General Liability
The centre of a North Dakota program. It carries the limits contracts name and the additional insured status WSI will not provide.
General liability coverage
Coverage by State
North Dakota Home Care Insurance
For agencies already operating in North Dakota. If a hospital has asked to be named as an additional insured and WSI has told you it will not do that, you are not stuck. That requirement gets met on the general liability side, and it does not have to wait for your renewal date.
If you already run a North Dakota home care agency
Here is the short answer, and North Dakota's differs from every other state's. Your workers compensation comes from WSI and always will, because state law does not permit private carriers to write it. Everything else is ordinary private-market insurance, and here it carries more contractual weight than anywhere else, because there are things WSI does not do that your contracts still demand.
The clearest example is additional insured status. Hospitals, facilities and payers routinely require it, and WSI states outright that it does not allow additional insureds to be listed on the account. That demand does not go away. It moves to your general liability, which is endorsable and ours to build.
So the work here is general liability at the limit your contracts name, professional liability sized to the care you deliver, an umbrella behind both, auto for long winter routes, abuse and molestation coverage, and certificates carrying the wording your counterparties asked for. An agency running seventy-five to a hundred caregivers out of Fargo, Bismarck or Grand Forks has a different problem from a startup, and this page is written for the former.
What North Dakota contracts require, and what happens when yours falls short
No North Dakota statute sets your liability limits. Your contracts do, and they ask for more than the law.
What the contracts typically ask for
Hospitals, health systems, skilled nursing facilities, managed care payers and government contracts converge on a familiar list. General liability at $1 million per occurrence and $2 million aggregate is the common floor. Professional liability is expected wherever care runs under a plan of care, often at matching limits. Auto liability covering agency vehicles and caregivers driving their own. Abuse and molestation coverage, increasingly named specifically rather than assumed. Evidence of workers compensation, which here means your WSI account. And an umbrella to lift the total where the primary layers stop.
Wording usually matters as much as the number. Contracts routinely ask to be named as an additional insured, for a waiver of subrogation, for cover to respond on a primary and non-contributory basis, and for advance notice if a policy is cancelled. Each of those is an endorsement on a policy rather than a sentence on a certificate.
The North Dakota complication, and why it is an opportunity
In most states those requirements spread across the whole program, workers compensation included. Here they cannot, because WSI states four limitations directly. It does not waive its rights of subrogation. It does not allow additional insureds to be listed on the account. It does not include general liability coverage. And because it is a state agency it does not issue a written policy, with all provisions stated instead in the form of North Dakota statute or administrative rules.
Read that list against a hospital contract and the consequence is obvious. Requests for additional insured status, for a waiver of subrogation, and for a policy document to attach to the agreement all land on the private side of your program or nowhere at all. That is a reason to build the private lines deliberately rather than treat them as the smaller half of the file.
When the contract asks for more than you carry
The first route is endorsement. The incumbent carrier will sometimes raise a limit or add required wording mid-term for additional premium, and that is the fastest path where it is available.
The second is an umbrella. Where a contract wants a total your primary layers cannot reach, excess limits stacked over general liability and auto usually get there quicker and for less than rebuilding the primary program underneath.
The third is re-marketing. Where a carrier will not extend, or the required wording sits outside what the form allows, the program moves. That takes longer, which is the argument for sending contract language when it first appears rather than the week it has to be signed.
Certificates of insurance and the rest of the operating year
For a running agency the broker relationship is mostly certificates and mid-term changes, and North Dakota puts more pressure on both.
Certificates
A certificate is evidence, not coverage; it states only what a policy does. If a Fargo or Bismarck health system requires additional insured status and your general liability carries no such endorsement, no certificate can create it, and WSI will not supply it from the other direction. The delay agencies feel there is an underwriter deciding, not paperwork.
So the habit that helps: when a new client, facility or payer sends paperwork, send us the requirements immediately. And when a counterparty asks for a copy of your workers compensation policy, expect the conversation, because WSI does not issue one.
