In senior living, the revenue leaves with the residents. The claim has to pay for the move, the closure and the months it takes to refill.
Last updated: October 2026
A fire in one room can empty a wing. A freeze or an outage can empty the building. HHSC calls, resident transfers, census loss and the inspections before reopening all start at once. We document and negotiate the full loss for the operator, and we tell you plainly when a question belongs with your attorney.
Start a claim review
Tell us what happened. A licensed Texas public adjuster will review your senior living loss with you, and tell you straight whether you have a fight worth having. The review is free.
For fire claims, we call you back within 1 hour and visit your property within 24 hours or less.
After Hurricane Harvey, 104 Texas nursing and assisted living facilities evacuated nearly 4,500 residents. When the Texas House committee met afterward, 39 of them were still closed. Every closed day was lost census, and the claim has to account for it.
Source: Texas House Human Services Committee interim report, 2018.
After a fire or storm at your community: the first 72 hours
The first three days decide two things at once: whether residents are safe and tracked, and whether the claim has the records it needs. Most of those records are ones Texas and federal rules already ask you to keep.
Track every resident. Log each resident's name, the receiving facility (where an evacuated resident goes), the date and how they were moved. Federal emergency rules for nursing homes call for this tracking, and the same log later supports your relocation costs and census loss.
Call HHSC right away. A fire at a Texas nursing facility or assisted living facility requires an immediate call to HHSC (1-800-458-9858), then a written fire report within 15 calendar days. Write down the date, time and intake reference.
Send the evacuation notices. Evacuating, sheltering in place (staying in the building) and returning each require notice to the HHSC regional office and the local emergency management coordinator. If a sister facility will go over its licensed capacity (the most residents its license allows), it needs HHSC authorization.
Keep the origin room and the failed items. Oxygen equipment, appliances, dryers, wiring, generators and frozen pipes can point to who caused the loss. Give notice before anything is thrown away. Evidence preservation duties are a question for your attorney.
Photograph every wing before cleanup. Map where sprinklers discharged. Keep timestamped temperature logs for resident rooms, refuge areas and medication refrigerators.
Notify every policy that might respond: property, general liability, professional liability and any evacuation coverage. Evacuation coverage can sit on a liability policy. Log claim numbers and every call.
Open a separate expense code today. Buses, ambulances, hotels, receiving-facility charges, staff travel, overtime, generator rentals and discarded food and medication are only recoverable if they are documented.
Keep communications factual. Families, media and investigators may call. Questions about resident injuries, deaths or liability go to your attorney, not into claim correspondence.
Sources: 26 TAC 554.1914 and 553.275; 42 CFR 483.73; HHSC Provider Letter PL 18-19; Sedgwick (2018).
Calls and reports HHSC requires, with deadlines
HHSC Long-Term Care Regulation controls notice, evacuation and reoccupancy for Texas nursing facilities and assisted living. These filings are regulatory duties first. They also become some of the strongest records in your claim.
Immediately
Call HHSC about the fire (nursing facility and assisted living). For assisted living, a death, serious injury or emergency threat also needs an immediate call.
In the claim: fixes the date of loss and the start of the interruption.
Within 5 working days
Assisted living: Form 3613-A (HHSC's assisted living incident report form) for a death, serious injury or emergency threat.
In the claim: part of the event record the carrier will ask about.
Within 15 calendar days
Written Fire Report for Long Term Care Facilities.
In the claim: an early written account of origin and spread.
On evacuation, shelter in place and return
Notices to the HHSC regional office and the local emergency management coordinator.
In the claim: dates the start and end of displacement, which drive extra expense and business income.
| Event | Nursing facility | Assisted living |
|---|---|---|
| Fire | Immediate call to HHSC, then a written fire report within 15 calendar days | Same |
| Evacuation, shelter in place, return | Notices to the HHSC regional office and local emergency management coordinator | Same |
| Receiving facility over licensed capacity | Needs HHSC authorization | Same |
| Construction or rehabilitation beyond "repair" | Written notice to HHSC before work begins, then HHSC final inspection before occupancy | Confirm the steps with your HHSC regional office |
Independent living: HHSC does not regulate independent living buildings. These communities skip the HHSC filings, but the claim still turns on the rent roll, the move-out dates and the city's approvals to reoccupy.
Whether a filing was on time, and what follows if it was not, are regulatory and legal questions for your attorney. We use the filings as records of what happened.
Sources: 26 TAC 554.1914, 553.275 and 554.330; HHSC PL 18-19; Texas Tribune via KPRC (2025).
