$1.1B. That’s what one university hospital system paid to settle sexual abuse claims involving a single physician. And it’s not an outlier. Across the country, sexual abuse and molestation (SAM) claims in healthcare are growing more frequent, more severe, and more visible.
Some insurers now call SAM “the next asbestos” due to its long-tail exposure and massive jury awards. These claims are costing far more than insurers ever priced for, leaving healthcare organizations exposed to financial and reputational damage.
You might assume SAM claims are rare or fully covered. That assumption no longer holds. With evolving laws, tighter insurance terms, and heightened public scrutiny, understanding today’s SAM risk is key to protecting your patients, your team, and your coverage.
Lookback window laws: Legal shifts are expanding exposure
Several states have passed "lookback window" laws that remove time limits for reporting sexual abuse. These changes allow survivors to file claims even if the incidents happened many years ago.
This has led to:
- Lawsuits involving multiple claimants
- Plaintiffs reopening previously closed claims
- Jury awards that go beyond coverage limits
- A rise in class-action suits that are complex, costly, and public
Law firms are advertising for survivors to come forward, which increases the number of claims. Even if your coverage includes past incidents, your limits may not be adequate to cover past incidents.
Reassess prior cases and prepare your legal and compliance teams to respond.
Insurance markets are responding
As claims rise, insurance companies are reevaluating how they treat SAM. What used to be part of your professional liability policy may now require its own coverage or self-insurance.
Recent changes include:
- Higher deductibles (some starting at $10M) or coinsurance
- Caps on what insurers will pay for SAM claims
- A separate or higher premium to include SAM coverage
- Policies that exclude SAM altogether
- Separate SAM policies with higher premiums and narrower terms/low limits
Some carriers also limit retroactive coverage or require detailed documentation of past prevention efforts. Others are carving out SAM entirely unless providers meet strict underwriting guidelines. These shifts are happening in part because underwriters are struggling to model long-tail SAM risk, especially when legal trends are evolving so rapidly.
If you don’t meet these new thresholds, insurers may ask you to pay more or assume greater risk. Reviewing your current coverage carefully and proactively gathering documentation can help you avoid surprises at renewal.
Operational risk factors are under the microscope
Insurers are looking beyond your claims history. They want to understand how you deliver care day-to-day and what protections you have in place.
Key risk areas include:
- Sedated patients without adequate supervision
- Staff crossing boundaries during transport or recovery
- Exams conducted without a chaperone
Notably, SAM claims don’t always involve clinical staff. Many recent cases name non-clinical or support personnel, widening exposure across departments and facilities.
Staffing shortages and fast-paced environments make it harder to monitor every interaction. If you can’t demonstrate how you’re addressing these challenges, you may be carrying more risk than you realize.
Underwriters may now request detailed assessments of how your protocols function in practice, not just what’s written in policy manuals.
Every gap in oversight becomes a potential point of exposure.
Company culture: Strengthening prevention and reporting
Having a policy isn't enough. What matters is whether your team understands it, follows it, and feels safe speaking up.
You can strengthen your culture by:
- Making chaperone use a clear, enforced requirement
- Offering safe, anonymous ways for staff to report concerns
- Breaking down hierarchies that discourage reporting
- Delivering hands-on, scenario-based training, not just check-the-box modules
Consider bringing in outside experts to review your prevention plans. These professionals have experience working in high-risk places like schools and religious institutions. They can help spot policy gaps, assess culture, and suggest better training and reporting processes. Internal teams may miss these issues.
Documentation as a defense strategy
If a claim does arise, strong documentation can support your response.
Make sure you’re consistently tracking:
- Chaperone presence and adherence to care protocols
- Reports of staff concerns or boundary violations
- Staff training, background checks, and follow-up actions
Digital tools can help streamline documentation and ensure accuracy. Insurers are increasingly asking for this information, which could mean the difference between limited or broad coverage options.
Renewal considerations: Here’s what to expect
Insurance renewals are now more involved. Even if you’ve never had a SAM claim, your insurer may ask:
- How are staff trained on SAM prevention?
- Are your leadership and board members involved in oversight?
- What’s your process for addressing staff concerns?
Shared risk is also a factor. For example, a provider named in a SAM claim may have worked at multiple facilities insured by the same carrier. In these cases, that carrier will be impacted under multiple policies with significant limits exposed. As a result, carriers are reducing capacity, so be prepared to engage additional carriers to maintain current limit structure.
Start renewal planning early. Coming to the table with clear documentation and risk-reduction efforts gives you more leverage.
Reducing risk in a shifting landscape
SAM claims reflect a broader, growing risk in healthcare. More organizations are shifting their focus from policies on paper to real culture change.
To stay ahead:
- Regularly review and revise your protocols
- Build cross-department teams to lead prevention efforts
- Track legal developments in your state
- Treat SAM prevention as a core part of your risk strategy
Emerging technologies like AI may one day help identify behavioral risks or flag concerning patterns. Today, your best tools are engaged staff, clear rules, and strong leadership.
The steps you take now can reduce risk, protect your organization, and help you maintain critical insurance coverage.
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