Specialty Lines Markets
Health care-related risk
Includes retirement and assisted living communities, nursing homes and senior condominiums/senior
By Larry G. France
Breaking news! We are all getting older by the day. I know that the 60s are the new 50s, but chronologically you are what you are. If you restore a 1957 Chevy to showroom condition, it is still a 1957 Chevy.
The U.S. life expectancy has risen to 77.6 years. Medical advances, better eating habits and more participation in exercise have all contributed to the upward trend.
According to the 2004 Census, there are 36.3 million people over 65 in the United States, or 12% of the total population, up from 35 million in 2000. That figure is estimated to grow to 86.7 million by 2050.
What does all this mean? It means that we will need to fix the Social Security mess, and it also means we will need more facilities that can accommodate the various levels of health care required by this growing number of seniors.
We are not just talking about nursing homes, which is the first thing that comes to mind. Facilities are needed for retirees who are capable of taking care of themselves but want services such as medical, transportation, beauty and barbershops, and recreational activities. Seniors may have a unit with a kitchen, bathroom and dining area. Assisted living centers usually provide other services depending on each person’s individual needs.
Other kinds of facilities include Alzheimer’s and Continued Care Retirement Communities (CCRCs), Personal Care Homes, hospice care, home health care and, relatively new, Adult Centers.
Adult Centers provide assistance for people who cannot be left alone for physical or medical reasons but who do not require 24-hour nursing care. These centers usually offer social interaction with others by way of card games, arts and crafts, bingo, singing, and meals. They also provide medical assistance, including skilled nursing, bathing, grooming, therapeutic massage and physical therapy. Some offer entertainment programs and trips. These facilities can assist in keeping people both physically and mentally healthy while providing individuals with a sense of anticipation that improves their well-being.
Coverages include professional liability (Nursing Home Professional, Adult Care Homes, Assisted Living Facilities and Nurses Professional), property, auto, general liability, and umbrella. Volunteers, if applicable, should be noted on non-owned and hired auto and workers compensation.
Due to the nature of the clientele, special attention should be given to possible slip and fall claims when assessing loss control.
Several years ago, nursing homes suffered because many were written without proper, if any, inspections and underwriting guidelines. This resulted in rates as high as $5,000 per bed, and several markets exited with very high loss ratios.
Since that time, the markets that offer programs have instituted strict guidelines consisting of hard copy loss runs, copy of license, copy of state inspections, current financials and any agreements between the facility and its residents. This has resulted in a more stable market and lower pricing for those that qualify.
Michael Walton of AmWINS Health-care says: “One of our focus areas is liability coverage for providers of ‘ElderCare.’ This would include nursing homes, assisted living, independent living and CCRCs. The professional liability market targeting these types of organizations has changed dramatically over the past five years. It is evident that we have moved through an LTC (long term care) liability capacity crisis to what is now an area where there is often significant competition to write ElderCare accounts. The result is often significant price reductions. Furthermore, a number of markets are looking to get into this class presently. These are markets that would be new to this line of business.
“While many underwriters have adopted more advanced and accurate risk assessment tools, there are still a number of carriers and RRGs (risk retention groups) that just don’t know what they are doing in this respect,” Walton observes. “They continue to use erroneous and faulty information to determine facility quality and risk characteristics. As such, we believe some of the newer entrants and RRGs forced to acquire and retain business with overly aggressive pricing will experience underwriting losses in results.”
Certainly this line of business is far healthier today than in the past. Many can remember the days of struggling to keep or place clients in this class. Sales opportunities will grow for senior care facilities as the 65-plus population expands and new types of operations evolve to address their needs.
Accompanying the December edition of Rough Notes will be the 45th edition of The Insurance Marketplace containing more than 675 coverages, programs, and insurance industry services. Two new categories this year are privacy insurance and auto service centers. Log on to www.insurancemarketplace.com to search for any of the current categories.
