Hidden risks in home healthcare
IN Partnership with
Why standard coverage simply isn’t enough in 2026
More
The home healthcare sector is big business in the US – and it’s only set to get even bigger in 2026. According to recent data, the US home healthcare market size was worth $162.35 billion in 2024 and is expected to reach $381.40 billion by 2033. Driven by an aging population who expect top-tier care, home health services are accessed by around 12 million Americans annually – covered by over 11,000 care agencies.
This expanding market, however, is riddled with potential risk. From caregiver shortages and cross-jurisdictional telehealth challenges to wage compliance and HIPAA exposures, the sector sits at the intersection of healthcare, employment law, transportation risk, and professional liability.
For many agencies, the assumption is that a standard business owner’s policy or general liability package is sufficient. However, according to Philadelphia Insurance Companies (PHLY), that assumption can leave critical and dangerous gaps. Tony Canci, vice president of underwriting – human services at PHLY, explains to Insurance Business that the exposures facing providers require far more specialized protection than many realize.
Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets, and underwrites commercial property/casualty and professional liability insurance products for select industries. We are corporately based outside of Philadelphia and have more than 50 offices nationwide. In business for over 50 years, PHLY is nationally recognized as a member of Ward’s Top 50, one of the Best Places to Work in Insurance, and one of the Healthiest 100 Workplaces in America.
Find out more
“When there is a claim, the home care agency wants peace of mind, knowing that they have an experienced team there to handle it. Our in-house claims team has 20 plus years of experience on average”
Tony Canci,
PHLY
Molestation, theft, damage, and property coverage “A lot of general liability policies exclude [coverages, which] you have to add back on as a separate coverage line. Importantly, it’s not just physical abuse but also sexual abuse… You have to make sure you interpret and understand the policy so that it includes both physical and sexual abuse. Because, unfortunately, both are present within the home care space.”
Abuse and molestation coverage is one of the most misunderstood areas in home healthcare insurance. While agencies may assume their general liability policy provides protection, exclusions often apply – and unless specifically endorsed back in, both physical and sexual abuse claims can fall outside coverage. Other gaps, as Canci explains, impact property damage or theft – incidents that have the propensity to happen often when a caregiver is present in a client’s home.
Share
Published April 6, 2026
Share
Contact Us
E-Newsletter
Authors
Regular Contributors
Advertise
Contact Us
Data Hub
Benefits
Cannabis
Catastrophe & Flood
Claims
Construction & Engineering
Cyber
Environmental
E&S
Hospitality
Life & Health
Marine
Motor & Fleet
Non-Profits & Charities
Professional Risks
Programs
Property
SME
Transformation
Travel
Workers Compensation
Specialty
Best in Insurance
Business Strategy
E-mag
Events
Guides
IB Talk
Industry Reports
Insurance Companies
Leaders Network
Legal Advisory Board
Legal Insights
Opinion
Premium Content
Regulatory
Webinars
White papers
Resources
Reinsurance
E&S
TV
Insurance News
Industry News
Columns
Diversity & Inclusion
Mergers & Acquisitions
Legal Advisory Board
Risk Management
News
Asia
New Zealand
United Kingdom
Canada
Australia
United States
Copyright © 2026 KM Business Information US, Inc
RSS
Sitemap
Contact us
About us
Conditions of Use
Cookie policy
Privacy policy
Terms & conditions
People
“Proper documentation is key. If you don’t have a trained staff and one piece of the documentation is missing, then it’s a challenge to defend that claim”
Tony Canci,
PHLY
Copyright © 2026 KM Business Information US, Inc
RSS
Sitemap
Contact us
About us
Conditions of Use
Cookie policy
Privacy policy
Terms & conditions
People
Copyright © 2026 KM Business Information US, Inc
RSS
Sitemap
Contact us
About us
Conditions of Use
Cookie policy
Privacy policy
Terms & conditions
People
“Maybe a caregiver picks up a family heirloom to clean and they drop it. That could be a $5,000 accident. It may be deemed that that possession was in the care, custody, or control of the employee. And, as such, the damage may be excluded under the basic general liability coverage form.”
And while a broken heirloom may seem minor in comparison to medical malpractice, for agencies operating on tight margins, uncovered property claims can be financially disruptive. Professional liability, however, is where the stakes escalate dramatically.
