New Doctor Frequently Asked Questions

HOMENew Doctor Frequently Asked Questions



Q. What is Medical Malpractice Insurance and why do I need it?

Medical malpractice insurance, called medical professional liability insurance is a must-have for every health care professional. Even the most skilled physician can make a mistake and must protect themselves against that possible outcome.  Defending yourself in a malpractice lawsuit is an expensive cost.  Since the cost of defense is high, in addition to the devastation of having a loss, having a medical professional liability policy is crucial to every physician and a physician practice.


Q. What is covered by my medical professional liability policy?

The PRI policy covers you for professional services you render or failed to render, such as, medical, or surgical treatments, diagnosis, opinion or advice, reading of charts, treatment of patients, basically claims of medical negligence.


Q. What are limits of liability?

The PRI policy has two limits of liability:

= Per Claim Limit: The amount of indemnity coverage you have for each claim that is reported. Typically, a policyholder purchases a per claim limit of $1,000,000.

= Annual Aggregate Limit: The amount of indemnity coverage you have for all claims reported during the policy term.  Typically, a policyholder purchases an annual aggregate of $3,000,000.

Other limits of liability options are available.


Q. What are Claims Made and Occurrence policies?

Claims-made policy means an insurance policy that covers liability for injury arising out of incidents, acts or omissions occurring during the policy period, as long as the claim is first made during the policy period or any extended reporting period.

Occurrence policy means an insurance policy that covers liability for injury or damage that the insured is legally obligated to pay arising out of incidents, acts or omissions that occurred during the policy period, and where a claim may be made during or subsequent to the policy period.


Q. Why is the Claims-Made policy premium less than an Occurrence policy?

Because the insurer has a small risk of loss during the first year of a new policy.  This is why the first year premium of a claims-made is lower.  Each year as the claims-made policy renews, the insurers exposure increases.  For the first eight years of a claims-made policy, the premium increases incrementally to reflect the increased exposure to the insurer.  This process is known as the “claims-made step factor”.  By the eighth year the step factor reaches a maturity because all possible exposure has been accounted for.  On the other hand, an insurers exposure under an occurrence policy includes the risk of claims reported after the termination of coverage, provided the claim occurred during the policy period.  As a result, the premium reflects the increased exposure.


Q. What is Tail coverage and Nose Coverage?

Tail coverage provides coverage for claims that are first made after the termination of a policy, arising from incidents which occurred during the policy period or back to the agreed-upon retroactive date.

Nose coverage, also known as “prior acts coverage” means coverage under the policy for injury or damage that occurs on or after the retroactive date and prior to the effective date of the new policy.  A retroactive date can be a date prior to the effective date of the new policy.


Q. Can I switch from a Claims-Made policy to an Occurrence policy?

You can switch from and occurrence to claims-made by simply requesting in writing to cancel the occurrence policy on a prospective date and to have a claims-made policy issued on the same date. However, if you want to cancel a claims-made policy and switch to an occurrence policy, you will have to pay tail before we could issue the new occurrence policy.


Q. Do I need to get a medical professional liability policy while still in residency/fellowship?

For medical care delivered by a resident/fellow as a function of his/her work in a training program, the physician in training will be covered under the program or hospital policy.


Q. Is the cost of professional liability insurance different depending on where you work?

Yes. The cost of insurance (i.e. the premium) is based on factors such as specialty and location of practice. Even within a state such as New York, the cost of insurance will depend on where the physician or other provider is practicing. This is because certain geographies are associated with higher frequencies of lawsuits as well as higher payouts to plaintiffs. A professional liability underwriter can provide you with a quote based on different locations or “territories” of practice.


Q. If I get sued, will my professional liability insurance increase or will the insurance company “drop” (i.e. non-renew) my coverage?

New York law requires insurers to adopt a rating plan for imposing rate surcharges based upon an individual’s past history of claims or disciplinary actions and other criteria.  The plan is intended to produce a more accurate individual premium by using past claim history to predict the likelihood of future claims.  There are multiple variables that are taken into account when evaluating a surcharge or non-renewal.


If you have additional questions not listed here, please feel free to contact us directly.

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