PVR

Risk management

Malpractice insurance comparison guide

Choose occurrence-based malpractice when you can — it eliminates the tail coverage problem. If you must accept claims-made (common for hospital employment or specialty markets), model tail cost as 150%–250% of the final year's premium. Never let coverage lapse; even a one-day gap can create uninsured exposure.

By Jordan Alderman, MBA, CMPE · Reviewed by Rania Hassan, JD, CHC · Last reviewed · Methodology

Disclosure: Independent editorial. No pay-for-placement, no affiliate rankings. Full editorial standards.

Who this is for: Physicians and clinicians shopping first malpractice policy or renewing.

Occurrence vs claims-made

Occurrence covers any incident that occurred during the policy period, whenever the claim is filed. Claims-made covers only claims filed while the policy is active — creating the need for tail coverage after departure.

Key specifications to compare

  • Coverage limits: standard $1M per claim / $3M aggregate; higher for surgery/OB
  • Consent-to-settle clause (hammer clause vs pure consent)
  • Defense costs inside or outside limits (outside is better)
  • Deductible / SIR (self-insured retention)
  • Prior acts / retroactive date (for claims-made)
  • Tail coverage cost (as % of last year's premium)
  • Insurer AM Best rating (A- or better)

Typical premium ranges (2026)

  • Family medicine: $8,000–$25,000/year (varies by state)
  • Internal medicine: $10,000–$30,000/year
  • Pediatrics: $10,000–$30,000/year
  • Psychiatry: $6,000–$18,000/year
  • General surgery: $35,000–$100,000+/year
  • OB/GYN: $50,000–$200,000+/year (state-dependent)
  • Orthopedics: $30,000–$120,000/year
  • Dermatology: $12,000–$35,000/year

Comparison workflow

  • Get 3+ quotes from carriers rated A- or better
  • Compare apples-to-apples (same limits, same deductible, same policy form)
  • Ask each broker for prior 5-year premium history for your specialty
  • Confirm consent-to-settle language
  • Model 5-year total cost including projected tail if claims-made
  • Confirm any risk-management discounts (CME, chart review)

Red flags in quotes

  • Carrier not rated by AM Best
  • Defense costs inside limits (erodes coverage)
  • Pure hammer clause (insurer can settle without consent)
  • No tail option quoted upfront
  • Retroactive date shortened from prior policy (creates gap)