While both indemnity and expense payments have fluctuated over time, ultimate severity of indemnity and expense payments has trended upward over the past 10 years, according to the latest CNA aging services professional liability claims study, Aging Services 2012: Data Analysis Supporting the Need for Industry Change.
The study, developed by a multidisciplinary team comprised of CNA Healthcare risk management consultants, actuaries, claim professionals, legal counsel and senior underwriters, was designed to provide a better understanding of the risks associated with providing care for the aging population, as well as presenting options for change.
Some key findings:
- Actuarial projections indicate that the frequency of claims that incurred indemnity or expense payments has fluctuated between 2.6 and 4.0 claims per thousand beds between 2001 and 2010.
- Not-for-profit facilities have disproportionately fewer closed claims relative to their share of the CNA book of business than for-profit facilities.
- Skilled nursing facilities have the highest average severity, followed by assisted living facilities.
- High severity allegations include elopement, failure to follow physician orders, gross improper care, pressure ulcer and failure to inform the physician on change in the resident’s condition.
- The most frequent injuries are death and fracture. Almost one-half of the closed claims – 48.6 percent – involve death.
The “Looking Forward” section of the study discusses new theories of liability that will emerge as factors in healthcare delivery models evolve. Long-range planning efforts should consider industry developments, such as accountable care organizations, mergers and acquisitions, information technology, living environment and resident-directed care, staffing shortage and burnout, social media and Internet usage, changes in reimbursement and increasing complexity of risk exposures.
The complete study, as well as other CNA Healthcare client risk control resources, can be accessed under ‘Client Resources’ at http://www.cna.com/portal/site/cna/riskcontrol.