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Survey Report

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

May 8, 2024

Continuing frequency of severity, coupled with overall inflationary pressures on many fronts, is driving rate increases for property, general and professional liability and auto coverages.
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) Flat to +20% for accounts with favorable loss history and venues, Anticipate higher variability and larger rate increase for challenging accounts
Property with non-challenged/CAT occupancies Increase (Purple arrow pointing top right) 0% to +10% for non-challenged/non-CAT occupancies
Property with challenged/CAT exposed occupancies Increase (Purple arrow pointing top right) +10% to +20% for challenged/CAT exposed occupancies
Workers compensation Increase (Purple arrow pointing top right) -5% to +2%
Auto Increase (Purple arrow pointing top right) +7.5% to +17.5%

Professional liability and general liability

  • In Q4 2023, we began to see rate stabilization similar to what we saw in 2022.
  • Risks with developed losses and difficult venues will continue to be closely underwritten and could see increases.
  • There continues to be frequent reluctance to deploy significant capacity in litigious venues such as NY, NJ, CA and FL. Other less-than-desirable venues are Philadelphia, PA and Cook County, IL.
  • Courts have reopened, resulting in more verdicts being issued, and losses continue to trend upward.
  • Pennsylvania venue shopping rule was repealed effective January 1, 2023.
  • Economic and social inflation is being priced into all business.
  • Sexual abuse and class action capacity continues to be difficult, and carriers are restricting coverage terms on existing business.
  • To reduce total cost of risk, many insureds are assuming larger deductibles or self-insured retentions, although increasing retentions is often not offsetting rate increases as we anticipated.
  • 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 with acceptable fronting or trust agreements.
  • 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.


  • Focusing solely on the average rate change can obscure the wide variation of rate increases we see in this market. In Q4, fewer clients were forced to choose between self-insurance and risk transfer because market capacity stabilized and increased in some areas. Deductible and term changes imposed by the markets, however, are not captured in the average rate change.
  • Challenging 2023 insurer reinsurance treaties resulted in direct insurers pushing price increases and retentions, although it waned in Q4 due to expanded direct insurer capacity/supply and appetite.
  • The shift in available capacity continued to pressure rate for both challenged and non-challenged occupancies to varying degrees during Q4 2023.
  • Insurers looked to deploy new/expanding capacity due to a benign Atlantic hurricane season and to meet year-end budgets, although constrained capacity remains for accounts with losses, as are those heavily CAT-exposed (e.g., Southeast windstorm and California earthquake).
  • CAT losses from severe convective storms contribute to what experts are calling the worst in history. U.S. severe convective storm losses so far in 2023 total close to $60 billion with total U.S. CAT losses more than $110 billion with further adverse development possible.
  • Insurers retain focus on severe convective storm exposures, resulting in a market push for sublimits and percentage deductibles.
  • Valuation methodology continues to be scrutinized but with less focus on requiring large year-over-year increases as inflation concerns recede. FM Global trend factors for 1/1/2024 indicate a 1.5% increase since January 2023, which is substantially below the cost trend factors for the pandemic era heavy inflation years leading up to 2024.
  • Submission flow into the market is still high but insurers are proactively seeking new business opportunities due to increased 2024 new business goals. Detailed submissions with robust modeling data and methodologies continue to differentiate risk quality.
  • Continue to re-evaluate cost efficiency of risk transfer vs. risk retention, with potential consideration for alternative risk strategies/solutions and parametric products.

Workers compensation

  • While the workers compensation marketplace in 2023 benefitted from the tailwinds of rising wages and strong investment income attributable to monetary policy actions, 2024 should bring more muted renewal outcomes as wage levels for highly compensated employees stabilize, and the Federal Reserve contemplates interest rate reductions.
  • Medical cost inflation, the main driver of large claims in workers compensation programs, continues to exceed top-line inflation figures; we expect carriers will be less accommodating on their rate stances as a result.
  • While 2024 may not be as insured-friendly as 2023, workers compensation remains a bright spot compared to other major lines of coverage as insurers continue to turn a profit. Insureds with good loss history or improving trends who did not seek alternatives in 2023 may still be able to take advantage of favorable marketplace competition.
  • Excess workers compensation trends should be similar; however, less competition resulting from a smaller number of carriers in the excess workers compensation marketplace is leading to average rate trends that are not as strong as overall workers compensation.


  • Despite 29 consecutive quarters of rate increases, the auto liability marketplace continued to deteriorate over the course of 2023. Adverse renewal outcomes accelerated for most insureds (60%) who experienced rate increases >5%.
  • After a decline in accidents during the pandemic, frequency rates have returned to pre-pandemic levels. Coupled with much higher severity resulting from inflation, medical costs and supply chain restraints, insurers are struggling to adequately price for their ever-increasing loss costs.
  • 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.
  • We recommend proactively evaluating alternative retention structures to minimize the total cost of risk and optimize renewal outcomes, where possible.


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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