Moving residents is often the first and largest extra expense
Buses, ambulances, hotels, receiving-facility charges, staff travel and overtime start the day the residents move. During Winter Storm Uri, Gainesville Nursing and Rehabilitation moved 36 residents to a college shelter by fire-rescue team and school bus, a move that took about four hours. A Collin County assisted living facility moved 21 residents to a hotel. During Harvey, First Colony Health and Rehab in Missouri City evacuated about 108 residents: 15 went with four staff to a sister facility in Weslaco, and 93 went to facilities across the state.
The order matters
Texas assisted living facilities must evacuate when the county judge or mayor orders it. Evacuation coverage often requires a mandatory order and reimburses after the operator pays. In Port Arthur during Harvey, no mandatory evacuation order was issued. Keep every order and every instruction from authorities. Whether a voluntary move is covered is a policy question, and in a dispute it belongs with your attorney.
Heat and cold can force a move without any damage
Texas assisted living facilities must keep resident areas at 68 to 82°F during emergencies. Long-term care facilities certified after October 1, 1990 must hold 71 to 81°F, and CMS expects residents to be moved if safe temperatures cannot be kept. A grid outage with no building damage can force an evacuation, which is why utility services coverage matters.
Who your residents are changes the cost of the move
| License or certification | Who it serves | Why it matters in the claim |
|---|---|---|
| Type A assisted living | Residents who can evacuate without staff help, need no routine nighttime attendance and can follow emergency directions | Moves are simpler, and more receiving facilities can take these residents. |
| Type B assisted living | Residents who may need staff help to evacuate, need nighttime attendance or cannot follow emergency directions; not permanently bedfast (confined to bed) | Moves need more staff and transport, which raises extra expense. |
| Alzheimer's certification (memory care) | Required to advertise specialized Alzheimer's care; needs a Type B license, a disclosure statement, dementia orientation and 12 hours of annual training for direct care staff | Residents need receiving staff trained to serve them, which narrows relocation options. |
The third column is claims practice, not a rule.
Sources: Senate Finance Committee, "Left in the Dark" (2023); KRGV; AJC (2017); Sedgwick (2018); 26 TAC 553.275 and 553.5; CMS Appendix Z; NCAL Texas summary.
Smoke, soot and sprinkler water in a defend-in-place building
Nursing homes had 48.6% of all U.S. health care facility fires in 2014 to 2016, and 75% of those nursing home fires stayed confined. More than half of nursing home fires were cooking fires, while fires starting in mattresses, bedding or electrical wiring caused a disproportionate share of casualties. A confined fire is still rarely a confined claim.
Nursing homes are built defend in place: divided into smoke compartments behind fire and smoke barriers, so residents can be moved within the building rather than out of it. That design saves lives. It also means the scope fight centers on rooms outside the fire compartment: cleaning, repainting, and soft goods such as mattresses, drapes and furniture. All Medicare and Medicaid nursing homes had to be fully sprinklered by August 13, 2013, so sprinkler water in rooms, floors below and stored supplies is common. Sprinklers matter: long-term care fires killed 10.8 people per 1,000 fires in unsprinklered buildings and 1.9 in sprinklered ones, figures cited in the 2008 CMS rule.
Fire in a resident room.
In September 2025, a fire at a Houston Northside nursing home on Janisch Road was contained to one room. One resident was found dead there, and arson investigators were examining the cause.
What it means for your claim: a contained fire still brings a death investigation, HHSC reports and a cause inquiry at once. Preserve the room.
Oxygen and smoking materials.
At Gabriel House, an assisted living facility in Fall River, Massachusetts, 10 residents died in July 2025. Investigators said medical oxygen contributed significantly to the fire's rapid spread; the cause was undetermined between an oxygen concentrator failure and smoking materials.
What it means for your claim: keep oxygen equipment and leased-equipment contracts; the cause points to who may be responsible.
Exterior or roof fire.
The December 2022 fire at North Pointe Nursing and Rehabilitation in Watauga started on the building's exterior; residents of damaged rooms moved to other parts of the campus, with repairs expected to take about 10 days. The July 2025 fire at Park Highlands in Athens started in the roof area, and the building closed as a precaution.
What it means for your claim: rooms out of service are a loss even when residents stay on campus. Track which rooms were out, and for how long. Document the water path through ceilings as well as the fire.
Smoke beyond the compartment.
Gabriel House lacked hallway fire doors and smoke barriers, per the fire department's after-action report.
What it means for your claim: expect the carrier to limit smoke scope to the fire wing.
Sprinkler water.
What it means for your claim: map the discharge zones before cleanup, including floors below and supply rooms.
Food, medication and linens.
Texas sets temperature rules for medication storage.
What it means for your claim: items exposed to smoke, water or heat are usually discarded. Log each item with times and temperatures.
What we do about it
We bring in industrial hygienists to test and document how far smoke and soot actually traveled, establishing which rooms are genuinely unusable to the standards a care environment requires. That finding drives both the displacement and the lost-revenue claim.
Running a hospital or other licensed health care facility as well? See our page on hospital fire claims.