The following have replied to our survey and indicated that they are a market for lines of business for health care-related risks:
All Risks, Ltd. and All Risks of CA Insurance Services, LLC
Atlanta, GA office
3930 East Jones Bridge Rd., Ste. 300
Norcross, GA 30092
Contact: David Imhoff, Ext. 232; Becky Stephenson, Ext. 217
Phone: (866) 484-5235
Fax: (770) 495-3591
E-mail: david.imhoff@allrisks.com bstephenson@allrisks.com
Web site: www.allrisks.com
Hunt Valley, MD office
10150 York Rd., 5th Fl.
Hunt Valley, MD 21050
Contact: Erik Halvorsen, Ext. 3091
Phone: (800) 366-5810
Fax: (410) 828-8179
E-mail: ehalvorsen@allrisks.com
Web site: www.allrisks.com
An E&S broker that operates in all states with limits of up to $10 million. Target classes are skilled care, assisted living and allied medical related classes: home health, durable medical equipment, staffing, long term care, and hospitals. Will consider any risk that has med mal exposures. All carriers are rated A- or better (a new relationship with Select Specialty Managers).
AmWINS Healthcare
660 Newtown-Yardley Rd.
Newtown, PA 18940
Contact: Michael Walton, Donald Tejeski, Edward Westermann
Phone: (267) 751-1421
Fax: (267) 751-1439
E-mail: michael.walton@amwins.com
A wholesale broker/program manager (health care professional liability) that operates in all states with various primary and excess limits. Target classes are nursing homes, assisted living facilities, hospitals, and allied health care providers. Will not write non-health care. Can offer property, workers comp, and umbrella. Carriers are all domestic, London and Bermuda markets writing medical professional liability coverage.
Aon Association Services
1120 20th St. N.W., Ste. 600
Washington, DC 20036
Contact: Maria Moreno Ext. 8553
Phone: (800) 432-7465
Fax: (312) 381-6211
Web site: www.askaspn.com
An MGA that operates in all states. Target classes are nonprofit and small for-profit aging services operations such as assisted living facilities, nursing homes, personal care, and services for the elderly. Can offer D&O and multiline P-C. CNA, The Hartford, and Travelers are the A rated or better carriers.
AVRECO
550 West Van Buren St., 12th Fl.
Chicago, IL 60607
Contact: William D. Yurek
Phone: (800) 776-7475
Fax: (312) 922-7563
E-mail: byurek@avreco.com
Web site: www.avreco.com
An E&S broker that operates in all states with primary limits of $1 million/$3 million and excess limits of up to $25 million. Target classes are skilled nursing homes and assisted living facilities. Occurrence forms are available in certain states. All carriers are A rated.
Bohrer, Croxdale & McAdoo, Inc.
P.O. Box 2760
Springfield, MO 65801-2760
Contact: Vicki Cota, Debra Shelton
Phone: (800) 779-2550
Fax: (888) 869-2550
E-mail: vcota@bcmins.com dshelton@bcmins.com
Web site: www.bcmins.com
An MGA/E&S broker that operates in AR, IL, KS, MO and OK with limits of $5 million (possibly more). Target classes are home health care, nurse staffing, group homes, distressed physicians, clinics, ambulance services, counseling, medical labs and more. Will not write preferred physicians. Can offer physical/sexual abuse, non-owned auto, and employee benefit liability available with GL and professional. All carriers are A rated.
Burns & Wilcox Ltd.
30833 Northwestern Hwy.
Farmington Hills, MI 48334
Contact: Local Burns & Wilcox office or visit the Web site.
Phone: (800) 521-1918
Fax: (248) 932-9050
E-mail: info@burnsandwilcox.com
Web site: www.burnsandwilcox.com
An MGA that operates in all states except AK and HI with limits of up to $5 million. Will consider all classes with an emphasis on home health care and medi-spas. Will not write standard physicians. Can offer property, D&O and EPLI. Darwin, Colony, Evanston, and USF are the carriers.
Continental/Marmorstein & Malone
P.O. Box 586
Paramus, NJ 07652
Contact: William H. Malone Jr.
