Why COTAs need their own liability insurance
Certified occupational therapy assistants work under supervision, but that doesn't eliminate personal liability. Common claims include patient falls during transfers, improper use of assistive devices, or documentation errors that lead to treatment delays. According to HPSO, the average total cost of a malpractice lawsuit against an occupational therapist is $60,299 — and COTAs can be named alongside their supervising OT.
Employer policies typically protect the facility first. They often exclude license defense coverage and end the moment you leave a job. If a claim is filed after you've moved on, you're on your own. A personal policy is portable, follows you across settings (clinic, school, home health, telehealth), and includes license protection.
What personal coverage includes
Individual policies from carriers like CM&F, HPSO, and CPH & Associates offer limits up to $1 million per claim and $6 million annual aggregate. Key features to look for:
- License defense reimbursement — HPSO provides up to $25,000 per incident; CPH offers $35,000 for state licensing board defense.
- Defense costs outside limits — Berxi and CPH both pay attorney fees without eroding your liability limit.
- Telemedicine included — Most major carriers cover telehealth as long as it's within your scope of practice.
- Occurrence form — Common for COTAs; no need to buy tail coverage when switching jobs.
How much does COTA malpractice insurance cost?
Annual premiums for occupational therapy assistants typically range from $100 to $350. CM&F offers competitive pricing for individuals and groups, with instant quotes and same-day coverage. HPSO, which insures one in three physical therapists through the APTA member program (10% off for APTA members), also covers COTAs. CPH & Associates provides occurrence-only policies (no tail needed) starting around the lower end of that range. Exact pricing depends on your state, practice setting, and claims history — always get a quote.
How to choose the right policy
Prioritize occurrence form to avoid future tail costs. Ensure license defense is included — employer plans rarely cover it. Compare limits: $1M/$3M is common, but $1M/$6M gives extra aggregate protection. If you work in multiple settings or pick up per-diem shifts, confirm the policy covers all locations and telehealth. For more details on policy types, see our guide on occurrence vs. claims-made.
Most COTA policies are written on an occurrence form, which covers any incident that happened while the policy was active — even if the claim is filed years later. No tail coverage is needed. Claims-made policies are less common for this profession because COTAs often change jobs or settings, and buying tail (typically 1.5–2 times the annual premium) can be expensive. Stick with occurrence unless you have a specific reason to choose claims-made.