Sources: USFA (2014 to 2016); NFPA via NIST FireDOC; CSE (2008); CMS S&C 13-55-LSC; 73 FR 47075; FOX 26 Houston (2025); Massachusetts Department of Fire Services (2025); Boston Globe (2025); NBC DFW (2022); KLTV (2025).
Lost census: how senior living income loss is measured
Senior living income loss is counted in resident days by payer, and it outlasts the repairs. Census means the residents in the building; average daily census is the average per day. Payer mix is the share of Medicare, Medicaid and private pay. A wing out of service, or a building emptied, removes days at each payer's rate until those residents return or are replaced.
A practice model, not a policy formula
Lost income = the sum, across each unit type and payer, of lost resident days × net revenue per day, minus expenses that do not continue.
| Input | What it includes | Where it comes from |
|---|---|---|
| Volume | Average daily census and occupancy by unit type: skilled, long-term care, assisted living, memory care, independent living; resident days by payer | Daily and monthly census reports |
| Rate | Revenue per day by payer: Medicare Part A, Medicaid, managed care, hospice, private pay; plus monthly rent and level-of-care fees in assisted living and memory care | Remittances, rent roll, level-of-care billing |
| Continuing expenses | Retained payroll, debt service, lease payments, management fees and contracts | P&L and payroll registers |
| Baseline | Your own 24 to 36 months of census, move-ins and move-outs, to show seasonality and the pre-loss trend | Census history, move-in pipeline, waitlist |
| Public cross-check | Skilled nursing facilities file Medicare cost reports (form CMS-2540-2010) into CMS's HCRIS database, and CMS publishes a public file from them, as submitted | Filed cost reports |
Expect Medicaid days to be valued at Medicaid rates, which is fair when documented. Private-pay and Medicare Part A days carry their own rates, and they should be valued at those rates too. Check whether your income is insured as business income or as rental value. That matters for assisted and independent living billed as rent.
How we push back
We do not hand the carrier one calculation. We model the loss several independent ways, against your real census and revenue by payer, against the rebuild and HHSC reoccupancy timeline, and against the cost of relocating and caring for residents, then use those models against each other. The look-back period matters too: a soft year inside a multi-year average can drag your baseline down when it does not reflect normal operations.
Policy terms that shape the number
- Under the standard ISO business income form, income loss is covered from 72 hours after the physical loss; extra expense starts at once
- If the business income limit is below the coinsurance percentage times 12 months of net income plus operating expenses, every income payment shrinks by that ratio, though extra expense is exempt
- Surplus lines and large-risk policies often use their own wording, so check each term against your policy.
Work through your numbers with the Business Income Worksheet and check your limit with the Coinsurance Penalty Calculator.
Sources: CMS SNF cost report methodology; ISO CP 00 30 specimen.
Extra expense, and why residents may not come back
Extra expense to document
- Transport: Gainesville Nursing and Rehabilitation moved 36 residents by fire-rescue team and school bus during Uri.
- Lodging: a Collin County assisted living facility moved 21 residents to a hotel during Uri.
- Staff and receiving-facility costs: four First Colony employees traveled with residents to Weslaco, where Retama Manor cleared a wing and added staff.
- Emergency power and water: Parmer Woods in Austin had no backup generator and brought one in the night after losing power; staff melted snow for toilets.
- Spoilage: Ella Springs Senior Living in Houston threw out all its freezer food after Beryl.
The census rebuild
A Lockhart nursing home evacuated over burst pipes during Uri and stayed closed more than seven months. Only four of its residents went home to their families. Residents placed elsewhere settle in. Families are reluctant to move a parent twice, and hospital discharge planners send skilled patients elsewhere during a closure.
That slow refill is what extended business income is for. The standard form covers 60 consecutive days after repairs are done and operations resume; an Extended Period of Indemnity option replaces 60 with the days shown on your declarations. Check the days you bought, and show the census ramp month by month against the pre-loss baseline.
Two more places income loss hides
- Staff retention: Retention bonuses and continuing payroll during a closure are argued as continuing expense or as extra expense, depending on the wording. Where the wording is in dispute, that belongs with your attorney.
- Contingent business income: A loss at a key hospital referral partner, pharmacy, food service or staffing vendor can cut revenue without touching your building. Coverage depends on the dependent-property wording.
Sources: Senate Finance Committee, "Left in the Dark" (2023); KRGV; Texas Tribune via KPRC (2025); ISO CP 00 30 specimen.
