Continuing Care Risk Retention Group

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Contact Info

Phone: 877-227-7452

Email: info@ccrrg.com

Address: CCRRG, 58 East View Lane, Suite 2 Barre, VT 05641

Continuing Care Risk Retention Group

Call 877-227-7452

Continuing Care Risk Retention Group

Home
About
Rate Relief
- How it Works
Claims
Risk Management
- Onsite Visits
- MARS
Success
- Working With CCRRG
News
Press
BROKERS
Contact
Blog

Continuing Care Risk Retention Group

Pre-Submission Questionnaire

Professional & General Liability Insurance Residential Care, Assisted Living and Independent Living Pre-Submission Questionnaire

Complete a separate questionnaire for each facility.

Number of Facilities

Member or Insured Name

Address (City, State, ZIP)

Contact Name

Type of Facility

Skilled Nursing Facility

Assisted Living

Residential Care

Independent Living

Free Text

Number of Licensed Beds

Skilled Nursing Facility

Assisted Living

Residential Care

Independent Living

What is your normal anniversary date?

Is this facility currently insured?

If no, last date of coverage

Please provide your desired coverage date

Current number in occupancy

Are there any special programs or units?

Check if applicable

Alzheimer's and Dementia

Pediatric

Hospice

Psychiatric

Home Health

Other

Current number of residents under age 65

Length of current ownership

Number of affiliated facilities not presented for review

How many years has your Administrator (ADM) worked in his/her position at your facility?

How many years has your Director of Nursing (DON) worked in his/her position at your facility?

Any open claims with reserves of over $25K?

If yes, list total reserves for each claim in the last 5 years

Any closed claims over $25K in the last 5 years?Any closed claims over $25K in the last 5 years?

If yes, list total paid for each claim in the last 5 years

Does the facility have any current de-certification action, enforcement action, monetary penalties or uncorrected / unresolved substandard care issues?

Have there been any substanitiated (or pending results of investigation) abuse allegations in the past 12 months?

Has the facility filed or considered filing for bankruptcy in the last 3 years?

Publicly traded stock corporation?

Thank you for contacting Continuing Care Risk Retention Group.

We will get back to you as soon as possible.

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Continuing Care Risk Retention Group

Home
About
Rate Relief
How it Works
Claims
Risk Management
Success
News
Contact

Phone: 877-227-7452

Email: info@ccrrg.com

Address: CCRRG, Magnolia LTC Management Services, Inc.

716 College Ave. Suite B, Santa Rosa, Ca. 95404

Continuing Care Risk Retention Group, Inc. | All Rights Reserved |

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