handled. This is the exhibit that moves the abuse sublimit.

One page describing who you are: ownership, how long you have operated, what the portfolio is, what the strategy is, and what changed this year. Underwriters see hundreds of submissions with no explanation of the business behind them.

Then a paragraph per large loss: what happened, what the operational response was, when it was implemented, and where the claim stands. A large loss with a dated operational response is a managed risk. The same loss with no explanation is an open question priced as such.

And a paragraph on what you want from the program, in structural terms: defense outside the limit, abuse at full limit, per-location aggregates. Stating the objective invites a quote against it rather than a quote against the cheapest structure.

Release the submission at least one hundred and twenty days before expiration. Underwriters in this class need referral authority for most accounts and a late submission gets a defensive price.

Send it as one organized package rather than as a stream of attachments over three weeks. A submission an underwriter has to assemble is a submission that goes to the bottom of the pile, and in a market with few participants the position of your file in that pile is worth real money.