Sublimits can be small next to a senior living loss
One 2018 senior living program brochure capped business income, extra expense and civil authority at $250,000 combined, and emergency evacuation at $100,000. That is one carrier's 2018 package, not a market norm. It shows why every limit should be checked against a realistic closure before the first number is accepted.
| Coverage | Example limit (GuideOne, 2018) | What to check |
|---|---|---|
| Business income, extra expense and civil authority | $250,000 combined | The limit against a realistic closure; business income versus rental value |
| Emergency evacuation | $100,000 including civil authority | Every policy that might respond; the trigger wording; whether salaries are excluded |
| Ordinance or law | Up to $1,000,000 per building | Whether the rebuild triggers sprinkler, generator or other code work, and whether the limit covers it |
| Utility services | $100,000 direct damage, $100,000 time element | Which utilities count, whether off-site lines are included, the waiting period |
| Spoilage | $100,000 refrigerated product, plus $100,000 under equipment breakdown | Food and medication logs; whether an off-site power failure triggers it |
| Residents' property | $50,000 per occurrence | The resident agreement's terms on personal property, and residents' own renters policies |
| Pollutant cleanup and debris removal | $50,000 pollutant cleanup; debris within the building limit (25% maximum) plus $50,000 | Contaminated debris, medical waste and soot cleanup costs |
| Equipment breakdown | Can sit on a separate form with its own deductible | Generator, boiler, chiller and switchgear failures, including freeze damage |
| Flood and named storm | Limited flood coverage, no stated limit | The flood definition and how the named storm deductible is calculated |
| Extended period of indemnity | Not stated in the brochure | The days covered after reopening while census rebuilds |
In lease structures, the property owner and the operator may each insure part of the loss. Check who insures the building and who insures the income.
How a policy applies to your facts is a legal question when it is disputed. We document the loss and present it; coverage interpretation in a dispute belongs with your attorney.
Source: GuideOne senior living communities coverage brochure (2018).
Rebuilding to code, and the inspections before residents return
The period of restoration (the time the policy pays income while you rebuild) has to include the steps a care facility cannot skip. For a Texas nursing facility, those steps are written into the rules.
What sets the period of restoration
Notice before work. A Texas nursing facility notifies HHSC in writing before construction or rehabilitation other than "repair."
Optional plan review. HHSC answers in writing within 30 days. The fee for additions or remodeling is 2% of construction cost, from $500 to $2,000 (HHSC Form 3703).
Fire protection plans. Fire alarm and sprinkler plans must be signed by State Fire Marshal's Office licensees or a licensed professional engineer.
Equipment. Generators ran 40 to 50 weeks on average in a 2026 roundup. A contractor reports 32 to 48 weeks for 500 to 1,000 kW diesel generators in 2026.
Final inspection. HHSC inspects before occupancy, and local fire and building officials must approve in writing. Incomplete or malfunctioning fire protection, emergency power or lighting can block approval.
Post-disaster checks. After Harvey, HHSC teams inspected damaged facilities on site before they resumed operations.
Census rebuild. Move-ins resume slowly after reopening. This is the extended period of indemnity.
Code upgrades
A rebuilt nursing home faces federal sprinkler and generator rules. CMS adopted the 2012 Life Safety Code for long-term care in 2016, and new or replacement nursing homes have needed generators under federal rules since 2016, per Texas Tribune reporting. For scale: CMS assumed $7.95 per square foot for sprinkler retrofits in 2008, and 2021 Texas testimony estimated generators at $200,000 to $500,000 per facility. Producer prices for new health care building construction rose 5.2% in the year to September 2026, and switchgear and industrial controls rose 12.4%.
Ordinance or law coverage (coverage for code-required upgrades) is where these costs belong. Under the standard endorsement, the added cost to rebuild to code is paid only if the building is actually repaired or rebuilt. Without it, the base form's code coverage is the lesser of 5% of the building limit or $10,000. Code-driven delay falls outside the income period unless an endorsement extending it was bought.
Assisted living and Texas HB 3595
Texas passed HB 3595 in 2025, setting outage-related requirements for assisted living facilities. Confirm with your attorney how it applies to your facility and to your rebuild before the scope is final. The rules for a rebuild keep moving: Harris County also announced in early 2025 that it was adding a generator requirement to its fire code for nursing homes and assisted living in unincorporated areas. Check the rules in force on the date of loss and on the permit date.
Estimate the code-upgrade gap with the Ordinance or Law Calculator.
Sources: 26 TAC 554.330 and 554.344; HHSC Form 3703; iRecruit (2026); Terrapin Construction Group (2026); 81 FR 26872; Texas Tribune via KPRC (2025); 73 FR 47075; KXAN (2021); BLS PPI Table 2 (Oct. 2026); ISO CP 04 05 and CP 00 30; Open Exam Prep.
Freeze, flood and power loss: lessons from Uri, Harvey and Beryl
In Texas, weather has displaced far more senior living residents than fire. Within three days of Winter Storm Uri, 996 of Texas's 4,046 facilities for older Texans and Texans with intellectual disabilities reported weather-related problems, including 491 nursing homes. At least 1,400 residents from at least 80 facilities were evacuated.
