According to Patrick J Malloy (Planning Your Entry into Medical Practice, Manhasset; 1998), 97% of young physicians entering a new practice are offered malpractice insurance as an employment benefit, but nearly all of these policies are "claims-made" insurance. Understanding the difference between "claims-made" and "occurrence-made" insurance could mean the difference between adequate protection of your assets and personal bankruptcy.
The two basic types of malpractice insurance are "claims-made" and "occurrence-made." "Claims-made" insurance protects you from malpractice claims only if the company that insured you at the time of the alleged "occurrence" is the same company at the time the claim is filed in court. For example, if company A was the malpractice insurer on December 1, 1998, the date of an alleged malpractice incident, and is still your insurer on May 1, 1999 when the claim is filed, you are covered for the claim. However, if between December 1 and May 1 you have switched from insurance carrier A to insurance carrier B, you are not covered, unless you purchased an insurance "tail." The switch from one insurance carrier to another may have occurred because of a change in jobs, or practice location.
With "occurrence-made" insurance, the insurance coverage will be seamless, regardless of job or location changes. With this type of policy, any malpractice occurrence will be covered by the insurance carrier, provided it was the carrier at the time of the alleged event, regardless if it is the carrier at the time the claim is filed. For example, if you are covered by carrier A with "occurrence-made" insurance on December 1, 1998 when an alleged event occurs, but the claim is not filed until May 1, 1999, carrier A will provide the malpractice coverage, even if you are currently insured by carrier B.
The important message here is to recognize the type of insurance that is being offered. If "claims-made" insurance is the benefit, you must recognize that additional insurance coverage will be necessary if you ever leave the practice and acquire a new insurance carrier in the new practice setting. This is important because you remain liable for malpractice acts performed when part of the previous medical group. The additional coverage is known as "tail insurance." Tail insurance will provide malpractice protection for acts committed when covered by a "claims-made" policy by insurance carrier A, even if you are now covered by insurance carrier B. The cost of "tail insurance" is a one time assessment that can be as much as 1.5 to 2 times a typical annual malpractice insurance premium.
Who should pay for the "tail insurance" when leaving one practice to join another? About half the time it will be provided by the new practice as a benefit or inducement to join the new group. Occasionally, the "tail" will be provided by the old group, to ensure that adequate protection of their group assets exists if you are sued. This benefit may have certain stipulations associated with it, such as the obligation to leave the area and not be a direct competitor of the original practice.
Patrick Malloy offers other advice regarding malpractice insurance including:
- Check with insurance providers in your area to determine if the malpractice coverage is adequate
- Determine if the losses covered are "pure losses" or "ultimate net losses." Pure loss coverage is only for the amount awarded to the plaintiff, whereas ultimate net loss will cover attorneys' fees and costs as well.
- Know the extent of the insurer's obligation to defend you. Will you be reimbursed for lost wages when in court? What services will be provided for you as part of your defense?
- How soon must you report a liability claim to the carrier in order to still be eligible for full coverage?
Data on median professional liability premiums are available from the 2009 Medical Economics “Exclusive Survey” reported in the November 20, 2009 issue. This study showed that the premiums have leveled off, and in some cases, dropped. The median malpractice premium in 2008 for internists was $12,500, which is the same rate median rate for family physicians and pediatricians. Regional variations continue, with overall rates for primary care physicians highest in the East and major western cities compared to the rest of the country. Other factors such as practice size, number of patient visits per week, and years in practice also influence the malpractice premiums paid. For more information about this study, click here
ACP Career Connection's
Job Search Advantage
Search for jobs that suit your internal medicine and/or specialty career path. Register as a Job Seeker for additional benefits.
- Build, edit and store your Job Seeker Profile
- Select Early Job Notifier to have job alerts e-mailed to you
New Video: Navigating the Maze of a Job Search
This presentation helps you determine your professional and personal interests, write a CV and cover letter, and prepare for an interview.
Resident/Fellow Member Benefits: ACP offers Resident/Fellow Membership for internal medicine residents and subspecialty fellows-in-training.
Join ACP: Take advantage of members only benefits by becoming a Resident/Fellow member of ACP today.
Connect with your peers
Join this ACP members-only virtual community to connect with other residents and fellows.
Find a Mentor
Find an experienced physician who can answer your questions about internal medicine.
New Leadership Webinars
The ACP Leadership Academy is offering FREE webinars covering the core tenets of leadership, leadership in hospital medicine, finance, and more.
Volunteer through ACP
ACP recognizes the importance of volunteerism and community service at both the national and local levels as part of its commitment to universal access to health care. View current volunteer opportunities and network with other ACP member volunteers today.
Join ACP Today!
ACP membership connects you with like-minded colleagues and provides access to a variety of clinical resources, practice tools, and ways to earn MOC and CME.