What to report during the year
Adding and removing caregivers needs no change to your private lines each time: they are rated on payroll and headcount and trued up at audit, and your WSI account is administered separately. What needs reporting is a change in the shape of the agency.
- A new service line, particularly a move from personal care into skilled nursing or therapy.
- A new office, or a move into counties you did not previously serve.
- Agency-owned vehicles, which need commercial auto rather than a caregiver reimbursement arrangement.
- Caregivers regularly crossing into Minnesota, South Dakota or Montana.
- An acquisition, a new entity, or a change of ownership.
- Any incident that could become a claim, reported when it happens rather than when it is served.
Coverages North Dakota home care agencies carry
The private program, sized to your payroll, territory and contracts. Workers compensation is not on this list because it comes from WSI rather than from any carrier.
Professional Liability
Clinical claims coverage for care delivered under a plan of care, usually required at limits matching your general liability.
Professional liability coverageCommercial Auto
For agency-owned vehicles on long rural routes where a single visit can absorb most of a shift and winter arrives with little shelter between towns.
Commercial auto coverageHired and Non-Owned Auto
The line most established agencies are short on, covering caregivers who drive their own cars between visits.
Hired and non-owned autoAbuse and Molestation
Coverage of up to $1 million for allegations standard liability excludes, and increasingly named in contracts rather than assumed.
Abuse and molestation coverageUmbrella Liability
Excess limits stacked over liability and auto, usually the fastest way to reach a total a contract has just raised.
Umbrella liability coverageCyber Liability
Breach response for the protected health information your agency holds: notification, ransomware, regulatory defense.
Cyber liability coverageProperty and Business Owners Policy
Cover for the office, its contents, and business interruption after a loss.
Home care agency insuranceProvider types we insure in North Dakota
Home Care Agencies
Non-medical agencies delivering personal care and companion work across the three metros and the sparsely settled balance of the state.
Home care agency insuranceHome Health Agencies
Agencies licensed through the Health Facilities Unit, providing nursing and related services in the homes of North Dakota residents.
Home health agency insurancePersonal Care Services
Bathing, dressing, grooming, and daily living support, the core of a North Dakota non-medical book.
Personal care services coverageSenior Care Providers
Agencies serving the roughly 133,000 North Dakota residents aged 65 and older.
Senior care coveragePrivate Duty Nursing
Skilled, high-acuity care that drives professional liability limits higher, usually with an umbrella behind it.
Private duty nursing coverageGroup Home Care
Residential group homes combining a facility with hands-on care, carrying premises and property exposure.
Group home care coverageNorth Dakota workers compensation and what WSI will not do
North Dakota is one of a small group of states running an exclusive state fund, and it is worth being exact about what that means for an operating agency.
WSI is the only source
Workforce Safety and Insurance describes itself as the sole provider and administrator of workers compensation in North Dakota, an exclusive employer-financed, no-fault insurance system covering workplace injuries, illnesses, and death. WSI also states that North Dakota law does not allow private insurers to underwrite workers compensation insurance in North Dakota.
We would rather be plain than vague. We do not place your North Dakota workers compensation, and no broker does. It comes from WSI directly, and any page saying otherwise is wrong.
Everyone, before the first shift
There is no headcount threshold to grow into. North Dakota's workers compensation law, with limited exceptions, requires all employers to insure all employees including full-time, part-time, seasonal, and occasional workers before employees begin working. Note the timing: coverage has to be in place before work starts, not once payroll runs.
The out-of-state test is broad too. An employer whose employment results in significant contacts with North Dakota, or enters into employment agreements in North Dakota, must secure coverage with WSI. Fargo and Grand Forks both sit on the Minnesota line, so agencies based over the border are caught more often than the map suggests. Two further points from WSI: no agreement by an employee to waive rights to compensation under Title 65 is valid, and it is unlawful to deduct any portion of the premium from wages or salary of any employee.
WSI refers to limited exceptions without enumerating them on the pages we read, so this page does not describe a domestic or household carve-out for North Dakota. We are not going to guess at exceptions we have not seen written down.
