Why private duty nursing is underwritten as clinical risk
A single missed ventilator alarm, a medication error during an infusion, or a delayed escalation on a pediatric case can produce a severe, high-value claim. Underwriters therefore look at nurse-to-patient ratios, supervision, on-call clinical leadership, competency validation, and whether the agency accepts vent-dependent or pediatric complex cases. Those answers, more than payroll, set your professional liability price.
Limits your contracts will demand
Hospitals, managed-care organizations, children's hospital discharge programs and Medicaid waiver payers set limits that are usually higher than state licensure requires. The pattern below is what KTL sees most often.
| Coverage | Common contract requirement | Notes |
|---|---|---|
| Professional liability | $1M per claim / $3M aggregate | Occurrence form preferred; claims-made needs tail planning |
| General liability | $1M / $2M | Often required to include products-completed operations |
| Abuse & molestation | $1M | Frequently required for pediatric cases |
| Commercial umbrella | $1M–$5M | Common for hospital discharge contracts |
| Cyber liability | $1M | Required by most payer agreements |
| Workers' compensation | Statutory + $1M employer's liability | Waiver of subrogation usually required |
Occurrence versus claims-made matters here
Clinical claims surface late. An occurrence-form professional liability policy responds to an incident that happened during the policy period no matter when the claim is filed. A claims-made policy responds only while it is in force plus any purchased tail. If your agency switches carriers on a claims-made form and does not buy the tail, years of past care become uninsured. Always ask which form is being quoted before comparing prices.
Staffing model changes the whole program
Agencies that employ their nurses carry the workers' compensation and the direct vicarious liability. Agencies that contract nurses shift some exposure but inherit credentialing and contingent exposure instead. Either way, carriers want to see license verification at hire and at renewal, documented competency for each clinical skill, and a written escalation policy. Most declined private duty submissions fail on documentation, not on loss history.
Cyber and HIPAA exposure
Private duty agencies hold clinical documentation, physician orders and payer data. A ransomware event or a lost device is both a business interruption and a reportable breach. Cyber liability covers breach response, notification, regulatory defense and business interruption, and most payer contracts now require it outright.
Have Insurance Requirements From a Client?
Send us the insurance requirements from your contract, lease, vendor agreement, or licensing agency. A KTL commercial insurance specialist will review the requirements and help determine the coverage, limits, and endorsements you need.
Talk to a home healthcare specialist
Get a benchmarked quote from multiple A-rated carriers within one business day.