Phone: (800) 932-0849
Fax: (201) 261-8922
E-mail: bmalone@ca-group.com
Web site: www.ca-group.com
An E&S broker that operates in CT, DE, NJ, NY and PA with limits of $5 million. Will write most classes including assisted living centers, clinical testing/trial facilities, CT scan labs, drug testing labs, drug/alcohol detox facilities, home health care agencies, medical personnel pools (providers), nursing homes, pain management centers, rehab facilities, and substance abuse centers. Liberty International Underwriters, Lloyd’s, Evanston, Western World, American Empire Surplus Lines, Admiral, and First State are the carriers.
Darwin Professional Underwriters, Inc.
9 Farm Springs Rd.
Farmington, CT 06032
Contact: Drake Manning
Phone: (860) 284-1300
Fax: (860) 284-1301
E-mail: info@darwinpro.com
Web site: www.darwinpro.com
An insurer that operates in all states with medical professional limits of up to $10 million, health care D&O/EPL up to $15 million, and managed care E&O up to $20 million. Target classes are hospitals, physicians, physician groups, managed care organizations, clinical research facilities, miscellaneous medical facilities, and long term care facilities. Can offer clinical research liability, network security, privacy and other technology coverages. Darwin National Assurance and Darwin Select are rated A-.
Health Care Insurers, a Div. of Risk Placement Services, Inc.
7011 Campus Dr., Ste. 200
Colorado Springs, CO 80920
Contact: Karen Jacobson (719) 219-3635; Ed Zarrella (312) 803-7415; Linda Wright (813) 281-2858
Phone: (800) 397-9697
Fax: (719) 528-8323
E-mail: kjacobson@hciusa.com ezarrella@hciusa.com lwright@hciusa.com
Web site: www.hciusa.com
A managing underwriter that operates in all states with limits of $100,000/$300,000 and up. Target classes are hospitals, nursing homes, home health care, clinics, labs, physicians, assisted living facilities, hospice, x-ray/MRI, dialysis centers and blood banks. Can offer PL, GL, umbrella, excess, D&O, E&O and property. Health Care Insurers represents more than 30 A rated companies.
Hospice and Community Care Insurance Services
183 Leader Heights Rd.
York, PA 17405
Contact: (underwriting) Marie Carson, Ext. 7590; (sales/marketing) Susan Federinko, Ext. 7584
Phone: (800) 233-1957
Fax: (717) 747-7021
E-mail: inquiries@hccis.com
Web site: www.hccis.com
An MGA that operates in all states with auto limits of up to $1 million, umbrella up to $5 million/$5 million, GL $1 million/$3 million, and D&O $1 million/$3 million. Target classes are hospices, home health care agencies, home health aide agencies and other private duty home care agencies. American Alternative is the A rated carrier.
International Brokerage and Surplus Lines, Inc.
5137 South Lakeland Dr., Ste. 2
Lakeland, FL 33813
Contact: Janner Holliday
Phone: (800) 348-4275
Fax: (813) 569-1768
E-mail: info@ibsl.com
Web site: www.ibsl.com
An MGA that operates in all states with limits of $5 million/$15 million (excess available). Target classes are skilled, assisted nursing facilities and independent long term care facilities. Can offer professional and GL including products/completed operations, sexual misconduct, physical abuse, employee benefits liability, tenants liability, and medical expenses. Can also provide onsite loss control and risk management services. All carriers are rated A or better.
Klinger Associates, Inc.
P.O. Box 503526
Indianapolis, IN 46256
Contact: Bob Klinger
Phone: (317) 845-9890
Fax: (317) 845-9800
E-mail: klinger@klinger-insurance.com
An E&S broker that operates in IL, IN, KY, MI, OH and the Midwest. Target classes are nursing homes, assisted living facilities and allied health care. Can offer property, professional GL and umbrella. All carriers are A rated.