Texas facilities for older Texans and Texans with intellectual disabilities reported weather problems within three days of Uri.
HHSC data via Texas Standard
long-term care facilities were still without power three days after Hurricane Beryl's landfall.
Texas Tribune via KPRC
of responding Texas assisted living facilities had a generator, against 99% of responding nursing homes; fewer than 60% of generators powered heating or cooling.
HHSC survey reported by KXAN, August 2022
Ike (2008): losing power alone can empty a building.
Many nursing homes and assisted living centers lacked power for an extended period, and residents who relied on medical equipment went to hospitals.
Harvey (2017): document every evacuation decision.
Water entered both Port Arthur nursing homes, nearly a foot deep. At La Vita Bella in Dickinson, residents were photographed waist-deep in water; the owner's son-in-law told AP that local authorities had told the owner to stay put. Flood is often excluded or sublimited with its own deductible, so record the cause of each item of damage separately.
Uri (2021): freeze damage means long closures.
The Lockhart nursing home stayed closed more than seven months after burst pipes. Pipe damage is a property claim; the long closure becomes the business income claim. In the freeze, commercial claims were about 10% of Texas claims but about 46% of paid losses.
Beryl (2024): power is the claim.
Beryl cut power to about 2.7 million people in southeast Texas. 27 of 36 Beryl-related deaths in five Houston-area counties were people aged 60 or older. Sharpview Residence and Rehabilitation Center in west Houston kept 86 residents through a multi-day outage on generator-powered fans and life-saving devices. Generator fuel, rentals and runtime logs become claim items.
Utility services and spoilage
An off-site power or water failure needs utility services coverage. It can cover power from plants, substations and transformers, but overhead transmission lines are often not covered automatically. Spoilage coverage under the standard form excludes a utility failure caused by fuel shortage or government order, and too little on-site generating capacity. During Uri, Denton cut power to nursing homes after losing its gas supply. Read both coverages together before assuming spoiled food and medication are paid.
If TDI designates a weather catastrophe, each Texas claim-handling deadline gets 15 more days (Tex. Ins. Code §542.059).
Sources: Texas Standard (2021); Senate Finance Committee, "Left in the Dark" (2023); Texas Tribune via KPRC (2025); KXAN and McKnight's Senior Living (2022); HB 1710 bill analysis (2009); AJC (2017); AP via NewsChannel 9 (2017); Houston Public Media via Texas Standard (2024); TDI February 2021 winter weather summary; NHC Beryl report; Rough Notes (2021); ISO CP 04 40.
What the insurance company will ask for, and where it will push back
Expect the carrier to ask for records the regulators already require, starting with 24 months of sprinkler testing. Expect questions about whether the evacuation was necessary and how long it lasted. A forensic accountant will rebuild your census and payer mix to test the income claim. HHS's inspector general found more than 2,200 instances of life safety and emergency preparedness noncompliance at 130 of 134 nursing homes visited in eight states. Gaps in these records invite a reservation of rights.
Records the carrier can request
- Sprinkler inspection, testing and maintenance records for at least 24 months
- Smoke detector and emergency lighting tests
- Generator weekly inspections and monthly 30-minute load runs
- Quarterly fire drills on each shift
- Kitchen hood cleaning every six months
- The federal emergency plan for nursing homes: risk assessment, resident tracking, receiving-facility arrangements and the generator plan
- For assisted living: the written emergency plan, at least one receiving facility plus an alternate with documented acknowledgment, and transportation arrangements
Large losses in this sector are contested on a handful of recurring fronts. None of these mean the carrier is acting in bad faith, it means the policy is complex and the default reading of it favors the insurer unless someone pushes back with documentation. Here is what they try, and what we do about each.
Smoke damage is limited to the fire wing.
Our move: We bring in industrial hygienists to document how far smoke and soot traveled, using your HVAC drawings and the standards a care environment requires.
Mattresses, drapes and furniture are cleaned rather than replaced.
Our move: We document the condition of each item and agree any salvage values in writing.
The move is called unnecessary, or too long.
Our move: We assemble the orders, HHSC notices, temperature logs and resident tracking that show why residents moved and when they could return. A dispute over the coverage wording goes to your attorney.
Lost residents are blamed on the market, not the loss.
Our move: We build the baseline from 24 to 36 months of census, move-ins, move-outs and the waitlist, and model the loss several ways.
Every lost day is valued at the lowest rate.
Our move: We value each payer's days at its documented rate from remittances, rent roll and level-of-care billing.
The timeline ignores HHSC and local inspections.
Our move: We reconstruct the real timeline: HHSC notice, plan review, equipment lead times, final inspection and the census rebuild.
Sprinklers and generators are called betterment.
