INSURANCE
Reducing Transportation Risk in Home Health Care
An insurance review can help providers prepare for the future
By John Hague
As home health organizations grow, client transportation often becomes a practical part of daily operations. Caregivers may drive clients to medical appointments, pick up groceries or prescriptions, or use personal vehicles for other work-related tasks. While these trips may seem routine, they can create safety, operational and liability concerns if expectations are not clearly defined. In many cases, decisions about transportation are handled differently across teams, which can lead to inconsistent practices.
Transportation may involve company-owned vehicles, employee vehicles used for work, rideshare services, or, in some cases, client-owned vehicles driven by staff. For home health providers, the key question is not simply whether transportation happens, but whether your policies, training and insurance review have kept pace with how transportation is actually being handled. Those day-to-day decisions can affect both safety and how coverage may respond if something goes wrong. Here are some steps to make sure you are doing this.
1.
Define acceptable transportation methods.
One of the first steps is deciding how clients will be transported and under what circumstances. A written policy can help distinguish between situations in which a company-owned vehicle, a personal vehicle, a rideshare service or paratransit/nonemergency medical transportation may be appropriate. Just as importantly, it can define when certain options should not be used.
Not every transportation method is suitable for every client. Clients who are nonambulatory, recently discharged after a procedure or reliant on oxygen may require a higher level of support than a personal vehicle or rideshare service can safely provide. Some organizations also discourage or prohibit the use of a client’s own vehicle because vehicle condition, maintenance and responsibility can be harder to assess and control. Clarifying these expectations in advance can reduce last-minute decision-making and promote more consistent practices.
2.
Screen drivers & monitor them over time.
Driver oversight should not stop at the time of hire. A stronger transportation program includes clear motor vehicle record criteria that define acceptable, borderline and unacceptable results, including moving violations, driving under the influence, suspensions and other relevant indicators. Those standards should align with a disciplinary or corrective action process so managers know how they will respond if a driver’s record changes.
Ongoing monitoring matters just as much as initial screening. An annual motor vehicle record review may be a starting point, but it may not identify developing concerns quickly enough for organizations that regularly transport clients. Where available, automated monitoring or more frequent review can help management identify issues earlier and act before a serious incident occurs. Consistency is just as important. If standards are applied unevenly, both safety and accountability can suffer.
3.
Set expectations for vehicles & driving.
When employees use personal vehicles for work-related trips, organizations should define minimum insurance requirements and establish how proof of coverage will be collected and reviewed. Personal auto coverage does not always align neatly with business use, so this is an area that benefits from proactive review rather than assumption. A transportation policy can also address vehicle conditions by requiring basic inspection checklists for any personal vehicle used to transport clients.
Expectations for safety should be just as clear. Policies often address seatbelt use, passenger securement, distracted driving and whether any phone use is permitted while driving.
4.
Prepare for incidents before they happen.
Transportation risk does not begin and end with the drive itself. Home health organizations also need clear procedures for reporting auto accidents, client injuries, employee injuries and transportation-related near misses. A written reporting protocol helps staff understand what must be reported, when it should be escalated and what documentation is required. That may include basic accident details, witness information, injuries, photographs and any follow-up actions.
Training should reinforce these expectations at hire and at regular intervals thereafter. In addition to safe driving practices, training can address transfers, seat belts, passenger assistance and what staff members should do immediately if there is an accident. Refresher training may also be appropriate after policy changes or transportation-related events.
5.
Don’t overlook transfers & third-party arrangements.
Some of the most important transportation-related risks arise before a vehicle begins moving or after it arrives. Assisting a client into or out of a vehicle, securing mobility aids or helping with a handoff to another transportation provider can all present challenges. Organizations that use rideshare, paratransit or nonemergency medical transportation vendors should clearly define who is responsible for transfers, supervision and documentation at each stage of the trip.
Contracts and service arrangements also deserve careful review. If an outside transportation provider is involved, organizations should understand how responsibilities are allocated in the event of an accident, injury, delay or missed handoff. Legal review can be especially helpful as transportation practices expand or when new vendor relationships are introduced.
6.
Review coverage before a claim occurs.
Operational controls are only part of the picture. Home health organizations should also review how transportation-related risks are addressed in their insurance program, especially when employees use personal vehicles or when more than one liability policy may apply. A practical starting point is confirming that every transportation method the organization allows is contemplated in its coverage.
It is also important to understand whether transportation-related claims would fall under a dedicated auto policy, another liability policy or a combination of policies. When coverage limits are shared, a transportation-related claim may reduce the amount of coverage available for other types of claims. Organizations should also pay close attention to how policy language addresses loading and unloading, client transfers and other incidents that may happen outside of a traditional roadway accident.
Where auto liability, general liability and professional liability are written separately, reviewing policy language together can help identify gaps or conflicting assumptions before a loss occurs. Coordination among operations leadership, legal counsel and insurance advisors can help ensure the coverage structure reflects how transportation is actually handled in practice.
What Providers Can Do Now
For many home health providers, transportation is not a formal service line, but simply one more responsibility that develops as clients’ needs evolve. That is exactly why it can be overlooked. A written transportation policy, consistent driver oversight, clear training and periodic insurance review can help reduce confusion and support safer client transportation practices.
A practical next step is to review current transportation practices to confirm that policies align with how transportation is being handled.
John Hague is an executive underwriter at Crum & Forster, a leading national property, casualty and accident and health insurer, providing specialty insurance products through its admitted and surplus lines insurance companies. He underwrites workers compensation and auto nationwide and works with agents to support home healthcare accounts ranging from startups to complex multi-state operations. Visit cfins.com.
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