London American Risk Specialists
11000 Richmond Ave., Ste. 600
Houston, TX 77042
Contact: Mike Mullens (214) 373-3936, Ext. 206
Phone: (800) 546-7630
Fax: (713) 977-7606
E-mail: mmullens@londonamericantx.com
Web site: www.londonamericantx.com
An MGA, E&S broker that operates in all states except AK and HI with various limits. Target classes are nonprofit or for-profit nursing homes, assisted living, group homes, halfway houses, rehab, homes for battered women, handicapped centers, alcohol/drug testing, homes for unwed mothers, and adoption agencies. Will not write lock-up facilities. Can offer professional and GL, non-owned auto, property—ACV or RC, business interruption, flood/earthquake, valuable papers, crime, inland marine, ordinance of law, signs, and accounts receivables. Various carriers are used to place coverage.
M.J. Hall & Company, Inc.
709 N. Center St.
Stockton, CA 95202
Contact: Sarah W. Marsh
Phone: (209) 948-8108
Fax: (209) 870-2955
E-mail: sarah@mjhallandcompany.com
Web site: www.mjhallandcompany.com
An MGA that operates in AK, AZ, CA and NV with primary limits of up to $3 million and med pay limits of $5,000 (can add on property and crime). Target classes are professional and non-professional home health care services to individual residential locations, retirement/assisted living communities, and nursing homes. Will not write contract physicians or surety. Can include E&O coverage up to policy limits and sexual/physical abuse coverage with limits of $25 million/$50 million (higher optional limits available). All carriers are A rated.
M.J. Kelly, Inc.
4415 E. Sunshine
Springfield, MO 65809
Contact: John Jennings, Ext. 108; Heather Duffield, Ext. 118
Phone: (800) 725-7211
Fax: (417) 883-7103
E-mail: jjennings@mjkelly.com
hduffield@mjkelly.com
Web site: www.mjkelly.com
An MGA that operates in AR, FL, IA, IL, LA, KS, MO, MS, OK, TN, TX and UT with limits of $2 million/$2 million. Target classes are home health care, emergency care services, nurses registries, medical equipment sales/rental, medi-spas, and specialty hospitals. Can offer professional, GL, and property. Western World, Western Heritage, and Admiral are the A+ rated carriers.
Metcom Excess
P.O. Box 559
Ridgefield Park, NJ 07660
Contact: Joanna Brancaleoni (800) 272-7436, Ext. 33
Phone: NJ only (800) 521-1717, (201) 641-5100
E-mail: jbrancaleoni@metcomexcess.com
Web site: www.metcomexcess.com
An E&S broker that operates in NJ, NY and PA with limits of $10 million. Target class is assisted living facilities. Can offer professional. Various carriers are used to place coverage.
Midlands Management Corp.
P.O. Box 22778
Oklahoma City, OK 73123
Contact: (professional and GL) Nettie Gober, (property) Roger Park
Phone: (800) 800-4007
Fax: (405) 840-5432
E-mail: nagober@midman.com rpark@midman.com
Web site: www.midlandsmgt.com
An MGA that operates in AR, CO, LA, MO, MN, MS, NE, NJ, NM, OK, TN, TX, VA and WY with usual limits of $1 million/$1 million/$3 million. Target classes are assisted living facilities (professional and GL), health care staffing services (professional and GL) and medi-spas (professional and GL). Check with Midlands for classes that will not be considered. Can offer health care EPL and property. The A rated carriers are Shand and Essex.
National Insurance Professionals Corp. A/D/O Risk Placement Services
P.O. Box 834
Poulsbo, WA 98370
Contact: Tammy Hight, Robin Stolle, Emma VanAcker
Phone: (800) 275-6472
E-mail: tamm.hight@rpsins.com robin.stolle@rpsins.com emma.vanacker@rpsins.com
An MGA that operates in all states with limits of $10 million (higher limits available subject to prior approval). Target classes are nonprofit or for-profit social service agencies including, home health care, alcohol/drug treatment centers, mental health counseling and treatment centers for the developmentally disabled/mentally ill. Will not write nursing homes, hospitals or medical clinics. Can offer all lines including professional, GL, auto, property, crime, and D&O including EPL. All carriers are A rated.