“Professional liability – that’s a no-brainer,” says Canci. “It fills critical gaps that general liability simply doesn’t cover. Whether it’s a nurse administering the wrong medication,
a client falling while the caregiver is helping them to the restroom, or a client being dropped from a lift when they’re trying to get out of bed – these are just a few examples of the professional liability claims we see.”
Beyond frontline caregivers, liability can extend to physicians and medical directors overseeing care. As Canci tells IB, in cases that require more skilled levels of care, primary medical coverage for individual doctors may be required – which PHLY can provide.
Furthermore, the coverage doesn’t just exist within the client’s home; it can also extend to outside activities – including transportation. “It’s not uncommon for nurses to drive from one client’s home to another,” says Canci. “Or, in some cases, caregivers may also need to drive clients to doctors’ appointments or run errands. If they get in an accident, that is when non-owned auto coverage comes into play.”
A multifaceted liability environment Modern home healthcare rarely operates in isolation, as multiple providers may be involved in a single patient’s care.
“Where a home care agency cannot provide the required level of care, another home care may step in to supply a nurse, often alongside a physician. It’s a multifaceted approach – you’re seeing multiple parties getting pulled into claims more often than ever before.”
And telehealth adds another layer of complexity, with the threat of cyber exposure and HIPAA violations always on the horizon, as well as cross-state concerns.
“If you have a client in Pennsylvania and the doctor is on the other line but they’re practising in Florida, then you might run into cross-jurisdictional issues,” adds Canci. “That’s because medical practice insurance is regulated on a state‑by‑state basis.”
Staffing pressures and liability risk But if coverage gaps are one side of the equation, workforce pressures are the other – and caregiver shortages and turnover have intensified across the industry.
“We see many claims stemming from a shortage of workers,” explains Canci. “We sometimes see a caregiver leave before another caregiver is supposed to arrive. When the next caregiver arrives, they may find the client on the floor after a fall, and then you’re looking at a claim.”
And training gaps can be equally damaging. As Canci tells IB, having lesser-trained staff – who are not necessarily experienced in how to use certain equipment or perform certain tasks – can lead to claims.
What’s more, documentation failures frequently complicate legal defence efforts.
“Proper documentation is key. If you don’t have a trained staff and one piece of the documentation is missing, then it’s a challenge to defend that claim. [Similarly], if a home healthcare agency pulls a background check for a potential employee and there are some question marks on there but they still hire the candidate because they need to fill a spot, that becomes a huge challenge in terms of trying to defend a claim, too.”
The operational reality is that home healthcare agencies are balancing urgent patient needs with an increasingly constrained labor pool. But from an insurance and liability standpoint, those pressures do not mitigate exposure – they amplify it. That’s why Canci emphasizes that protection must extend beyond policy language to active risk management support.
“In terms of what PHLY can do, it’s really seen in our risk management and claims support.”
Rather than functioning solely as a claims-payer, PHLY positions its risk management resources as a frontline defence mechanism with a goal to equip agencies with tools that help prevent losses before they occur – or, at a minimum, improve defensibility when incidents arise.
“Our risk management team has an expansive library of offerings,” he tells IB. “The first is technical bulletins. They spell out specific scenarios or claims, and they dive deep into them. We also have interactive online courses that home caregivers can access. There are specific classes and courses catered towards home care services such as bed rest skills, abuse prevention, and various fall-prevention courses.”
PHLYTRAC: peace of mind with telematics In a sector where fall injuries and mobility assistance incidents remain leading sources of claims, targeted education can materially reduce exposure. Technology also plays a role in mitigating risk tied to transportation – another common loss-driver.
“If there is a fleet of vehicles, we have PHLYTRAC – it’s a telematics tool in which the business owner can then identify risky driving like speeding or hard braking by employees.”
For agencies whose caregivers drive between client homes
or transport patients to appointments, oversight tools provide both accountability and documentation – two elements that become crucial during claim investigations. Still, prevention is only part of the equation. When claims do occur, agencies need experienced handling that allows leadership to stay focused on patient care and operational stability rather than becoming consumed by legal processes.
“When there is a claim, the home care agency wants peace of mind, knowing that they have an experienced team there to handle it,” adds Canci. “And our in-house claims team has 20 plus years of experience on average.”