Our move: We tie code-driven work to the ordinance-or-law coverage you bought.
Food and medication losses are held to a small sublimit.
Our move: We document every item with times and temperatures and check every coverage that could respond.
What often triggers a reservation of rights
- Questions about cause, such as a resident-set fire or contractor work
- Impaired or poorly maintained fire protection
- Late notice
- Concurrent wind and flood
- Mold or long vacancy
Examinations under oath and proof of loss follow the policy terms. Under the standard form, a signed, sworn proof of loss is due within 60 days after the insurer asks for it. Their legal effect is a question for your attorney. Build the document set early, because census and evacuation records are hard to rebuild later.
Liability runs alongside the property claim
At two Port Arthur nursing homes after Harvey, police opened a negligence inquiry, HHSC investigated and families consulted lawyers. After the Gabriel House fire, the business had no liability insurance; a court froze its $6 million property policy proceeds at the request of a man whose mother died in the fire, and the Massachusetts Appeals Court upheld the freeze, Insurance Journal reported in January 2026. Liability exposure can reach the property recovery. Keep claim communications factual, and route every liability and family question to your attorney.
Sources: Montana DPHHS Life Safety Code Maintenance Manual (2017); 42 CFR 483.73; 26 TAC 553.275; Senate Finance Committee, "Left in the Dark" (2023); ISO CP 00 30; AJC (2017); Insurance Journal (January 2026).
The Texas claim clock, and your rights under it
Texas law sets deadlines for how insurers handle a claim. A notice of claim means a written notice, and business days exclude weekends and Texas holidays.
| Step | Deadline | Surplus lines |
|---|---|---|
| Acknowledge the claim, start investigating, request documents | 15 days after notice of claim | 30 business days |
| Accept or reject in writing, with reasons | 15 business days after receiving all requested items | Same |
| Accept or reject when arson is suspected | 30 days after receiving all requested items | Same |
| Pay an accepted claim | 5 business days | 20 business days |
| TDI-designated weather catastrophe | Each deadline above gets 15 more days | Same |
An insurer that is liable for the claim but misses these deadlines owes 18% annual interest as damages, plus reasonable attorney's fees, under Tex. Ins. Code §542.060. Weather claims carry a different interest rate. Whether and how these apply to your claim is a question for your attorney.
A commercial policy may not prohibit you from hiring a licensed public adjuster. Texas caps a public adjuster's total fee, including expenses, at 10% of the settlement, and you may cancel the contract in writing within 72 hours of signing.
Track your dates with the Texas Prompt Payment Deadline Calculator.
Sources: Tex. Ins. Code §§542.051 to 542.060, 4102.007, 4102.103 and 4102.104; 28 TAC §19.708.
Documents to pull this week
Several of these are regulatory filings with hard deadlines, starting with the written fire report due within 15 calendar days. The carrier will ask for most of the rest.
Regulatory notices
record of the HHSC call (date, time, intake reference); the Fire Report for Long Term Care Facilities; Form 3613-A for an assisted living death, serious injury or emergency threat; evacuation, shelter-in-place and return notices; any HHSC authorization for a receiving facility over capacity; any county judge or mayor evacuation order.
Event and scene
fire department and fire marshal reports; alarm panel event history; photos and video of every wing before cleanup; a map of sprinkler activation zones; timestamped temperature logs for refuge areas, resident rooms and medication refrigerators.
Residents
resident tracking log (name, receiving facility, date, transport); receiving-facility agreements and acknowledgments; transport, hotel and shelter invoices; residents discharged, transferred permanently or who died; family communications log.
Life safety and maintenance
24 months of sprinkler inspection, testing and maintenance; fire alarm, smoke detector and emergency lighting tests; generator logs and fuel deliveries; kitchen hood cleaning and fire drill records; previous survey reports and plans of correction; the State Fire Marshal's Office fire alarm installation certificate, sprinkler record drawings and test certificates.
Property
furniture, fixtures and equipment inventory, including resident-care, kitchen and laundry equipment; leased equipment contracts, including oxygen equipment; residents' property inventory and the resident agreement's personal property terms; statement of values, every policy with endorsements and prior loss runs.
Financial (24 to 36 months)
daily and monthly census by payer and unit type; rent roll and level-of-care billing; Medicare and Medicaid remittances and filed cost reports; monthly P&L, budgets, payroll and agency staffing invoices; move-in pipeline and waitlist; a separate expense code for every loss-related cost.
Spoilage
logs of discarded food and medication, with temperatures and times.
Rebuild and reopening
HHSC notices and plan review submittals, including Form 3703 for nursing facilities; local permits, inspection reports and final inspection correspondence; equipment quotes with written lead times.
Sources: 26 TAC 554.1914, 553.275 and 554.330; 42 CFR 483.73; HHSC PL 18-19; HHSC Form 3703; Montana DPHHS manual.