NIF Group, Inc./NIF Pro
30 Park Ave.
Manhasset, NY 11030-2444
Contact: See Web site for office list.
Phone: (800) 892-8892
Fax: (516) 365-7392
E-mail: marketing@nifgroup.com
Web site: www.nifgroup.com
An MGA/E&S broker that operates in all states (nonadmitted basis in 30 states) with limits of $1 million/$2 million (excess of up to $10 million. Target classes are any health care-related or difficult-to-place. Can offer GL or professional. All carriers are A rated.
Philadelphia Insurance Companies
One Bala Plaza, Ste. 100
Bala Cynwyd, PA 19004
Phone: (800) 873-4552
E-mail: phlysales@phlyins.com
Web site: www.phly.com
An insurer that operates in all states except LA. Target classes are nursing homes, clinics (property, auto, inland marine and crime only), senior condos and homeowners associations (property and GL). Will not write assisted living facilities. Philadelphia Insurance Companies is an A+ rated company.
Quaker Special Risk
12 Christopher Way, Ste. 201
Eatontown, NJ 07724
Contact: Frank Walsh, Ext. 2232
Phone: (800) 447-4180
Fax: (732) 223-9072
E-mail: fwalsh@qsr-insurance.com
Web site: www.qsr-insurance.com
An MGA/E&S broker that operates in all states with limits of $5 million (excess limits available over $5 million). Target classes are home health care, surgical centers, MRI facilities, physical therapy centers, medi-spas, medical staffing, assisted living, nursing homes, adult day care, nonemergency medical transportation and dialysis centers. Carriers are ACE, Admiral, CNA, Evanston, General Star, Interstate, Landmark American, Lloyd’s, Lexington, Maxum Indemnity, and United National.
Roush Insurance Services, Inc.
P.O. Box 1060
Noblesville, IN 46061
Contact: Tony Armor, Ext. 17; Gail Pierce, Ext. 18
Phone: (800) 752-8402 (IL, IN), (317) 776-6880
Fax: (317) 776-6891
E-mail: tony.armor@roushins.com gail.pierce@roushins.com
Web site: www.roushins.com
An MGA/E&S broker that operates in IL, IN and OH with liability limits of $1 million-$15 million (excess available) and $10 million property. Target classes are hospitals, large physician clinics, nursing homes, assisted living communities and non-medical senior apartments/condos. Can offer property, GL, commercial auto, D&O, E&O, EPL and equipment breakdown. Evanston, Essex, and CNA are the A rated carriers.
Russell Bond & Co., Inc.
295 Main St., Ste. 866
Buffalo, NY 14203
Contact: Nancy Cooley, Ext. 153; Tony Ambrose, Ext. 143
Phone: (800) 333-7226
Fax: (800) 677-6779
E-mail: ncooley@russellbond.com aambrose@russellbond.com
Web site: www.russellbond.com
An MGA/E&S broker that operates in CT, MA, NJ, NY, PA, VA and VT with primary limits of $1 million/$3 million (unlimited excess available). Target classes are health care including retirement and assisted living communities, nursing homes, senior condos, and clinics. Can offer property, D&O, E&O, EPL, environmental, auto and workers comp. All carriers are rated A- or better.
S.I.U., LLC
700 N. Brand Blvd., Ste. 300
Glendale, CA 91203
Contact: Bruce Rinehart, Ext. 21
Phone: (818) 547-1333
Fax: (818) 547-9003
E-mail: brinehart@siumanagers.com
Web site: siumanagers.com
An MGA/E&S broker that operates in CA only with property limits of $5 million including enhancements such as equipment breakdown and EDP. Will consider all classes. All carriers are rated A- or better.
Smith Bell & Thompson, Inc.
