What Is Medical Malpractice "Tail" Coverage?

What happens when a medical malpractice claim is made after the health care provider's insurance coverage has expired?

By , Attorney (University of Maryland School of Law)
Updated by David Goguen, J.D., University of San Francisco School of Law

As with many kinds of injury-related claims, insurance coverage plays a big part in a medical malpractice case. But what if an injured patient brings a malpractice lawsuit against a doctor (or other health care provider) whose malpractice insurance policy has lapsed? Here's what to know:

  • When an injured patient files a medical malpractice lawsuit, any court award or out-of-court settlement is almost always going to come from the provider's professional liability insurer.
  • In situations where the health care provider's standard insurance coverage may have lapsed, the provider may have purchased additional "tail coverage."
  • "Tail coverage" applies to malpractice claims made after the provider's main policy expired.

Medical Malpractice and Standard Claims-Made Insurance Policies

To understand what tail coverage is, it helps to first understand what standard claims-made insurance policies cover when it comes to an alleged medical error that forms the basis of a medical malpractice lawsuit.

A claims-made policy protects the health care professional or facility from claims based on an incident that occurred and was reported while the policy was in effect. This is the typical medical malpractice claim/coverage scenario.

Learn more about standard medical malpractice insurance coverage.

Tail Coverage for Medical Malpractice Claims

In contrast to a standard policy, tail coverage provides protection for medical malpractice claims that are reported after the provider's policy expired or was cancelled.

Let's look at an example of how tail coverage works. Let's say Doctor A's insurance policy is in effect from January 1, 2015 through December 31, 2025.

  • Patient B alleges that Doctor A committed malpractice on September 1, 2025, but Patient A does not bring a malpractice lawsuit until May 1, 2026.
  • The case is filed in court on time according to the medical malpractice statute of limitations, but by this point, Doctor A's insurance policy has been cancelled.
  • Doctor A's new insurance does not cover prior acts.
  • Unless Doctor A has purchased tail coverage, Doctor A will not be insured for this claim.

Why Tail Coverage Matters for Patients and Providers

This issue is crucial not just for Doctor A (who may not be covered and may therefore be personally liable for the harm caused to the patient), it's also critical to Patient B's lawsuit.

That's because even if Patient B's lawsuit is successful and they receive a significant medical malpractice damages award from the court, collecting a judgment against an individual doctor is going to be a lot harder than collecting from an insurance company.

A few important points regarding tail coverage:

  • It only protects health care providers for acts that were committed during the original policy period, so it will not provide protection for claims arising from acts that occurred during the period of tail coverage.
  • The provider's tail coverage may have a different limit of liability than the standard claims-made policy had.

Cost of Tail Coverage

Tail coverage requires that the policy holder pay an additional premium. Most claims-made policies must give the doctor the option to buy tail coverage to cover claims if and when the policy is cancelled.

The issue, however, is that the additional premium coverage can be extremely expensive—sometimes 150 or even 200 percent of the price of a claims-made policy, depending on the medical specialty and the location.

Sometimes this cost can be spread out over several payments. It can often be written off as an unreimbursed business expense for tax purposes as well. The best case-scenario is that the doctor joins a group that agrees to cover (or split) the cost of tail coverage.

Are There Options Other Than Tail Coverage?

Some insurance companies offer options to doctors such as an "extended reporting" endorsement that is less expensive than purchasing standard tail coverage.

Another option is to purchase lower limits of liability or limited term tail coverage as opposed to the standard unlimited term. However, it's important to make sure that these options satisfy any requirements of the hospital or group practice the doctor is joining.

What Is "Nose Coverage" for Medical Malpractice Claims

Another option in lieu of tail coverage is "nose coverage." Nose coverage is coverage for prior acts. It's offered by the doctor's new or subsequent insurance policy to cover acts that occurred before the new policy took effect. It's basically the opposite of tail insurance, but effectively provides the same kind of coverage.

Again, the best-case scenario would be that the doctor's new group or practice pays for nose coverage. However, you should note that it's not necessarily offered to all doctors. For example, some insurance companies will not offer nose coverage to doctors who have had numerous claims filed against them, or who practice in a highly litigious area.

Sometimes nose coverage is not offered to doctors who came from a group practice, since the doctor's liability for prior acts could be tied into the group's liability, and complications can arise by roping in two different insurance companies (and two different law firms) into one defense.

Getting Help With a Medical Malpractice Claim

If you're an injured patient who's thinking about suing a doctor or other health care provider, understanding the insurance coverage picture is only one piece of a complex puzzle. Medical malpractice cases are notoriously tough to win. They require:

  • careful analysis of complex medical records
  • compliance with special laws and court rules,
  • expert presentation of evidence, and
  • the skills to fight for a fair result.

All of this means you need an experienced legal professional on your side if you're going up against a health care professional and their insurance company. There's no substitute for a lawyer's experience willingness to battle it out and build the best case for their client, often with the help of a network of medical expert witnesses and consultants.

Learn more about hiring a medical malpractice lawyer and how it might boost your chance of a successful case. You can also use the tools on this page to connect with an attorney in your area.

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