Claims-made insurance policies respond to claims based on when the claim is first made alleging malpractice. Claims-made is the most common form of medical professional liability insurance policy in the USA. It is different than occurrence form coverage. Occurrence form, in contrast, responds to claims based on when the incident occurs.
Example to illustrate the difference between claims-made and occurrence:
Dr. Smith has claims-made coverage with a 7/1/2014 retroactive date. He operated on Patient Doe in 2015. Patient Doe filed a lawsuit in 2016 alleging malpractice against Dr. Smith. Dr. Smith’s 2016 policy is the one that responds to this claim, because claims-made coverage responds based on when the claim is first made.
Dr. Smith has occurrence coverage (no retroactive date with occurrence). He operated on Patient Doe in 2015. Patient Doe files the lawsuit in 2016. Occurrence coverage responds to claims based on when the incident (the operation) occurred. In this case, the policy that was in force during the operation in 2015 responds to the claim. Occurrence form of insurance is more familiar to most people since home and auto insurance are written on occurrence form.
Claims-made is the most common form in medical professional liability insurance. Claims-made should not be confused with claims-paid coverage.