In practice, that experience translates into faster assessments, clearer communication, and strategic defence management – all of which reduce disruption to the agency’s core mission.
“We want home care organizations focusing on hiring, training, and continuing education for their staff.”
A constantly changing landscape Overlaying these operational risks is a regulatory environment that continues to evolve at both state and federal levels. Wage requirements, reimbursement structures, documentation mandates, and emerging technology oversight create a compliance framework that is anything but static.
“This is a tough one because the landscape is always changing. I could say something today, and it might change in two weeks from now. We have minimum wages changing, there are specific regulatory requirements in terms of overtime and monitoring and tracking employees. And right now, we’re seeing cuts in the Medicare reimbursement rates, documentation, and compliance. That’s always a huge issue.”
And, for agencies facing regulatory investigations or disciplinary inquiries, PHLY’s specialized coverage can provide critical support here, too.
“We have a sublimit of $100,000, which will provide help in terms of legal defence and legal costs that a home care agency incurs due to an investigation by a state regulatory or disciplinary action official,” adds Canci.
PHLY offers a comprehensive and flexible approach to addressing the evolving risks faced by home care agencies – including a range of coverage options designed to fill gaps and provide enhanced protection.
“The general liability policy we offer includes HIPAA coverage built into our extension endorsement,” explains Canci. “And while employment practices liability coverage is not included in our package policy, PHLY does offer a separate policy for that which will pick up claims stemming from improper terminations of employees, such as harassment claims but also wage and hour [issues]. We also have a basic cyber endorsement under our package policy – but for many organizations, PHLY also offers a separate cyber policy that is more appropriate to deliver broader coverage.”
For Canci, this top-tier level of coverage is something that’s really going to come into fruition in the months and years to come, as regulations continue to evolve and technology changes the face of home healthcare across the US.
“[All of this] is certainly going to be more important than ever as we go into next year and the future years because of AI. That technology is going to be a key feature going forward.”
And at PHLY, they’re ready and waiting to help with these changes – expected or not.
The US home healthcare market was worth $162.35 billion in 2024
That figure is expected to reach $381.40 billion
by 2033
Home health services are accessed by around 12 million Americans annually – covered by over 11,000 care agencies
US home healthcare market: a snapshot
Source: Grand View Research
For over 60 years we’ve maintained a disciplined approach to business. This allows us to deliver security and unsurpassed customer service to our customers, while supporting our employees and the communities where we live and work.
PHLY’s history and values
Source: PHLY
Asia
New Zealand
United Kingdom
Canada
United States
Australia
Advertise
Regular Contributors
Authors
E-Newsletter
Contact Us
Contact Us
Data Hub
Benefits
Cannabis
Catastrophe & Flood
Claims
Construction & Engineering
Cyber
Environmental
E&S
Hospitality
Life & Health
Marine
Motor & Fleet
Non-Profits & Charities
Professional Risks
Programs
Property
SME
Transformation
Travel
Workers Compensation
Specialty
Best in Insurance
Business Strategy
E-mag
Events
Guides
IB Talk
Industry Reports
Insurance Companies
Leaders Network
Legal Advisory Board
Legal Insights
Opinion
Premium Content
Regulatory
Webinars
White papers
Resources
Reinsurance
E&S
TV
Insurance News
Industry News
Columns
Diversity & Inclusion
Mergers & Acquisitions
Legal Advisory Board
Risk Management
News
Asia
New Zealand
United Kingdom
Canada
Australia
United States
Advertise
Regular Contributors
Authors
E-Newsletter
Contact Us
Contact Us
Data Hub
Benefits
Cannabis
Catastrophe & Flood
Claims
Construction & Engineering
Cyber
Environmental
E&S
Hospitality
Life & Health
Marine
Motor & Fleet
Non-Profits & Charities
Professional Risks
Programs
Property
SME
Transformation
Travel
Workers Compensation
Specialty
Best in Insurance
Business Strategy
E-mag
Events
Guides
IB Talk
Industry Reports
Insurance Companies
Leaders Network
Legal Advisory Board
Legal Insights
Opinion
Premium Content
Regulatory
Webinars
White papers
Resources
Reinsurance
E&S
TV
Insurance News
Industry News
Columns
Diversity & Inclusion
Mergers & Acquisitions
Legal Advisory Board
Risk Management
News