Loss Amount:
$340,000
What Happened:
A resident suffering from Alzheimer's disease wandered away from an assisted-living facility. She walked into a liquor store and fell, breaking her hip.
The assisted-living facility incurred expense treating the injury and caring for a woman who will be non-ambulatory for the rest of her life. Also, the assisted-living facility waited a year before notifying the insurer.
The claims adjuster discovered that the liquor store had been sold and the owner at the time of the accident had moved overseas. The delay in reporting the accident to the claims department made it impossible to investigate the accident fully, or to pursue any action against the liquor store.
Lessons Learned:
Assisted-living facilities should develop systems to prevent residents from straying away from the facility. Besides constant supervision, there are a variety of alarms that can be purchased. Alarms range from those activated by opening a door to wristbands that activate an alarm when the patient approaches an exit. If a facility is not equipped to handle wanderers, the resident should be relocated to a facility that has adequate controls in place for wandering.
Assisted-living facilities should notify the claims department immediately after learning of an accident. The sooner the claims department can work on a claim, the better the chances of a complete investigation of the facts. Witnesses can be located sooner and their memories are clearer. The claim may then be settled with lower costs, and if possible, costs can be subrogated to other parties who are partially or fully at fault.
