What Is Medical Malpractice Insurance?

Medical malpractice insurance is a specialized type of professional liability insurance that covers physician liability arising from disputed services that result in a patient’s injury or death. Medical liability insurance is required in almost all states and most medical systems as a requirement to practice. 

Malpractice insurance is usually available through traditional insurance carriers or from a medical risk retention group, which is a mutual organization of medical professionals organized to provide liability insurance (sometimes sponsored by state medical societies). Additionally, some large medical systems may be “self-insured;” instead of purchasing commercial insurance, a medical liability trust fund is created that is used to pay for defense of malpractice claims and any resulting judgments against their physicians. Although it is possible for smaller medical groups and practices to self-insure, there are significant legal and business obstacles that make this a difficult option for most.

Individual and group malpractice coverage plans are available for those in independent or small practices. For employed physicians, medical liability coverage is typically offered as part of a group plan purchased by the employing hospital or health system. 

The optimal type and amount of insurance you need to meet your state’s malpractice insurance minimum requirements and for adequate personal and practice asset protection may vary greatly based on your individual circumstances. Therefore, it is important to confer with a professional medical insurance consultant or institutional risk manager to determine the appropriate type and amount of coverage for your particular practice situation.

It is important to understand the two basic types of malpractice insurance: “claims-made” and “occurrence.” A claims-made policy will only provide coverage if the policy is in effect both when the incident took place and when a lawsuit is filed. As can be seen, this requires that coverage must extend for a significant period of time to provide adequate protection since a considerable amount of time may elapse between when an incident may have occurred and when a claim is made.

Because of this, some claims-made policies are written to provide a period of coverage referred to as a “tail” that extends coverage for a set amount of time (such as five years) after a policy ends. If not offered as part of the original policy, tail coverage may also be purchased; the cost of tail insurance is typically a one-time assessment that can be as much as 1.5 to 2 times a typical annual malpractice insurance premium.

Tail coverage, however, is extremely important in situations where you have been covered with a claims-made policy but are changing insurance carriers, moving to a new position, or are retiring, to ensure continued malpractice coverage during these transition times for incidents that may have occurred in past years. The costs of tail coverage may be covered by your previous practice to ensure adequate protection of their group assets, or by your new practice either as a benefit or an inducement to join the group. Tail coverage may be an appropriate item of negotiation with a prospective new practice.

Occurrence policies differ from claims-made insurance in that they cover any claim for an event that took place during the period of coverage, even if the claim itself is filed after the policy lapses. In general, this type of policy does not require tail coverage, although this type of insurance is usually significantly more expensive and less frequently offered by employers. 

It is also important to understand the finer details of your medical malpractice coverage. Policies typically cover a range of expenses associated with defending and settling malpractice suits, including attorney fees, court costs, arbitration and settlement costs, medical damages, and punitive and compensatory damages. Medical malpractice usually does not cover liability that arises from criminal acts or sexual misconduct. It is critical to know what your insurance policy would specifically cover and what it does not to make sure you are adequately protected. It is also important to know the amount of coverage for each occurrence and all claims that may be made against you. Although some states require minimum amounts of coverage for both the amount per each claim and the total of all of the claims that may be made, it is important to discuss the potential need for additional coverage above these minimums with a professional malpractice insurance consultant or institutional risk manager to ensure that your personal assets are protected.

If you are entering a private practice, remember that in addition to medical liability claims, medical practices also face potential claims associated with other medically-associated risks such as cyber liability and regulatory requirements such as compliance with the Health Insurance Portability and Accountability Act (HIPAA). Some medical malpractice policies may cover these types of exposures; if not, separate policies to protect against these risks are usually available.

What Does Medical Malpractice Insurance Cover?

Medical malpractice coverage is for legal claims arising from allegations of medical negligence and malpractice. This insurance helps to cover defense fees, expert witness costs, legal fees and settlement costs. Many insurance policies for medical malpractice cover professional work as a physician or other medical professional but may also cover your work on peer review panels. If such a decision results in a lawsuit, malpractice coverage will protect you up to the policy limit.

Who Needs Medical Malpractice Insurance?

Any provider of healthcare services has a need for medical malpractice insurance, including, but not limited to, physicians, nurses, nurse practitioners, and physician assistants. In most states, physicians are required by law to have malpractice insurance, though the amount of coverage needed to satisfy these requirements varies. Also, hospitals often require physicians and other providers to have malpractice insurance as a condition of obtaining staff privileges. In any case, especially for physicians, it’s wise to be covered as there is a likelihood of facing a claim at some point in a healthcare provider’s career. Explore historic rate data by state and county and discover more about individual state regulations and insurance rates here.

1: Physicians

Physicians need to have medical malpractice insurance. There is no way around it. Not only is it legally required in many states, but, as mentioned above, it is often a condition of getting hospital staff privileges. Becoming a physician requires a large investment in both time and money, and proper insurance protects this investment.

2: Nurses

All types of nurses should have medical malpractice insurance, including Registered Nurses (RNs) and specialized types of nurses, such as Nurse Practitioners (NPs) and Certified Registered Nurse Anesthetists (CRNAs). RNs should be able to easily acquire insurance for a very reasonable rate, often for less than $100 per year. Insurance premiums for NPs and CRNAs are more expensive and more variable. Rates for these specialist-nurses will depend on their underwriting profile and the state where they practice. Discounts on insurance for NPs and CRNAs who complete risk management courses and other continuing education programs are sometimes available.

3: Physician Assistants

Physician Assistants represent one of the fastest growing professions in the healthcare industry. Because they work in a variety of settings and have different levels of independence depending on the state they practice in, medical malpractice insurance can be highly individualized. As with physicians and nurses, completing risk management coursework can help lower medical malpractice premiums for Physician Assistants. 

4: Podiatrists

With more Americans turning to podiatrists for foot, ankle and lower leg care, and their growing prominence in treating diseases such as diabetes, podiatrists are in high demand. Medical malpractice insurance for podiatrists is generally less expensive than for physicians, but it is equally important to protect podiatrists from allegations of medical malpractice.

5: Medical students

In general, medical students are unlikely to be named in a lawsuit and, if they are, the expenses are usually covered by the institution at which they are training. However, there are some exceptions to this rule and it is important to know about them.

6: Group Practices

Group practices most often purchase medical malpractice insurance under a group practice policy, rather than each physician and healthcare provider purchasing his or her own policy. This can allow for better pricing and customized insurance plans for the entire practice.

7: Medical Spas

Medical spas, or medi-spas, first became common in the late 1980s. Since then, the medi-spa industry has grown to generate more than $12 billion in annual revenue. Medi-spas provide a variety of specialized treatments and services, including microdermabrasions, Botox injections, chemical peels, and even cosmetic surgery. Depending on the types of services offered, medi-spa insurance options can vary greatly.

8: Hospitals

Hospitals require medical malpractice insurance, referred to as Hospital Professional Liability (HPL). In recent years, many hospitals, especially larger ones and those that are part of hospital systems, have begun self-insuring part or all of their professional liability risk. This is possible because of the size of the facility. Physicians, along with other healthcare providers employed at the hospital, will often be insured under the hospital’s self-insurance plan.

Other Types of Facilities that Require Coverage

Many other types of healthcare organizations and facilities may require medical malpractice insurance, including same-day surgery centers, long-term care facilities and behavioral health centers, among others. The specific insurance needs will depend on the type of facility, the location and the kinds of care and procedures the facility provides.