What Is Claims‑Made Malpractice Insurance?

A claims-made policy covers incidents when the incident occurs on or after the retroactive date and the claim is filed while the policy is still in force.

Two conditions must be met for coverage to apply:

• The incident must have occurred on or after the policy’s retroactive date
• The claim must be filed while the policy is still in force

Claims-made policies are the most common type of coverage offered by employers to physicians who work for a hospital or health system.

Key Components of a Claims-Based Med Mal Policy

These are common phrases that you’ll hear when discussing medical malpractice (or “med mal” in industry shorthand) with your insurance advisor.

• Retroactive date: This is the earliest incident date the policy will cover. Anything before it is not covered, even if the claim is filed during the active policy period.
• Reporting period: Claims must be reported while the policy is active. Once coverage ends, so does the ability to report new claims under that policy, unless you have tail coverage.
• Nose coverage (prior acts coverage): When switching carriers, a physician may be able to ask the new carrier to honor the retroactive date from the previous policy to prevent gaps in coverage. Not all carriers offer this.
• Coverage gaps: Gaps typically happen when a physician leaves a position covered by a claims-made policy without securing tail coverage or nose coverage. If a patient files a claim outside the reporting period, the physician may not have coverage for the claim.
• Tail coverage: Tail coverage lets a physician report claims after a claims-made policy ends.

Example Claims-Made Scenario

Dr. Chen recently completed her residency, during which time she was covered under a claims-made policy from 2020 to 2025. In 2026, she started a fellowship at a new institution with coverage under a new policy.

Recently, a patient filed a malpractice claim for treatment Dr. Chen provided in 2025 during her final year of residency. Because the claims-made policy from her residency is no longer active, the claim is not covered. Without tail coverage in place, Dr. Chen may have no coverage for claims arising from incidents during that period.

An occurrence-based policy covers any incident that happens during the active policy period, regardless of when the claim is filed.

Occurrence policies offer the advantage of not requiring tail coverage; however, some carriers do not offer occurrence-based policies, and availability may vary by specialty or state.

Key Components of Occurrence-Based Med Mal

• Per-Occurrence Limit: The maximum amount the insurer will pay for a single claim.
• Aggregate Limit: The total cap on all payouts within a policy period. With occurrence coverage, each policy year carries its own aggregate limit.
• Long‑Tail Claims: These are claims not filed until years after the incident. With occurrence policies, coverage still applies as long as the incident occurred during the policy period. In this case, tail coverage is not required if a physician leaves a practice, switches carriers, or retires.

Example Scenario with an Occurrence-Based Policy

Dr. Reyes had an occurrence-based malpractice policy from January 2022 through December 2025. The policy ended when she moved to a new practice in 2026.

In 2027, a patient filed a claim for a procedure Dr. Reyes performed in 2024. The incident occurred during the policy period, so it is still covered. No tail coverage is needed.

Core Differences of Claims-Made and Occurrence

Claim coverage

• Claims-made policies: the incident must occur on or after the retroactive date, and the claim must fall within the active policy period.
• Occurrence-based policies: the incident must occur during the policy period, regardless of when the claim is filed.

Tail coverage

• Claims-made policies: tail coverage is typically recommended when changing jobs, switching carriers, or retiring to maintain coverage.
• Occurrence-based policies: tail coverage is not needed.

Long-term protection

• Claims-made policies: protect you only while the policy is active, unless tail coverage is in place for long-term protection.
• Occurrence-based policies: offer long-term protection for any incident that occurs during the policy period, even after the policy ends.

Cost

• Claims-made policies: generally cost less up front, with premiums that increase over time as the policy matures. While the initial premium may be lower than occurrence-based, if tail coverage is needed, it can cost 1.5 to 3 times that of an occurrence-based policy.
• Occurrence-based policies: typically carry higher premiums than claims-made policies, reflecting the broader, long-term coverage they provide.

To learn more about malpractice insurance costs, see “A Closer Look at Medical Malpractice Premiums.”

Which Type Do Physicians Usually Have?

Most employer-provided malpractice policies are claims-made. If you are employed by a hospital, health system, or large group practice, there is a good chance your coverage is claims-made.

For physicians on claims-made policies, understanding your retroactive date, knowing what creates a coverage gap, and having a plan for tail coverage when transitions happen are the most important things to stay on top of.

Occurrence policies are more common in small private practices, locum tenens arrangements, and certain specialty settings.

Physicians working as independent contractors or in locum tenens arrangements should confirm that coverage applies across all practice locations and is not limited to just one.

For more information, listen to an interview with Chris Albano, National Account Manager at AMA Insurance, where he shares strategies for navigating the complexities of medical malpractice insurance.

For a related look at common mistakes physicians make navigating these decisions, see Avoid These Five Costly Malpractice Insurance Mistakes.