The insurance company's adjuster works for the insurance company.
After a major loss, the carrier sends its own adjuster, and often a forensic accountant and engineering consultants, all retained by the insurer. They are competent and they are not neutral; their job is to resolve the claim on terms favorable to the company that pays them. A public adjuster is the licensed counterweight: we represent the policyholder only, we build and present the claim, and we negotiate the settlement.
On a senior living loss the asymmetry is the whole problem. The carrier brings cause-and-origin investigators, engineers, building consultants, industrial hygienists and forensic accountants who rebuild your census. We document the full loss with the same rigor, and we are paid a percentage of what we recover, so our incentive is your number. We are licensed public adjusters, not attorneys. Licensing questions with HHSC, resident injuries or deaths, family claims, and disputes over how the policy language applies belong with your attorney, and we work alongside your attorney rather than in place of one.
What happens after you call.
Loss review and policy analysis
We read the actual policy - limits, business interruption and extra-expense, relocation-related provisions, ordinance-or-law, valuation terms, exclusions - and assess the full scope before anyone commits to a number.
Document everything, including the smoke migration
Structure, every affected unit, and the true reach of smoke through shared corridors and HVAC. We bring in industrial hygienists to establish which units are genuinely uninhabitable to care-facility standards, while the evidence still exists.
Build the business-interruption claim, modeled several ways
From real occupancy and care-revenue records: the rebuild-and-recertification timeline, relocation and care-continuity costs, and the right look-back baseline, modeled independently and used against each other to substantiate the full loss.
Present, negotiate, and settle
We present the documented claim, contest the predictable shortfalls, and negotiate the settlement on your behalf through to resolution.
Questions senior living and nursing facility operators ask.
What must a Texas nursing home or assisted living facility report to HHSC after a fire?
An immediate call to HHSC, then a written fire report within 15 calendar days. Evacuating, sheltering in place and returning each need notice to the HHSC regional office and the local emergency management coordinator. Assisted living also files Form 3613-A within five working days after a death, serious injury or emergency threat. HHSC does not regulate independent living buildings.
Are resident evacuation and relocation costs covered?
Often, in part. Moving residents is usually extra expense, and some policies add evacuation coverage. Evacuation coverage can sit on a liability policy, often requires a mandatory order and reimburses after you pay. Check every policy that might respond, and keep every invoice.
Our insurer says we evacuated voluntarily. Does that matter?
It can. Texas assisted living facilities must evacuate when the county judge or mayor orders it, and some coverage depends on an order. In Port Arthur during Harvey, no mandatory order was issued. Keep every order and instruction. Whether a voluntary move is covered is a question for your attorney.
How is lost income calculated with Medicare, Medicaid and private-pay residents?
Lost resident days by unit type and payer, times net revenue per day, minus expenses that stop. The baseline comes from 24 to 36 months of census. Medicaid days are valued at Medicaid rates, and private-pay and Medicare Part A days at their own documented rates.
Does business interruption cover residents who move elsewhere and do not return?
The standard form covers 60 days after reopening while income stays below normal, and an extended period of indemnity can lengthen that. A Lockhart nursing home closed more than seven months after Uri, and only four residents went home to their families. Show the census ramp month by month.
Only one room burned, but we closed a wing. Is that covered?
Often, yes. Smoke and soot travel beyond the fire compartment, and the carrier may limit scope to the fire wing. Industrial hygienist testing documents which rooms are unusable to care-facility standards. That finding drives both the property scope and the lost income.
Does HHSC inspect before residents move back in?
For a Texas nursing facility doing construction or rehabilitation beyond "repair," yes: written notice to HHSC first, then an HHSC final inspection and written local approvals before occupancy. After Harvey, HHSC teams inspected damaged facilities before they resumed operations. Assisted living operators should confirm the steps with their HHSC regional office.
Is food and medication spoilage covered after a power outage?
It depends on your spoilage and utility services coverage. The standard spoilage form excludes a utility failure from fuel shortage or government order, and too little on-site generating capacity. Log every discarded item with times and temperatures.
Will insurance pay for sprinklers or a generator required when we rebuild?
Ordinance or law coverage pays code-required upgrades up to its limit, and the added rebuild cost is paid only if you actually repair or rebuild. Without that coverage, the base form's code coverage is small. Have your quotes and the code requirements ready.
What does Texas HB 3595 mean for our assisted living claim?
Texas passed HB 3595 in 2025, setting outage-related requirements for assisted living facilities. Confirm with your attorney how it applies to your facility and your rebuild. The answer may affect the code-upgrade part of the claim, so settle it before the scope is final.
Does a memory care unit change how the claim works?
Usually. Alzheimer's certification requires a Type B license and trained direct care staff, so receiving facilities must be able to serve these residents. That narrows relocation options and can raise transport and staffing costs.
