Strip a home care agency down to its operating unit and you get this: one employee, alone, unsupervised, inside the home of a vulnerable person — having driven their own car to get there.
Almost none of that is a general liability exposure. The care itself is professional liability. The unsupervised access is abuse and molestation and employee dishonesty. The drive is hired and non-owned auto. The lifting and transfers are workers' compensation, which in this class is usually the largest line on the program by a wide margin. General liability covers the office.
Home care is one of the fastest-growing small-business categories in the Southeast, and inside a hundred-mile circle of Statesboro, Georgia it is everywhere — companion and personal care agencies in Statesboro, Savannah, Richmond Hill, Hinesville, Vidalia, Dublin and Waynesboro, skilled home health serving the rural counties where the nearest hospital is a long drive, private duty nursing, and a growing number of small independent agencies started by nurses and former facility staff.
These are real commercial accounts — substantial payroll, meaningful premium, and a risk profile that most generalist agents place badly because it looks like a service business and behaves like a healthcare provider with a fleet.
| Coverage | What it answers for | Characteristic failure |
|---|---|---|
| Professional liability | The care itself — missed medication, mishandled transfer, care plan not followed, change in condition not reported | Agency carries GL only; GL excludes rendering of professional services |
| Abuse & molestation | Allegations of sexual, physical or verbal abuse, neglect, or financial exploitation | Excluded by default; when added back, often a sublimit with defense inside it |
| Workers' compensation | Lifting and transfer injuries, falls, repetitive strain, auto accidents between clients, needlesticks | Usually the biggest line, and the one where the experience mod quietly compounds |
| Hired & non-owned auto | Agency liability when a caregiver crashes their own car on the job | Assumed to be the caregiver's problem; the agency gets named anyway |
| Commercial crime | Employee theft — including theft of a client's property from a client's home | Form covers the agency's own money only; the actual claim isn't covered |
| Cyber / privacy | Breach of protected health information, scheduling and payroll systems | Treated as an IT problem rather than a regulated-data problem |
General liability, property on the office, employment practices liability and an umbrella sit around this. Directors and officers matters once there is a board or outside investors — see our note on D&O for small business.
General liability is a premises-and-operations form. It contemplates someone slipping in your lobby or your business physically damaging something. Standard forms commonly exclude liability arising out of the rendering or failure to render professional services — and delivering care in a client's home is professional services by any reading.
So the claims that define this industry — a medication missed or doubled, a transfer that ends in a fractured hip, a care plan not followed, a deteriorating condition not escalated, a fall during an unassisted bathroom trip — land on professional liability, not general liability. For this class it is frequently written as a combined general and professional form, which is convenient but makes it more important, not less, to confirm the professional grant is actually there.
Ask which trigger the policy uses. Professional liability in healthcare-adjacent classes is often claims-made rather than occurrence, which means the retroactive date and the tail matter enormously. An agency that switches carriers and loses its retro date has quietly uninsured every hour of care it delivered before the switch.
This is the exposure that most defines the class and the one most often found missing. The setting is a single employee, unsupervised, with a client who may be elderly, cognitively impaired, physically dependent, or unable to give a reliable account of what happened. Allegations here are not limited to sexual misconduct — they include physical abuse, verbal abuse, neglect and financial exploitation, which is the most common version and the one families pursue hardest.
Most GL and professional forms exclude abuse or molestation, so coverage has to be added back deliberately. When it is, three details decide whether it is worth anything:
Underwriters price this on your program, not your intentions. Background check scope and how often you re-run them, reference verification, license verification for clinical staff, supervisory visit frequency, care documentation, and how complaints get investigated and recorded — those are the pricing inputs. The same structural logic governs our page on abuse and molestation liability for churches and youth organizations; the difference is that in home care the vulnerable party is usually an adult and the setting is private property you do not control.
Caregivers drive their own cars all day — between clients, to pharmacies, to grocery stores — and many transport clients to appointments. When a caregiver causes a serious accident on the clock, the injured party's attorney names the employer, because the employer has the assets and the caregiver has a modest personal auto limit.
Hired and non-owned auto liability is the coverage that responds to the agency's liability from vehicles it does not own. It is inexpensive relative to what it does and it is missing from a large share of the small agencies I look at.
Two adjacent decisions belong in writing rather than in practice:
People expect liability to dominate this program. In practice workers' compensation usually is the largest premium line, because payroll is the whole business and the injury profile is frequent: lifting and transfer injuries, falls in unfamiliar homes, repetitive strain, motor vehicle accidents between clients, and on the skilled side needlesticks and bloodborne pathogen exposure.