The four limitations that shape your private program
This is the part most agencies discover mid-contract rather than in advance. WSI states four things it does not do:
- WSI does not waive its rights of subrogation.
- WSI does not allow additional insureds to be listed on the account.
- WSI does not include general liability coverage.
- WSI, because it is a state agency, does not issue a written policy. All provisions are stated in the form of North Dakota statute or administrative rules.
Each has a direct commercial consequence. A hospital requiring additional insured status cannot be accommodated on the state fund, so that requirement moves to your general liability. A contract asking for a waiver of subrogation will not get one. A counterparty asking for a copy of the policy will find there is no document to send. And because the fund covers workplace injury alone, every other line your contracts demand is private-market business.
North Dakota licensing and regulatory context
Short version, because you already hold whatever authority you operate under. It earns space only because that authority is what a carrier underwrites against.
Home health agencies in North Dakota are licensed by North Dakota Health and Human Services, through the Health Facilities Unit within Public Health Regulation, Licensure and Certification. They provide nursing and related services in the homes of North Dakota residents, and the governing rules sit at N.D. Admin. Code chapter 33-03-10.1.
We could not confirm to our own standard how purely non-medical personal care and homemaker work is authorized in North Dakota, so this page does not state it. Confirm your own position with Health and Human Services, tell us what applies, and we will build the program to the authority you actually hold rather than to a label.
Medicare, Medicaid and what actually sets your limits
Medicare covers short-term skilled home health under a plan of care. That work raises the stakes on documentation and on professional liability, and it sits on a different footing from personal care and companion work.
Medicaid in North Dakota is administered by the Health and Human Services Medical Services Division. We are not going to describe how its in-home programmes are structured or funded, because we could not confirm it.
What matters commercially is the point this page opened with: your limits are set by the hospitals, health systems and payers you contract with, not by any North Dakota statute. That is why we ask to see the contract language rather than guessing at a number. If your agency runs skilled care, our home health agency insurance page covers how that program is built. For the non-medical side, see personal care services.
The North Dakota home care market
North Dakota has about 797,000 residents, and roughly 133,000 of them are 65 or older, close to 17.2 percent of the civilian population.
Three small metros hold most of the state between them: Fargo about 268,000, Bismarck about 139,000 and Grand Forks about 104,000. Everything else is sparsely settled, with long drives and severe winters. Fargo and Grand Forks both sit on the Minnesota line, so border work is routine.
For an operating agency that shape drives two things. Auto exposure is heavier than the population suggests, because routes are long and winters unforgiving. And the Minnesota edge means the out-of-state test cuts both ways: your caregivers working over the line, and Minnesota agencies working in Fargo.
Agency-owned vehicles need commercial auto, and caregivers using their own cars create a hired and non-owned auto exposure a personal policy usually will not cover on a work trip. Read our Minnesota, South Dakota, Montana and Wisconsin pages, and the full list is on our coverage by state hub.
North Dakota resources for home care providers
The sources behind everything above.
- WSI coverage requirements, where the sole provider status and the no-threshold rule are stated.
- WSI coverage limits, rights and subrogation, the page listing the four limitations above.
- State WSI FAQ, including the significant contacts test for out-of-state employers.
- Home health agencies, North Dakota Health and Human Services.
- Health Facilities Unit.
- N.D. Admin. Code chapter 33-03-10.1, the home health agency rules.
- Home Care Association of America, North Dakota chapter. We checked for a North Dakota-specific home care association and could not find one that resolves.
- National Association for Home Care and Hospice, for national home care standards and guidance.
Why North Dakota agencies choose HCBI
We are straightforward about the one thing we do not do here. Your workers compensation comes from WSI, we do not place it, and we will not pretend otherwise to win a conversation.
What we do is everything WSI leaves on your side of the line, and here that is more than it is elsewhere. A hospital requires additional insured status and the state fund will not list one. A payer wants a waiver of subrogation WSI does not give. A facility asks for a copy of a policy that does not exist as a document. A caregiver crash on a winter route exposes how little a personal auto policy does on a work trip. Each of those lands on the private program, which is ours to build and endorse.