Should we hire a public adjuster, an attorney, or both?
They do different jobs. A public adjuster documents, presents and negotiates your property and income claim. An attorney handles legal questions: licensing, resident injuries, family claims and coverage disputes. On a serious senior living loss, many operators need both, working together.
What does it cost to hire a public adjuster?
We work on a percentage of the recovery, with no upfront cost. We are only paid if and when you recover, which aligns our incentive with maximizing your settlement. Fee specifics are discussed up front before you commit to anything.
Tell us what happened. We'll tell you straight whether you have a fight worth having.
No cost, no obligation. The fastest path is the phone - for a major loss, call and talk to a person today. A licensed Texas public insurance adjuster will review the loss with you.
713-369-4300Start a claim review
Tell us what happened. A licensed Texas public adjuster will review your senior living loss with you, and tell you straight whether you have a fight worth having. The review is free.
For fire claims, we call you back within 1 hour and visit your property within 24 hours or less.
A major loss is decided in the first moves. Make yours count.
Talk to a public adjuster who works only for you. No upfront cost - we're paid a percentage only if you recover.
713-369-4300Crossroads Insurance Recovery Advocates · TDI License 1924788
This page is general educational information about commercial property claims, not legal advice or advice on your specific claim. Crossroads Insurance Recovery Advocates, Texas public adjuster entity license #1924788.
Don't take our word for it
- Texas House Human Services Committee: interim report (2018)
- U.S. Senate Finance Committee: "Left in the Dark" (2023)
- Texas Standard: Texas facilities that faced storm-related problems (2021)
- Texas Tribune via KPRC: lawmakers push for generators after Beryl (2025)
- Houston Public Media via Texas Standard: Beryl deaths and Houston-area seniors (2024)
- KXAN: HHSC generator survey (2022)
- KXAN: push to require backup generators (2021)
- McKnight's Senior Living: HHSC generator survey
- 26 TAC 554.1914: nursing facility emergency preparedness and fire reporting
- 26 TAC 553.275: assisted living emergency preparedness
- 26 TAC 553.5: types of assisted living facilities
- 26 TAC 554.330: nursing facility construction and final inspection
- 26 TAC 554.344: nursing facility plan review
- HHSC Form 3703: plan review application
- HHSC Provider Letter PL 18-19 (2019)
- NCAL: Texas assisted living regulation summary
- HB 3595 House committee analysis (2025)
- HB 1710 bill analysis (2009)
- 42 CFR 483.73: long-term care emergency preparedness
- CMS Appendix Z, long-term care excerpt (LeadingAge Minnesota)
- Federal Register: Fire Safety Requirements for Certain Health Care Facilities, 81 FR 26872 (2016)
- CMS 2008 long-term care sprinkler rule, 73 FR 47075 (via vLex)
- CMS: S&C 13-55-LSC
- CMS: Skilled Nursing Facility cost report methodology
- USFA: medical facility fires snapshot, 2014 to 2016
- NIST FireDOC: U.S. Structure Fires in Nursing Homes (NFPA, 2008)
- CSE: Protecting a vulnerable population (2008)
- Montana DPHHS: Life Safety Code Maintenance Manual (2017)
- GuideOne: senior living communities coverage brochure (2018)
- Sedgwick: Should we stay or should we go? (2018)
- Insurance Journal: Gabriel House owner denied access to insurance funds (2026)
- iRecruit: long-lead equipment roundup (2026)
- Terrapin Construction Group: 2026 lead times
- BLS: PPI Detailed Report, Table 2 (Oct. 2026)
- Massachusetts Department of Fire Services: Gabriel House preliminary findings (2025)
- Boston Globe: Gabriel House fire report released (2025)
- FOX 26 Houston: Janisch Road nursing home fire (2025)
- KLTV: fire forces evacuation of Athens nursing home (2025)
- NBC DFW: Watauga nursing home fire (2022)
- AJC: Port Arthur nursing home evacuation (2017)
- AP via NewsChannel 9: residents in flooded nursing home photo (2017)
- KRGV: First Colony evacuees in Weslaco
- TDI: February 2021 winter weather data summary
- NHC: Tropical Cyclone Report, Hurricane Beryl
- ISO CP 00 30 10 12 business income form (specimen)
- InsuranceXDate: CP 04 05 ordinance or law
- InsuranceXDate: CP 04 40 spoilage
- Open Exam Prep: BPP coverage form
- Rough Notes: utility services coverage (2021)
- Tex. Ins. Code §542.055
- Tex. Ins. Code §542.056
- Tex. Ins. Code §542.057
- Tex. Ins. Code §542.059
- Tex. Ins. Code §542.060
- Tex. Ins. Code Chapter 4102
- Tex. Ins. Code §4102.104
- 28 TAC §19.708