P.O. Box 730
Burlington, VT 05402-0730
Contact: Bill Thompson, Marie Gaudette, Kara Tencellent
Phone: (800) 735-1800
Fax: (802) 658-6191
E-mail: thompson@sbtinsurance.com mgaudette@sbtinsurance.com ktencellent@sbtinsurance.com
Web site: www.sbtinsurance.com
An MGA/program administrator that operates in all 50 states. Target classes are home health care, medical equipment suppliers, medical staffing, medical facilities and social services. Can offer D&O, professional and GL, E&O, non-owned/hired auto, and crime.
Tri-City Brokerage, a Division of BISYS Commercial Insurance Services
158 N. Harbor City Blvd.
Melbourne, FL 32935
Contact: Cathy Perry
Phone: (877) 247-9772
Fax: (321) 757-6147
E-mail: bspmarketing@bisys.com
Web site: www.bisyspc.com
An E&S broker that operates nationwide with primary limits of $1 million/$3 million and $25 million plus excess. Target classes are all types of allied health care, medical products, physicians/surgeons, dentists and other health care providers. Can offer professional and GL, excess liability, umbrella and products liability.
USG Insurance Services, Inc.
1000 Town Center Way, Ste. 300
Canonsburg, PA 15317
Contact: Kristen A. Taylor
Phone: (800) 886-3897
Fax: (724) 265-5751
E-mail: ktaylor@usgins.com
Web site: www.usgins.com
An MGA/E&S broker that operates in all states except AK and HI. Target classes are assisted living, home health care, nursing homes, clinics, labs, imaging centers and senior citizen centers. All admitted and nonadmitted carriers are A rated.
W.H. Greene & Associates
400 Quaker Rd.
East Aurora, NY 14052
Contact: William H. Greene III, Ext. 312; William A. Cote, Ext. 313
Phone: (716) 805-1090
Fax: (716) 805-1099
E-mail: bgreene@whgreene.com wcote@whgreene.com
Web site: www.whgreene.com
An MGA/E&S broker that offers primary coverages in PA and NY only and umbrella/excess in all states except AK and HI—with limits of up to $2 million/$6 million on primary—depending on class—and up to $10 million on umbrella/excess. Will consider all classes. Can offer both property and casualty coverages. All carriers are rated A- or better.
Western World Insurance Group
400 Parson’s Pond Dr.
Franklin Lakes, NJ 07417
Contact: Timothy P. Hochkeppel
Phone: (201) 847-8600
Fax: (201) 847-1010
E-mail: t.hochkeppel@westernworld.com
Web site: www.westernworld.com
An insurer that operates in all states with GL limits of $1 million/$2 million. Target classes are home health care/nurse registries, therapists/therapy centers (physical, respiratory, occupational, speech, etc.), nurses, EMTs, paramedics, ambulance/non-emergency medical transport, psychologists, drug/alcohol rehab centers, counseling centers, druggists/drug stores, audiologists, optometrists, medical equipment rental/sales, diet centers/nutritionists, dieticians and x-ray/imaging centers. Will not consider nursing homes, assisted living facilities, hospitals, surgical centers, primary detox centers, physicians and psychiatrists. Can offer sexual molestation and property (package). Western World is rated A+, as is Tudor.
Yates & Associates Insurance Services, Inc.
17822 E. 17th St., Ste. 300
Tustin, CA 92780
Contact: Linda Peters, Ext. 214; Betty Haun, Ext. 215
Phone: (714) 550-5050
Fax: (714) 550-5051
E-mail: lpeters@yates-assoc.com bhaun@yates-assoc.com
An MGA that operates in CA only with various limits (excess also available). Will consider all classes. Can offer auto, professional and E&O. All admitted and nonadmitted carriers are A rated.
York Claims Service, Inc.
99 Cherry Hill Rd.
Parsippany, NJ 07054
Contact: Mark Aussicker
Phone: (973) 404-1215
Fax: (973) 541-2567
E-mail: mark.aussicker@york-claims.com
Web site: www.yorkisg.com
A third-party administrator/independent adjuster that operates nationwide. *