Specialty Coverage

Sexual Abuse & Molestation (SAM) Coverage for Home Healthcare

Caregivers work alone in client homes with elderly, disabled and cognitively impaired patients. That exposure is why most general liability and professional liability forms exclude sexual abuse and molestation — and why payers, hospitals and franchisors require agencies to buy it back by endorsement or on a standalone form.

  • Usually excluded on standard GL/professional forms
  • Common contract requirement: $1M per incident / $1M aggregate
  • Defense costs may be inside or outside the limit
  • Coverage triggers vary: occurrence vs. claims-made

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Why home care agencies need SAM coverage

An allegation alone can cost six figures to defend, even when it is ultimately unfounded. SAM coverage responds to allegations of sexual abuse, molestation or physical/mental abuse by an employee or contractor against a client, including claims of negligent hiring, training and supervision brought against the agency itself.

How SAM is written

There are three common structures. Which one you have matters more than the limit on the certificate.

StructureHow it worksWhat to watch
GL endorsementBuy-back of the abuse exclusion inside the GL policyOften sublimited below the GL limit
Professional liability endorsementAdded to the medical professional formMay be claims-made with a retro date
Standalone SAM policySeparate limit, separate carrierCleanest for large or franchised agencies

Limits contracts typically demand

Hospital discharge contracts, Medicaid waiver programs and franchise agreements commonly require $1M per incident and $1M–$2M aggregate, listing the payer as additional insured. Verify whether defense is inside the limit — an eroding limit on a $1M SAM policy can be consumed before a case reaches trial.

Have a contract to review? Send it to KTL

How to reduce the exposure (and the premium)

Underwriters price SAM on your hiring and supervision controls:

  • Documented background checks at hire and periodically after
  • Two-person visits for high-risk clients where feasible
  • EVV and visit documentation that establishes who was present, when
  • A written abuse-prevention policy with mandatory annual training
  • A defined reporting/escalation procedure with immediate suspension

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Frequently asked questions

Usually not. Most GL forms carry an abuse or molestation exclusion. Coverage has to be added back by endorsement or bought as a standalone policy.