Nobody starts a home care agency expecting to deal with an abuse claim. You start your agency to help people remain safe and comfortable at home, give families peace of mind, and provide care that truly matters.
That makes abuse and molestation an uncomfortable topic—and one that can be easy for agency owners to overlook when reviewing insurance coverage. Unfortunately, it is also a risk the insurance industry takes very seriously.
Here's what home care agency owners need to know: most general liability policies specifically exclude claims involving abuse or molestation. For an industry built around providing care to vulnerable individuals in their homes, that exclusion can leave a significant gap in coverage.
Why home care carries this exposure
Think about what your caregivers actually do. They work alone, inside a client's home, with people who may be physically frail, cognitively impaired, or both. There is no supervisor down the hall. There are no cameras. For hours at a time, the only two people who know what happened in that house are the caregiver and the client.
That setting is exactly why families trust you, and it is exactly why insurers treat home care as a high-exposure class for abuse allegations. It does not mean your employees are dangerous. The overwhelming majority of caregivers are exactly who they appear to be. But an allegation does not require guilt to be expensive. It only requires an accusation, a lawyer, and a policy that does not respond.
The exclusion most owners never read
Pull out your general liability policy and look for the abuse and molestation exclusion. It is usually there, sometimes as an endorsement, sometimes buried in the definitions. Carriers added these exclusions decades ago precisely because abuse claims are severe, emotional, and hard to defend. The result is a strange gap: an agency can be fully insured, current on every premium, and still have zero coverage for one of the most damaging claims it could ever face.
Unfortunately, many agency owners don't discover this gap in coverage until it matters most—after a claim has already been filed.
What dedicated coverage actually does
Sexual abuse and molestation coverage, sometimes written as SAM or abuse and molestation liability, does two things that matter.
First, it pays for defense. Even a claim that goes nowhere generates legal bills, and in an abuse case those bills climb fast. Defense cost coverage means a false or unprovable allegation does not bankrupt you on the way to being cleared.
Second, it covers liability if your agency is found responsible for the acts of an employee or contractor, typically under theories like negligent hiring or negligent supervision. Plaintiffs rarely sue only the individual. They sue the agency that hired, trained, and placed that person.
Some policies also respond to allegations involving one client harming another, or incidents involving third parties in the home. The forms vary widely, which is a real reason to have someone who reads these policies for a living look at yours.
What insurers expect from you
Carriers do not hand this coverage to just anyone. They want to see that you run a tight operation: documented background checks on every hire, reference verification, abuse prevention training, clear reporting procedures, and supervision practices that fit the realities of in-home work. Written policies matter. So does proof you follow them.
This is not just underwriting box-checking. The same practices that make you insurable make an incident less likely in the first place. Agencies that treat screening and training as a paperwork nuisance tend to pay for it twice, once in premium and once in claims.
The contract angle
More and more referral sources, states, and payer contracts now require abuse and molestation coverage explicitly. If you are pursuing Medicaid waiver work, VA contracts, or partnerships with facilities and franchisors, expect to be asked for proof. Owners who wait until a contract demands it end up shopping under deadline pressure, which is the most expensive way to buy anything.
Where to go from here
Read your current policy, or better, have it read for you. Confirm whether an abuse and molestation exclusion applies, what your limits would be if a claim came in tomorrow, and whether your screening and training practices would satisfy an underwriter today.
This is what we do all day at Home Care Business Insurance. We work only with home care and home health agencies, we know which carriers write this coverage well, and we can tell you quickly whether you have a gap and what closing it costs. A conversation is free. Finding out about the exclusion after a claim is not.