Occurrence vs. claims made malpractice: which OB/GYN policy do I have?

Read the policy form before you price the offer, because in OB/GYN the form decides what you owe on the day you leave, and the amounts in this specialty run to six figures. The form decides who owns the tail. An occurrence policy covers an incident from the years the policy was in force, whenever the claim is later filed. A claims made policy covers a claim only when two dates line up: the care happened after the policy's retroactive date, and the claim is reported while that policy, or its tail, is still in force. Neither form marks a good or bad employer. Occurrence coverage costs the buyer more each year and ends cleanly. Claims made coverage costs less in the early years and leaves an exit bill called tail coverage, priced at commonly 150 to 200 percent of the mature annual premium. Where the premium itself can reach $243,988 a year, that exit bill decides real careers.

Part of the OB/GYN hub.

The two forms, in plain terms

An occurrence policy is the simpler instrument to hold. If you were covered in the year the patient was seen, that year's policy responds to a claim about that care, even if the claim arrives after you have moved to another job. There is no tail to buy when you leave, because each year stands on its own. When an employer offers occurrence coverage, that is real compensation. Lisa, the established OB/GYN in the Lisa and Mark case, carries employer occurrence coverage, so her file has no tail question waiting at exit.

A claims made policy works like a window that must stay open. Care delivered inside the window is covered only if the claim is reported while the window is open, or while an extension of the window, called tail coverage, is in force. When the job ends, the window closes unless someone buys the tail. The tail extends the reporting period for care you already delivered; it does not insure future care. Buying it is not optional in any practical sense in this specialty, because in many states the malpractice clock for a child does not start running until the patient turns 18, so a delivery can become a claim nearly two decades later.

What the tail costs on OB/GYN premiums

Tail coverage is commonly priced at 150 to 200 percent of the mature annual premium, as a one time lump sum when the policy terminates, and carriers generally bill within about two months of cancellation. Run that band against the premiums the American Medical Association reports for $1M/$3M OB/GYN policies, and the specialty's problem comes into focus.

Florida, Miami Dade: the annual premium is $243,988. At 150 percent, $243,988 times 1.5 equals $365,982. At 200 percent, $243,988 times 2 equals $487,976.

California, Los Angeles and Orange County: the annual premium is $49,804. At 150 percent, $49,804 times 1.5 equals $74,706. At 200 percent, $49,804 times 2 equals $99,608. Same specialty, same form, same band, and the exit bill differs by a factor of about five because the premium underneath it does. Geography is a malpractice decision before it is a lifestyle decision in OB/GYN. Other markets in the same AMA exhibit sit between those poles: Illinois at $207,907, New York at $176,358, Connecticut at $159,537, Pennsylvania at $135,974, New Jersey at $94,640.

Then read who pays it, because that term varies more than the price does. Some employers pay the tail when a physician leaves in good standing after a stated period. Some pay it only on retirement, death, or disability, and leave the ordinary resignation on you. Some split it. Some require you to pay even when the separation is not your choice. Heidi, the new attending in the Heidi and Spencer case, practices under claims made coverage with the tail covered by her employer. That term removes the largest exit cost in the specialty from her balance sheet. A rival offer would need to exceed her current package by the priced value of that term before the salary lines are even compared.

How to tell which form you hold

Ask for the declarations page and the policy form itself, not a recruiting summary. If the documents say claims made, find the retroactive date and confirm it reaches back to your first day of covered practice, because care before that date sits outside the window unless prior acts coverage was arranged. Ask who pays for tail on each kind of exit: resignation, termination with cause, termination without cause, retirement, and the group losing its hospital contract. Ask what limits the policy carries and whether defense costs sit inside or outside those limits. Ask whether the policy requires your consent before a claim can be settled, because a settlement follows your record long after the job ends.

Do this reading at signing, not at separation. A physician who knows the tail term can negotiate it, fund it, or choose the other offer. A personal tail is a known future liability, and known liabilities belong in the Safety Net reserve plan from the start.

Follow up questions

My offer says malpractice is included. Is that enough?

No. Included tells you a policy exists during the job. It says nothing about the form, the limits, or the tail at exit. Two offers that both say malpractice included can differ by the entire cost of a tail at separation, which on a Florida premium runs from $365,982 to $487,976. Ask for the form and the tail clause in writing.

My new employer offers prior acts coverage. Does that replace a tail?

It can. Prior acts coverage, also called nose coverage, means the new carrier covers claims from care you delivered before you arrived, by honoring your retroactive date. When the new policy does that on clean terms, the window never closes and the old tail does not need to be bought. Confirm the retroactive date matches your original one, and keep the paperwork for as long as the exposure runs.

Related questions

• My claims made policy says I pay the tail. What will it cost an OB/GYN?
• What should an OB/GYN check on tail coverage and restrictive covenants?
• How do I budget for OB/GYN malpractice premiums in private practice?

Sources

• American Medical Association, Policy Research Perspectives, medical liability premiums, which reports $1M/$3M OB/GYN premiums of $243,988 in Florida (Miami Dade) and $49,804 in California (Los Angeles, Orange), accessed October 2026.
• Physician Side Gigs, malpractice tail insurance coverage guide, which establishes that tail coverage commonly costs 150 to 200 percent of the mature annual premium and that in many states the malpractice clock for a child does not start running until the patient turns 18, accessed October 2026.
• Financial Fellowship Heidi and Spencer case, the new attending under claims made coverage with the tail covered by the employer, accessed October 2026.
• Financial Fellowship Lisa and Mark case, the established OB/GYN carrying employer occurrence coverage, accessed October 2026.

Takeaways

• Occurrence coverage insures each year of care on its own. Claims made coverage insures care only when the claim is reported while the policy or its tail is in force.
• Tail commonly runs 150 to 200 percent of the mature premium: $365,982 to $487,976 in Florida, and $74,706 to $99,608 in California.
• Who pays the tail matters more than the form name. Heidi's employer carries hers.
• Confirm your form, retroactive date, and tail term in writing before you sign.