Which Malpractice Insurance Policy Should You Choose?
You’re about to sign a job offer or buy your own policy, and the broker throws out terms like “occurrence” and “claims-made.” It sounds like jargon, but picking the wrong one can cost you thousands — or leave you uncovered when a lawsuit shows up years later. Here’s what you actually need to know.
What’s the Difference Between Occurrence and Claims-Made?
The core difference is simple: when you’re covered.
Occurrence coverage pays for any incident that happened while the policy was active, no matter when the claim is filed — even if you’ve switched jobs, retired, or cancelled the policy. Think of it as locking in coverage for that year’s work forever.
Claims-made coverage only pays if the policy is active when the claim is filed. If you had a policy in 2022 but a patient sues in 2025 — and you’ve since left that job or changed carriers — you’re not covered unless you bought a “tail” (extended reporting endorsement).
Most employer-provided policies are claims-made. And here’s the trap: when you leave, the coverage stops. You’re then on the hook for any claims from your time there, unless you purchase tail coverage — which often costs 1.5 to 2 times your annual premium.
Why Does This Matter When You Change Jobs or Go Independent?
Let’s say you’re a nurse practitioner leaving a hospital for private practice. If your employer had a claims-made policy and didn’t offer tail, you’d need to buy tail coverage yourself — or risk being personally sued for something that happened years ago. That’s a six-figure exposure for a few thousand dollars in tail.
With an occurrence policy, you’re covered for work done during that period, period. No tail needed. That’s why many independent practitioners prefer occurrence: it’s simpler and eliminates the tail-cost surprise.
But occurrence isn’t always available — some carriers don’t offer it in certain states or for higher-risk specialties. And it’s usually more expensive upfront. For example, Berxi offers both occurrence and claims-made, depending on your profession. Proliability (Mercer) offers occurrence up to $1M/$3M for NPs. CPH & Associates offers occurrence exclusively for therapists and counselors.
What About Employer Policies? Are They Enough?
Employer policies are designed to protect the facility, not you. They often exclude license defense, may settle without your consent, and — as noted — usually end when you leave. The American Association of Nurse Practitioners (AANP) warns that employer coverage is typically claims-made and may not cover you after separation.
If you’re a nurse, therapist, or tech, your employer’s policy might cover you while you’re there, but it’s worth checking: does it include license defense? Is it portable? Can you get a tail if you leave? Many individual policies from carriers like HPSO or Berxi are occurrence-based and portable — meaning they stay with you between jobs.
How Much Do These Policies Cost?
Prices vary by profession, state, and limits. Here are typical annual ranges:
- Nurse Practitioner (NP): $990–$2,000. Proliability lists ~$991 employed, ~$1,190 self-employed. Berxi typical $1M/$3M ~$1,400.
- Therapist / counselor: Berxi ~$363 supplemental, ~$765 primary. CPH occurrence often lower.
- Registered Nurse (RN): $100–$150.
- Physical/Occupational therapist: $100–$350.
- Dental hygienist: $45–$150.
- Allied-health techs (phlebotomist, CNA): $50–$200.
- Massage therapist: BBI from $96/yr; ABMP $199/yr; AMTA $235/yr.
- Esthetician: BBI from ~$120/yr.
- Notary E&O: $20–$100 (bundled business E&O ~$500 via Thimble).
- CRNA: $1,500–$3,000.
These are estimates. Final pricing comes from the carrier at quote.
Which Policy Form Should You Choose?
For most individual practitioners — nurses, therapists, techs, aestheticians — occurrence is the better choice if it’s available and affordable. You avoid the tail-coverage trap, and you don’t have to worry about coverage gaps when you switch jobs. Many carriers like HPSO and Proliability offer occurrence policies for a range of professions.
Claims-made can work if you’re staying in one job long-term and your employer provides tail. But if you’re independent or plan to move, occurrence means you never have to think about a tail bill later.
Some carriers, like Berxi, offer both — you can choose. Others, like CM&F Group, offer portable, occurrence-like coverage (often called “claims-made with tail included”). Read the fine print: if the policy says “portable” or “tail included,” it may function like occurrence.
Common Questions
Which is better, occurrence or claims-made?
For most independent practitioners, occurrence is better because it covers you for life for work done during the policy period — no tail needed. Claims-made is cheaper upfront but can cost you later if you need tail. If you’re in a stable job with tail provided, claims-made may be fine.
What happens to claims-made coverage when I leave a job?
Your coverage ends. You’ll need to buy a tail (extended reporting endorsement) to cover claims from your time at that job. Tail often costs 1.5–2x your annual premium. If you don’t buy it, you’re personally exposed for any future claims from that period.
Is occurrence more expensive?
Generally, yes — occurrence premiums are higher upfront because the insurer covers the “long tail” of future claims. But over your career, occurrence can be cheaper than claims-made plus tail. It depends on how long you stay with one carrier and whether you change jobs.
One honest caveat: not all carriers offer occurrence in every state or for every specialty. Always compare quotes from multiple carriers — see our carrier comparison hub — and ask whether the policy is occurrence or claims-made, and if tail is included.