Skip to main content
main content, press tab to continue
Survey Report

Insurance Marketplace Realities 2022 – Senior living and long-term care

November 15, 2021

While many coverage, program structure and capacity challenges remain, rate increases are stabilizing, and the emergence of new capacity will drive future competition.

Rate predictions

Rate predictions: Senior living and long term care
  Trend Range
General and professional liability Neutral increase (yellow line, purple triangle pointing up)
Flat to +25% (higher for adverse loss experience and/or poor venue)
Non-challenged occupancies Increase (Purple triangle pointing up) +5% to +15%
Challenged occupancies Increase (Purple triangle pointing up) +20% or more
Workers compensation Neutral Decrease Increase (flat yellow line, arrow pointing up and down) -2% to +4%
Auto Increase (Purple triangle pointing up) +8% to +15%

Key takeaway  

While many coverage, program structure and capacity challenges remain, rate increases are stabilizing, and the emergence of new capacity will drive future competition. 

Professional liability and general liability

  • Capacity reductions of 2020 and increasing claim severities drove deterioration in rates and terms into 2021. Conditions are easing, as market entrants increase. While cautious, more carriers are stepping into the senior living space, a trend we expect to continue into 2022.
  • While the new capacity has not filled the gap created by the market constriction of 2020, the continued interest in senior living by commercial carriers has helped to level out rate increases and moderate premiums.
  • Underwriters continue to carefully evaluate issues that have been problematic from a severity perspective, including class actions, punitive damages, and sexual abuse and misconduct. Exclusions, limitations and reductions in sub-limits are the most common methods employed to address these exposures. Puni-wraps are becoming harder to find and the attachment of silent cyber exclusions is on the rise
  • Nearly all carriers are attaching COVID-19-related exclusions — typically referring to communicable diseases or pandemics to further the reach of the exclusions.
  • To reduce their total cost of risk, many insureds are assuming larger deductibles or self-insured retentions. Buyers need to be proactive in securing lender waivers when retentions exceed those allowed in standard loan covenants or when captives are used without acceptable fronting arrangements.
  • We are seeing a significant uptick in the use of captive programs for primary layers.
  • Renewal timelines continue to be longer than usual due to substantially increased submission flow and less underwriting authority at the desk level.
  • Underwriters are seeking more detailed data and information for the renewal process. In particular, information requests may focus on vaccine protocols, staffing adequacy and virus statistics.
  • Buyers seeking to differentiate their risks must focus on incident reporting, claim mitigation, policies and procedures. Emphasis on clinical program management will also have a positive impact, particularly when insureds demonstrate a focus on fall management, elopement, medical management and infection prevention and control.


  • The recent increase in capacity is causing a deceleration of rate increase for non-challenged occupancies. However, challenged occupancies (i.e., senior living) and certain geographic locations continue to see sharp rate hikes.
  • Capacity remains constrained for accounts not considered technically priced or where engineering visits are required for underwriting.
  • Insurers continue to restrict many coverages previously offered, such as communicable disease and cyber. Additional coverage tightening is occurring on CBI (contingent business interruption), service interruptions, deductibles for convective storms and increased waiting periods.
  • We are seeing continued pressure on insureds to move from manuscript to insurer forms.
  • Valuations are being heavily scrutinized, and submissions require ample data to attract new markets.
  • Due to the array of occupancy classifications that can apply to this sector, accurate occupancy classifications are an imperative to ensure the most competitive pricing.

Workers compensation

  • Six consecutive years of profitable results have allowed rates to level off more quickly in workers compensation than in other lines of insurance.
  • Underwriting concerns continue regarding opioids, the aging workforce, regulatory reform and medical bill inflation.
  • Carriers (including incumbents) are taking an in-depth look at insureds’ COVID-19 and infection control protocols and asking more questions about policies and procedures.


  • 2020 appears to be the auto liability segment’s best accident year in 10 years due to the limited number of vehicles on the road. However, combined ratios are still over 100 and the volume of vehicles on the road is increasing as the pandemic subsides.
  • In 2020, the estimated rate of death spiked 24% despite the reduced number of miles traveled.
  • Distracted driving remains a significant issue and communities with high numbers of drivers using their own vehicles will find more underwriting scrutiny and higher pricing.
  • Similarly, higher occupancy vehicles are also viewed less favorably and may add rate to a community’s auto premium if their fleet involves multiple vans and/or buses.


Willis Towers Watson hopes you found the general information provided in this publication informative and helpful. The information contained herein is not intended to constitute legal or other professional advice and should not be relied upon in lieu of consultation with your own legal advisors. In the event you would like more information regarding your insurance coverage, please do not hesitate to reach out to us. In North America, Willis Towers Watson offers insurance products through licensed subsidiaries of Willis North America Inc., including Willis Towers Watson Northeast Inc. (in the United States) and Willis Canada, Inc.


Healthcare Industry Vertical Division Leader, North America

Head of Office, Bermuda

Related content tags, list of links Survey Report Healthcare Real Estate Insurance United States
Contact us