Which malpractice policy form do I have, occurrence or claims made?
By Ryan Inman
Published · Updated
The short answer
Read the policy form before you price the offer, because in emergency medicine the form decides what you owe on the day you leave. Claims made plus tail is the staffing company standard. 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 retroactive date, and the claim is reported while that policy, or its tail, is still in force. Most emergency physicians meet the second form first, because large groups and staffing companies buy it for the physicians they place. The coverage can be sound. The exit cost is the part that surprises people, and the exit cost lives in one word in your contract: tail.
Part of the emergency medicine 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 policy responds to a claim about that visit, even if the claim arrives after you have moved to another state and another job. There is no tail to buy when you leave, because the coverage for each year stands on its own. When an employer offers occurrence coverage, that is real compensation, and it should be counted when you compare offers, even though no dollar figure for it appears on the salary line.
A claims made policy works like a window that must stay open. Care delivered inside the window is covered only if the claim is made and 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 any future care. Buying it is not optional in any practical sense, because emergency care given to undifferentiated patients, often with no prior relationship and a chart written under time pressure, can produce claims well after the visit.
What the tail costs, and why no honest page gives you one number
Tail coverage is priced as a multiple of the expiring claims made premium. That is the mechanism, and it is the only honest way to state the cost on a general page, because the premium underneath the multiple varies with your state, your claims history, your practice profile, and the limits the policy carried. A page that quotes a single percentage of salary, or a single dollar figure, for tail in emergency medicine is guessing with your money. What you can do before signing is arithmetic on your own offer. Ask the group for the annual premium your claims made policy carries. Ask what multiple the tail is priced at under the current program. Multiply the two numbers, and you have the order of magnitude of the check that exists at your exit if the contract puts the tail on you.
Then read who pays it, because that term varies more than the price does. Some groups 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 it even when the group loses the hospital contract and your job ends through no choice of yours. That last version deserves your full attention in this specialty. Emergency groups hold contracts with hospitals, and contracts change hands. When a group loses the contract, a department full of physicians can be separating at once, each with a tail question attached.
What to ask before you sign
Ask which form the policy is, occurrence or claims made, and do not accept a summary answer in a recruiting call. Ask for the clause itself. Ask who pays for tail on each kind of exit: resignation, termination with cause, termination without cause, retirement, and the group losing the hospital contract. Ask whether the obligation changes if you stay a stated number of years. Ask what limits the policy carries and whether defense costs sit inside or outside those limits, because a policy that spends its own limit on defense leaves less for a judgment. Ask whether the policy requires your consent before a claim can be settled. A settlement follows your record long after the job ends.
Pierce, the established emergency physician in the Pierce and Donna case, carries claims made coverage with no tail arranged after fifteen years of practice. His file is the cautionary version of this page: the exit cost sits there uncounted. You are reading this at the start of your attending career, which is exactly when the answer is cheapest to get. A physician who knows the tail term can negotiate it. A physician who never asked finds out the price on the way out, when there is nothing left to negotiate with.
The main points
- 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.
- Claims made plus tail is the staffing company standard in emergency medicine, so the tail clause is part of nearly every first contract in this specialty.
- Tail is priced as a multiple of the expiring premium. Ask for your premium and the multiple, do the multiplication on your own offer, and never plan around a general percentage.
- Before signing, learn who pays the tail on every kind of exit, including the group losing the hospital contract, and confirm your retroactive date in writing.
Related 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. Ask for the form and the tail clause in writing. Two offers that both say malpractice included can differ by the entire cost of a tail purchase at separation, and that difference belongs in your comparison of the two offers.
Can I just buy my own tail later, when I actually leave?
You can elect tail at separation, inside the election window the policy sets, and many physicians do exactly that. What you cannot do is decide years later, after the window has closed. You also cannot assume the price at that future date. The premium and the multiple in force at your exit set the cost, which is one more reason to learn the current terms before you sign, and to prefer prior acts coverage from a new employer when it is offered on clean terms.
Sources
- Financial Fellowship Pierce and Donna case, which establishes the established emergency household carrying claims made coverage with no tail arranged, accessed October 2026.