On the facts we work from WSI's own pages and the state's licensure material, and where something was not written down we leave it out. That is why this page describes no domestic exemption: WSI refers to limited exceptions without listing them, so we do not list them either.
We place coverage through exclusive carrier programs that write home care risks, and we coordinate the private side of the program end to end: general liability with the additional insured wording your contracts demand, professional liability, commercial and hired and non-owned auto for long rural routes, umbrella limits to reach what your contracts require, cyber, and abuse and molestation coverage of up to $1 million. That reach is backed by working relationships across the wider home care and healthcare industry, including CareerStaff Unlimited and Genesis Healthcare in staffing and healthcare services, HOMELINK in the medical equipment and home care network space, and Bright Horizons Family Solutions on the family care side.
North Dakota home care insurance FAQ
Answers for agencies already operating under North Dakota rules.
No, and this is the single most useful thing to know about operating in North Dakota. WSI states plainly that it does not allow additional insureds to be listed on the account. So when a hospital, facility or payer requires additional insured status, that requirement gets satisfied on the general liability side of your program instead. It is why an agency here still needs a broker even though workers compensation is not ours to place.
Usually, and usually before renewal. The underlying general liability limit can sometimes be raised by endorsement. More often an umbrella stacked over general liability and auto reaches the required total faster and for less than rebuilding the primary program. Where the carrier will not extend, the program is re-marketed. Send us the insurance exhibit rather than a summary, because the wording matters as much as the number.
No, and nobody can. WSI describes itself as the sole provider and administrator of workers compensation in North Dakota, an exclusive employer-financed, no-fault insurance system covering workplace injuries, illnesses, and death. WSI also states that North Dakota law does not allow private insurers to underwrite workers compensation insurance in North Dakota. Your coverage comes from WSI directly. Everything else in your program, including the general liability that has to absorb your contract demands, is placed in the private market.
No. WSI states that because it is a state agency it does not issue a written policy, and that all provisions are stated in the form of North Dakota statute or administrative rules. That surprises agencies the first time a contract asks for a copy of the policy, and it is another reason the private lines carry more contractual weight here.
The certificate is quick. What takes time is anything it has to evidence that your policy does not yet do: additional insured status for a named health system, a waiver of subrogation, primary and non-contributory wording, or a notice-of-cancellation provision. Those are endorsements, not lines typed onto a form. Here it matters more than usual, because general liability is carrying requirements WSI will not meet.
Not person by person. Your private lines are rated on payroll and headcount estimates and trued up at audit, so ordinary hiring and turnover does not require a policy change. What does need reporting is a change in what the agency does: a new service line, a move into skilled work, a new office, agency-owned vehicles, an acquisition, or regular work over the Minnesota line. Your WSI account is administered separately.
Very likely. The state puts it broadly: an employer whose employment results in significant contacts with North Dakota, or enters into employment agreements in North Dakota, must secure coverage with WSI. Fargo and Grand Forks both sit on the Minnesota line, so this catches more agencies than the geography suggests. WSI also states coverage must be in place before employees begin working, so it is not a thing to sort out after the first shift.
North Dakota Health and Human Services, through the Health Facilities Unit within Public Health Regulation, Licensure and Certification. Home health agencies provide nursing and related services in the homes of North Dakota residents, and the rules sit at N.D. Admin. Code chapter 33-03-10.1. We could not confirm to our own standard how purely non-medical personal care work is authorized in North Dakota, so we do not state it here. Tell us what you actually hold and we will build to it.
Loss runs for the last five years, current declarations pages for every private line, payroll by class, caregiver headcount, the counties you serve, and the insurance exhibits from your largest contracts. Start sixty to ninety days out rather than in the last fortnight. A non-renewal shortens the list of carriers, and lead time is what buys the options back.
Send us the contract and we will build to it
Tell us your payroll and caregiver count, the states your caregivers actually work in, and what your largest contract requires. If a counterparty wants additional insured status the state fund cannot give, start there and we will build it into your general liability. A specialist will place the private side of your program through exclusive carriers that write home care in North Dakota. There is no obligation.