National Guardianship Association » Coverage for Care Managers

The NGA endorsed professional liability insurance policy underwritten by Lloyd's of London provides coverage for work performed in a variety of professional capacities. The basic policy form provides coverage for work performed as a:

1. Fiduciary;
2. Daily Money Manager;
3. Care Manager; and
4. Computer Consultant.

Additional capacities can be added by endorsement.

Care management is of particular interest to guardians because it often involves the same type of services a guardian would perform, except that the provider is not under the same legal responsibility that a fiduciary would be. The policy defines a care manager as follows:

Care Manager" means one who provides the following services to others for a fee:

1. coordinating assistance from paid service providers and/or unpaid help from family and friends to enable individuals with functional limitations to obtain the highest level of independence consistent with their capacity and preferences for care;
2. face-to-face interviewing of individuals with functional limitations;
3. assessment of functional limitations;
4. care plan development for individuals with functional limitations;
5. administrative and clerical aspects of care plan implementation and monitoring of individuals with functional limitations.

The services performed by a Care Manager do not include:

1. providing actual health care services directly; or
2. performing any services in any trade, business or profession other than a Care Manager, including without limitation activities as a nurse or other health care provider.

In response to a recent inquiry by an Assured regarding whether this coverage would apply to such work provided as a "social worker" under contract with a home health care agency, underwriter's counsel observed:

The fact that the Assured is providing Care Manager services per diem for the home health care agency does not appear to affect coverage under the Policy as long as work is performed on behalf of the Named Assured.

Thus, it appears that for purposes of determining coverage, the fact that an Assured is performing the type of services described in the definition of Care Manager is more determinative than whether the Assured is actually called a "Care Manager". Having said that, holding oneself out as a Care Manager, rather than a social worker, would certainly be preferred from a coverage perspective.