Medical Malpractice Insurance Coverage Basics

Here's what both sides of a medical malpractice case need to know about the role of insurance coverage.

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

Insurance coverage is sure to play a vital role in any medical malpractice case, just as it does in most injury-related claims:

  • If you've been injured as a patient, you'll almost certainly be dealing with the health care professional's insurer (or an attorney hired by the insurer) as part of the medical malpractice claim process.
  • If you're a doctor or other care health provider, you need to make sure you have proper insurance coverage in place in case you end up facing a medical malpractice lawsuit.

Let's look at how medical malpractice insurance works, and why it's so pivotal to the outcome of a malpractice case.

Types of Medical Malpractice Insurance Coverage

The three most common types of medical malpractice insurance coverage are claims-made coverage, "tail"/"nose" coverage, and occurrence-made policies.

Claims-Made Medical Malpractice Insurance

A claims-made policy will protect the insured health care provider against a medical malpractice claims as long as the policy was in effect when both:

So, let's say the alleged malpractice took place on September 1, 2025, but the doctor's claims-made coverage expired on December 31, 2025. The patient doesn't make a malpractice claim until March 10, 2026. So there's no coverage under this claims-made policy. But that doesn't mean there's no coverage at all.

Medical Malpractice Tail/Nose Coverage

In examples like the one above, it's important to know whether the doctor purchased "tail" or "nose" coverage. Medical malpractice tail coverage will protect a health care provider in claims that are made based on treatment provided while the policy was in effect, even when the claim itself is filed after the policy was cancelled or expired.

Similarly, medical malpractice "nose" coverage protects health care providers for acts that occurred before the insurance policy took effect.

Note that some claims-made policies require that the medical malpractice lawsuit be filed in court during the policy period; other policies only require that the incident first be reported within the policy period. The fine print of the policy can be crucial when it comes to details like these.

Occurrence-Made Medical Malpractice Insurance

An occurrence-made policy will cover the doctor for events that happened when the policy was in effect, regardless of when malpractice is first claimed by a patient. So, continuing with the example above, the occurrence-made policy will provide coverage even if the malpractice is first claimed on March 10, 2026, and even if the doctor has purchased a new insurance policy (or has no insurance policy in place at all) by that point.

What Are Medical Malpractice Insurance Coverage Limits?

There are typically two main types of medical malpractice insurance coverage limits:

  • A per-occurrence coverage limit is the total amount an insurance company will pay for a single medical malpractice claim.
  • An aggregate limit is the total amount the insurance company will pay for medical malpractice claims over a period of time.

For example, a $1,000,000 per-occurrence limit with a $3,000,000 aggregate yearly coverage limit means that the most the insurance company will pay on any one medical malpractice claim is $1,000,000, and the most the company will pay in one year is $3,000,000 total for all medical malpractice claims made against the covered care provider.

Certain medical specialties (for example, obstetrics) are associated with extremely high medical malpractice settlements and verdicts. Likewise, certain cities and states (for example, New York, NY), are associated with a high number of malpractice lawsuits. A health care professional's medical specialty and practice location may be a factor in how much coverage they carry.

Finally, any coverage should be examined to figure out whether two or more "occurrences" that are factually related will be considered a "single claim" governed by a single coverage limit.

What If the Doctor Doesn't Have Enough Medical Malpractice Insurance Coverage?

If a patient brings a successful medical malpractice lawsuit, but the health care provider's medical malpractice insurance coverage limit is too low to cover the verdict, and no umbrella protection is in place, the doctor could be personally on the financial hook for any amount that exceeds the coverage limits.

That's bad news for the doctor or other care provider, but it's also potentially bad news for the injured patient too. It's one thing to collect a judgment when an insurance company is writing the check. Trying to recover a medical malpractice damages award against a doctor can be a challenge, even if the patient is successful at trial.

It's important to find out whether a coverage limit includes attorney's fees, expert witness fees, and court costs. If it does, it will reduce the amount that can be paid to the injured patient for a settlement or verdict.

Malpractice Insurance: More Factors to Consider

  • Group Coverage: A group policy usually covers all employees at a hospital or other care facility, or a sub-set of employees. Some employees, such as Physicians' Assistants and Nurse Practitioners, may need to pay an additional premium for individual coverage under a group policy.
  • Personal Coverage: A health care professional may carry personal coverage even if they are covered by a group or hospital's policy. Whether this additional protection is necessary can depend on many factors, such as whether the group coverage limit is adequate or whether the professional practices medicine outside the group.
  • Exclusions: Not every act by a health care professional is covered by a medical malpractice insurance policy. If a doctor makes a misrepresentation on the policy application, it can void the policy altogether. Also, illegal acts and sexual misconduct are usually not covered.

Next Steps

If you're a patient who may have been harmed by a medical professional's mistake, trying to sort out the malpractice insurance coverage picture isn't a task you want to tackle on your own. It might make sense to discuss the details of your case with an experienced attorney, and let them take things from there. Learn more about how a medical malpractice lawyer can help your case.

For doctors and other health care providers, it's crucial to have the right medical malpractice insurance coverage in place. Make sure you understand the ins and outs of your current policy, talk to any employer or professional group you're affiliated with, and make any adjustments necessary to ensure you're properly covered.

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