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Survey Report

Insurance Marketplace Realities 2024 – Senior living and long-term care

November 9, 2023

Property renewals are of most concern to owners and operators, especially those in CAT-prone and challenged occupancies.
Rate predictions: Senior living and long-term care
  Trend Range
General and professional liability with favorable loss experience and venue Increase (Purple arrow pointing top right) +5% to +20%, anticipate higher variability and larger rate increase for challenging accounts.
Property with non-challenged/CAT occupancies Increase (Purple arrow pointing top right) +5% to +20%
Property with challenged/CAT exposed occupancies Increase (Purple arrow pointing top right) +20% to +50%
Workers compensation Increase (Purple arrow pointing top right) -5% to +2%
Auto Increase (Purple arrow pointing top right) +4% to +12%

Professional liability and general liability

  • Markets are more aggressively seeking rate increases as compared to 2022 and early 2023. Risks with developed losses and difficult venues will continue to see greater rate increases.
  • There continues to be frequent reluctance to deploy significant capacity in such litigious venues as NY, NJ, CA and FL. Other less-than-desirable venues are Philadelphia, PA and Cook County, IL.
  • Staffing shortages are contributing to loss severity — failure to monitor/appropriate monitoring are common allegations as a result. The use of contracted employees continues to be scrutinized.
  • Courts have reopened, resulting in more verdicts being issued and losses trending upward.
  • Economic and social inflation is being priced into all business.
  • Underwriters have continued incorporating a broader communicable-diseases exclusion rather than simply excluding COVID. Stand-alone communicable disease liability policies are available, but large capacity is still not available.
  • Sexual abuse and class action capacity continues to be difficult, and carriers are restricting coverage terms on existing business.
  • New capacity from Bowhead, Munich Re and Arch has entered, and new entrants may not be able to offer comparable terms to our long-term care/senior living markets on primary PL/GL.
  • Clients seeking to differentiate their risks must focus on incident reporting, claim mitigation, policies and procedures. Emphasis on the clinical program management will also have a positive impact, particularly for those with a focus on fall management, elopement, medical management and infection prevention and control.
  • 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 and other self-insured approaches are used without acceptable fronting or trust arrangements.


  • Ian, a later-season 2022 hurricane, and winter storm Elliott significantly affected many senior living owners and operators. Add to this continued freeze, historic rain, severe convective storms and wildfire losses have driven up insurers’ loss ratios adversely impacting profitability.
  • Treaty reinsurance renewals were impacted by the reduction in capital and increase in exposures, which in turn has led to the hardest reinsurance market in approximately 30 years. Reinsurers have been pushing price increases, increased retentions, and lowering limits they will offer.
  • The recent shift in available capacity is causing an acceleration of rate for both non-challenged and challenged occupancies to varying degrees. To contain cost increases, owners and operators are increasing deductibles as well as purchasing less limit to an amount deemed adequate. Additional consideration for alternative risk strategies/solutions and parametric products may be justified.
  • Valuations continue to be heavily scrutinized, due to significant cost increases evolving from material demand, supply chain issues and labor shortages. Occurrence limits of liability endorsements and margin clauses are frequently considered by insurers to limit their liability in the event of perceived undervaluation of property values.
  • Insurers continue to restrict many coverages previously offered, such as communicable disease and cyber. Additional coverage tightening is occurring on CBI (contingent business interruption) and service interruptions, as well as increasing deductibles for freeze claims and convective storms.
  • There is continued pressure to move from manuscript to insurer forms.
  • Due to the array of occupancy classifications that can apply to this sector, it is imperative to use accurate occupancy classifications for modeling to ensure the most competitive pricing.
  • Submission flow into the market is very high, and submissions require ample and robust data to attract new/renewal markets and differentiate risk quality. Insurers are being highly selective, and to drive the best results the comprehensiveness and quality of the renewal submission is critical.

Workers compensation

  • 2022 marked the ninth consecutive year of underwriting gain, and the sixth consecutive year of combined ratios under 90%.
  • While we were seeing some rate stabilization in senior living and long-term care, underwriters are now beginning to seek rate more aggressively. We believe this is a result of carriers providing rapid rate relief at the end of COVID. Loss development and difficult venues continue to be intensely analyzed.
  • Underwriting concerns continue regarding opioid addiction, the aging workforce, and medical bill and payroll inflation.
  • Due to increased competition and labor market withdrawal, employers are paying higher wages. Inflation impacting client exposure bases (wages) is not commensurate with hazard risk. Clients look to adjust exposure bases to offset inflationary trends (e.g., headcount or hours worked as opposed to payroll).


  • Combined ratios are still over 100%, and the volume of vehicles on the road and miles driven continued to increase as the pandemic subsided.
  • Higher occupancy vehicles continue to be viewed less favorably and may add rate to a community’s auto premium if its fleet involves multiple vans and/or buses.
  • With the highest economic and social inflation in 40 years, insurance claim costs have continued to rise faster than the underlying consumer price index. Rates and premiums have not kept pace with the rise in claim costs, which results in unprofitable results for insurers.
  • Persistent industry trends — characterized by increased fatality rates and distracted drivers — are driving sustained increases in auto liability rates despite 26 consecutive quarters of rate upturn.


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 entities, including Willis Towers Watson Northeast, Inc. (in the United States) and Willis Canada Inc. (in Canada).


Healthcare Industry Vertical Division Leader, North America

Senior Vice President, Client Executive

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