Why HHA Operators Come to Us

You’re running a Medicare-certified or Medicaid-enrolled Home Health Agency.

Your RNs and LVNs make clinical calls in living rooms. They adjust medications, assess wound healing, and evaluate neurological changes—alone, without a supervisor, without a crash cart down the hall.

Most HHA programs we audit carry at least one professional liability gap and at least one auto liability gap. The gaps aren’t accidental—they’re structural. Field-based operations look different to an insurer than office-based ones.

When your aide picks up medication in her personal car on the way to a patient visit, most policies treat it like she’s off the clock. She’s not. And if there’s an accident, your agency is exposed.


Coverage Reality

Where HHA Claims Actually Come From

These aren’t hypotheticals. They’re the claim patterns we’ve seen across Texas HHA programs for 46 years. Each one has a policy response—or a gap where one should be.

The Exposure Coverage That Responds What It Protects Financial Exposure
Medication Error. Your RN administers insulin during a home visit. The dosage is off. The patient’s blood sugar drops dangerously and they’re hospitalized. The family alleges clinical negligence tied to medication administration. Professional Liability (PL) for Clinical Services Coverage for clinical errors, medication mistakes, and nursing negligence by licensed staff in the field $150K–$300K
Transfer Liability. Your aide assists a patient transferring from bed to wheelchair. The patient loses balance, falls, and fractures a hip. Surgery required. Family alleges inadequate training and improper technique. General Liability (GL) + Professional Liability (PL) Bodily injury during patient care—requires both GL (the fall) and PL (the clinical judgment call behind the technique) $200k-$400k
Missed Vital Sign Dispute. A nurse documents elevated blood pressure but does not escalate care. Hours later, the patient suffers a stroke. Family alleges failure to recognize warning signs and take appropriate action. Professional Liability (PL) for Clinical Negligence Alleged failure to recognize a deteriorating condition and act—the judgment call made alone in a patient’s home $250K-$500K
Work Errand Auto Exposure. An aide stops to pick up medication on the way to a patient visit using her personal vehicle. She causes an accident. Because she was on the clock running a work errand, the injured party sues your agency. Her personal auto policy caps at $30K. Hired & Non-Owned Auto (HNOA) Employee-owned vehicles used for patient visits, medication pickups, and work errands during business hours $350K-$500K
Workers’ Comp Misclassification. An auditor reviews your mileage logs and scheduling software, discovers field nurses were coded as “office employees” (8810) to save premium. All field staff reclassified retroactively to 8828. Back-premium bill arrives due in 30 days. Workers’ Compensation — Class Code 8828 vs. 8810 Field nurses correctly coded as 8828 (visiting nurses) from day one—not discovered and reclassified at year-end audit $35K-$60K
Abuse & Molestation Exposure. Family alleges an aide made inappropriate comments while assisting an isolated elderly patient with bathing in their home. Your General Liability caps abuse claims at $100K. The jury sides with the patient. Abuse & Molestation (A&M) with Dedicated Limits Dedicated $1M limit for abuse allegations, kept entirely separate from your general liability aggregate $500K-$1M+

If you're not sure how your policy handles these scenarios, we can walk through it with you.

Review My Coverage

Critical HHA Coverage Details

  • Note on Claim Costs: The financial exposures above aren’t just settlements. They factor in legal defense costs. Even if you win the case, defending a professional liability claim routinely costs $100K–$200K in attorney fees alone. Defense Outside Limits (DOL) is critical—without it, your defense costs erode the same limit meant to pay a settlement.
  • Professional Liability must cover all licensed staff: RNs, LVNs, and any licensed therapists (PT, OT, ST) need explicit PL coverage. Verify each license type is listed on your policy declarations—not just a blanket “nursing services” endorsement.
  • HNOA is not optional for field-based agencies: If your staff drives personal vehicles to patient homes, you need Hired & Non-Owned Auto. This is the most consistently missing coverage in HHA programs we review.
  • Workers’ Comp class codes matter at year-end: Field nurses are 8828. Office staff is 8810. Wrong codes mean a retroactive bill at year-end audit—typically due in 30 days, when your cash flow is already stretched.

Your nurses make life-or-death decisions in living rooms, not exam rooms.

No supervisor watching. No second nurse confirming the insulin dose. No crash cart down the hall. Just your RN, a patient, and a judgment call.

That’s the reality of home health—and most insurance policies are written like your staff works in a clinic. They don’t. The gap between how your nurses actually operate and what most policies cover is exactly where claims fall through.

The question isn’t whether your nurses are competent. It’s whether your policy will defend them when a grieving family disputes a clinical decision made in a living room.

We don’t quote you first. We read your current policy first. We look for the gaps between how your nurses actually work—solo, mobile, making independent clinical calls—and what your policy covers. Then you decide what to fix.


What We’ve Seen

Across Texas HHA Programs

Hundreds
Healthcare programs reviewed across Texas over 46 years
Majority
Contain at least one material coverage gap tied to field operations
$150K+
Typical starting point for claims when field coverage gaps surface

Most gaps tie to professional liability and employee auto use—the exact places field-based operations diverge from what a standard policy assumes. When claims occur, they typically land in the $150K–$500K range. Most operators discover this during a claim, not before.


Get Started

Let’s audit your Home Health program.

30-minute call. You walk us through your field staff, how care is delivered, and how your team moves. We’ll tell you exactly where your current policy breaks—and what a claim would actually cost.

Common Questions

Our current policy says we have Professional Liability. Isn't that enough?

Usually not on its own. Most standard PL policies exclude or sublimit Abuse & Molestation, don't respond to HNOA exposures when aides run errands in personal vehicles, and weren't written with your specific staffing model in mind. "We have PL" and "we have complete coverage" are two different statements. The audit is specifically designed to find the gap between them.

We use a mix of W-2 employees and 1099 contractors. Does that matter?

It's one of the most significant underwriting variables in home health. Most standard policies are written assuming a W-2 workforce. If your 1099 contractors are delivering care — and most HHA programs rely on them — you may have a structural gap in your professional liability and workers' comp coverage that your current carrier hasn't flagged. We look at this on every program review.

We're Medicare and Medicaid certified. Doesn't that mean our coverage requirements are already met?

CMS certification sets clinical and operational standards — it doesn't mandate specific insurance program design. TAC 558 sets minimum coverage thresholds for Texas licensure, but minimum thresholds and adequate coverage are not the same thing. Most operators meet the floor and assume they're protected. The floor is not the ceiling.

What happens if one of our aides has an accident while driving to a patient's home?

If the aide is using their personal vehicle, your commercial auto policy almost certainly doesn't cover it. If you don't carry Hired and Non-Owned Auto (HNOA), you may have no coverage for that loss at all — even if the aide had personal auto insurance. This is one of the most common uncovered exposures we find in HHA programs.

We've never had a claim. Does that mean our coverage is fine?

Not necessarily — it means you've been fortunate. Coverage gaps don't show up until there's a claim to expose them. The question isn't whether you've had a claim; it's whether your program would respond correctly if you did. That's what the audit answers.

What if we're happy with our current broker?

That's a completely valid position, and we're not here to disrupt a relationship that's working. What we offer is a second set of eyes specifically trained on healthcare operator exposures. If your current program is solid, the audit confirms that. If there are gaps, you'll have the information you need to address them — with whoever you choose.

Office 6750 West Loop South, Suite 767
Bellaire, TX 77401