Frequency plus high turnover is exactly the recipe for an experience modification factor that drifts upward and then prices the agency out of its own market. Treat the mod as something you manage deliberately rather than receive, and expect the annual premium audit to be a significant event given the payroll base.
Some agencies engage caregivers as independent contractors, and some operate as registries that place caregivers a client technically employs. Whether a particular worker is an employee turns on state law and specific facts and belongs with your carrier and counsel — but three consequences are worth stating plainly, because they are frequently a surprise:
Our pages on 1099 workers and workers' comp, staffing and temp labor and PEO versus direct comp cover the same seam from three other industries.
Employees have unsupervised access to cash, jewelry, prescription medication, checkbooks and financial documents. Allegations are common even where nothing was taken, because a family notices a missing item and reaches the obvious conclusion.
Commercial crime coverage addresses employee dishonesty, and the detail that matters is whether the form reaches theft of a client's property from the client's premises or only theft of the agency's own money and property. The second is the standard grant; the first is the claim you will actually get.
Related: a great many agencies advertise that they are "bonded and insured." If you make that representation, confirm what you carry actually matches it. A family relying on that phrase after a loss will expect it to mean something specific, and the gap between the marketing and the policy is a bad place to be discovered.
Where an agency sits on the acuity ladder largely decides the placement. Non-medical companion and personal care is the lighter end. Skilled home health — nursing, wound care, injections, infusion, catheter and ostomy care, therapy services — raises the professional profile considerably, adds medical waste and needlestick exposure, and narrows the carrier pool. Private duty nursing, pediatric and ventilator-dependent care, and hospice are more specialized again.
The dangerous part is the drift. Agencies add a nurse, accept a higher-acuity client, or begin administering medications without repapering anything. The application described one business and the agency is now running another, which is the specific mechanism that produces an uncovered claim. Describe the real service mix at application, state explicitly what you do not do, and update it when it changes.
Bettr Coverage is an independent commercial insurance agency serving Georgia and the wider Southeast, and home care is a class where the difference between a good and a bad placement is invisible until a claim. On a home care review we check whether professional liability is actually granted rather than assumed inside a GL form, whether abuse coverage exists and what its sublimit and defense treatment are, whether the retro date survived your last carrier change, whether non-owned auto is on the program at all, whether crime coverage reaches client property in client homes, and whether the umbrella schedules the professional and auto layers underneath it. One agency, one relationship, all of it read together.
Send your declarations pages and a description of your service mix. We'll tell you whether professional liability is actually granted, what your abuse sublimit really is, and whether your caregivers' cars are a gap.
Get a free coverage reviewOnly the office half. GL commonly excludes rendering of professional services, and delivering care in a client's home is professional services. The claims that define the industry belong on professional liability, often written as a combined GL and professional form.
Because the operating unit is one employee alone with a vulnerable person. Allegations include physical abuse, neglect and financial exploitation, not just sexual misconduct. Confirm the coverage exists, what the sublimit is, and whether defense costs sit inside that sublimit.
Not unless you arranged it. Hired and non-owned auto responds to the agency's liability from vehicles it doesn't own, and the agency gets named when a caregiver crashes on the clock. Decide in writing whether clients are ever transported.
Skilled services raise the professional liability profile, add needlestick and medical waste exposure, and narrow the carrier pool. The dangerous part is drift — adding a nurse or a higher-acuity client without updating the application is what produces uncovered claims.
Yes, and check the wording. Commercial crime forms often cover the agency's own money and property; what you need is coverage reaching theft of a client's property from a client's home. Also confirm your "bonded and insured" advertising matches what you actually carry.
No honest single number. Revenue and payroll, service mix, acuity, client transport, headcount and turnover, employee-versus-contractor status, states of operation, your screening program and loss history all move it. Workers' comp is usually the largest line, not liability.
Evidence of control over unsupervised employees: revenue and payroll by service line, an explicit statement of services not performed, census and acuity, turnover, the screening and supervision programs, the transportation policy, the complaint procedure, licensure status, and three to five years of narrated loss history.
For general information only. Not legal advice, not medical advice, and not a quote or contract of insurance. Policy forms, endorsements, sublimits and exclusions vary by carrier and form edition — professional services exclusions, abuse and molestation grants and sublimits, defense-within-limits treatment, retroactive dates on claims-made forms, crime coverage for client property, and wage-and-hour treatment on EPLI must be read as actually issued. Whether a particular worker is an employee for workers' compensation and liability purposes turns on state law and specific facts; confirm classification with your carrier and counsel. State licensure, caregiver certification, background-check and supervision requirements differ by state and by service type and are amended; confirm your obligations with your state licensing authority. Handling of protected health information is subject to federal and state regulation; confirm your obligations with qualified counsel. Coverage subject to policy terms, conditions, exclusions and carrier appetite.