Choosing the wrong malpractice policy can cost you six figures over time. Here’s how claims-made and occurrence coverage actually differ, and how to choose the right one for your career.

Choosing the wrong malpractice policy can cost you six figures over time. Here’s how claims-made and occurrence coverage actually differ, and how to choose the right one for your career.

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What Are the Main Differences Between Occurrence and Claims-Made Medical Malpractice Insurance?

Occurrence and claims-made policies can both cover the same procedures and protect physicians from the financial impact of malpractice claims, such as legal fees, settlements, expert witness fees, and damages.

The key differences come down to when your coverage applies, when you’re actually protected, and how much you’ll pay over time.  

  • Occurrence Policy: Covers any incident that takes place during the policy period – regardless of when the claim is submitted. However, it’s more expensive at the onset and isn’t available in every state or for every specialty.

  • Claims-Made Policy: Covers incidents that occur during the policy period, but only if the claim is reported while the policy is still active. Once the policy ends, coverage stops unless you purchase tail insurance. Claims-made is more affordable at the outset, but rates increase over time.

With occurrence coverage, the physician is covered for all malpractice claims related to patient care that took place during the policy period, regardless of when the claim is submitted.

With claims-made coverage, the physician is covered for malpractice claims when both the patient care and claim submission fall within the policy period.

Case Study: A New York Neurosurgeon Moves to Florida

Dr. Jones is a neurosurgeon who, until recently, practiced in New York under a medical malpractice policy with Insurance Company A. In 2024, he left his position to open a private practice in Florida and secured new claims-made coverage with Insurance Company B.

In 2026, a former New York patient files a malpractice claim.

Whether Dr. Jones is protected depends on the type of policy he carried in New York.

Surgeon Debating Claims-Made vs. Occurrence Coverage

  • Option 1: New York Occurrence Policy
    If Dr. Jones carried an occurrence policy in New York, Insurance Company A covers the claim – because the treatment occurred while the policy was active, regardless of when the claim was filed.

  • Option 2: New York Claims-Made Policy
    If Dr. Jones carried a claims-made policy, Insurance Company A would only cover the claim if he purchased tail coverage within the policy’s opt-in period – typically within 30 days of his original policy ending. If he relocated to Florida without tail coverage, Insurance Company A denies the claim.

    Insurance Company B would also deny the claim unless Dr. Jones added prior acts coverage (also known as nose coverage) to his new Florida policy.

Which Is More Affordable, Claims-Made or Occurrence?

Total cost depends on your specialty, location, claims history, and long-term plans—but policy type plays a major role.

At MEDPLI, we often see that many physicians choose claims-made policies because of the lower upfront cost, but early savings often disappear over time.

  • Occurrence Policy: Higher premiums at the start of the policy, but the rate stays the same for the entire length of the policy, and no tail coverage is required.

  • Claims-Made Policy: Lower premiums at the start of the policy, but rates often double from the first year to the second year and continue increasing until the policy matures after 4-5 years.

When the policy ends, you’ll typically face a large, one-time tail premium, often around 200% of your annual rate, just to maintain protection.

The example below shows how the premium costs add up over time.

Occurrence vs. Claims-Made

Estimated 4-Year Rates for a Neurosurgeon in Los Angeles, CA (Updated 2026)

Policy Type 2026 2027 2028 2029 Tail Total
Claims-Made $18,000 $35,000 $48,000 $55,000 $110,000 $266,000
Occurrence $60,000 $60,000 $60,000 $60,000 N/A $240,000

These estimated rates are for informational purposes only. Quotes require a completed application and underwriter approval. Compare your claims-made vs. occurrence policy options and get a tailored estimate.

How Do Claims-Made and Occurrence Policies Affect Premiums in Liability Insurance?

Claims-made and occurrence policies are priced differently based on how much risk the insurer takes on:

  • Claims-made policies start cheaper because they carry less risk for insurers, who retain the right to adjust premiums annually as market conditions or the legal climate shift. However, costs rise significantly in the early years. 

  • Occurrence policies carry higher upfront premiums because insurers take on more risk, giving up the ability to raise rates down the line – but in exchange, you get predictable, locked-in costs over the life of the policy.

In our experience advising physicians, occurrence coverage offers a more stable rate structure – but the higher upfront costs can be a barrier for some physicians, and not all physicians will qualify.

Why Not All Physicians Qualify for Occurrence Coverage

While both policy types can technically cover the same range of medical care and procedures, insurance carriers cannot offer occurrence coverage for certain practice risk profiles. High-risk profile providers, such as neurosurgeons or OB-GYNs, will often be limited to claims-made policies.

How Do Limits of Coverage Apply for Occurrence vs Claims-Made Insurance?

There are fundamental differences in how the limits of coverage are applied to occurrence vs claims-made policies:

  • Occurrence Policy: If you have a standard policy of $1 million per occurrence/ $3 million per annual aggregate, those coverage limits apply to each year of the policy. This is another reason occurrence form coverage is more expensive.

  • Claims-Made Policy: The $1 million/$3 million limits apply to your entire prior acts period – so if your retroactive date is 10 years old, you are covering that entire 10 year period with the $1 million / $3 million limits.

Pros & Cons of Occurrence vs. Claims-Made Coverage (And Which Is Right for You?)

Both policy types have strengths and are designed to protect against the financial burden of medical malpractice claims. When determining whether occurrence or claims-made coverage aligns with your needs, consider the following features:

Policy Features

Occurrence Policy

Claims-Made Policy

Fixed, flat cost for premium across the length of the policy

No need to purchase tail insurance

Can easily switch from one policy to another

Most affordable at the outset

Attractive option for doctors in the last 5 years before retirement

Available in all 50 states and for all medical specialties

There is no one right answer to the claims-made vs. occurrence question – what’s right for you will depend on your circumstances and what features matter most to you.

Claims-made is often the better fit if: 

  • You want a lower upfront cost
  • Your employment contract stipulates that your employer will pay for tail insurance
  • You plan to retire soon (retirees often get free or heavily discounted tail coverage)
  • You work in a high-risk specialty (many insurers only offer claims-made to high-risk specialties)

Occurrence might work best for you if:

  • You want long-term rate stability 
  • You’ll be responsible for purchasing tail coverage 
  • You plan to practice for many years
  • You’re able to budget for higher upfront premiums

 

If you’re unsure what’s available or which option is best for your situation, MEDPLI brokers are here to help. We’ll discuss your past, current, and future malpractice needs, assess your risk profile, location, and specialty, and compare options to find coverage that fits your needs and budget. Talk with a MEDPLI advisor to compare quotes from top A-rated carriers and find the right coverage for your career.

Occurrence vs. Claims-Made Coverage FAQs

Malpractice quotes are highly individualized – accurate pricing requires underwriter review, so there’s no reliable online comparison tool. You can request quotes from each carrier directly, but sourcing, comparing, and vetting them is time-consuming.

MEDPLI’s brokers do the heavy lifting for you, gathering quotes from multiple carriers, reviewing the fine print, and helping you determine which policy best fits your specialty, risk profile, and budget.

Claims-made and occurrence policies offer different benefits, so what’s best for surgeons will depend on their budget, risk profile, claims history, state, specialty, long-term plans, and desired policy features, as well as which (if any) carriers offer occurrence policies for their specialty. 

While many insurers offer coverage, we recommend sourcing quotes from A-rated carriers to ensure financial strength and comprehensive protection. Below are some of the top providers in the market:

  • The Doctors Company
  • Medical Protective Company
  • Coverys Group
  • ProAssurance Group
  • MagMutual Group
  • CURI Group
  • ISMIE Group

To see our top 25 recommendations, read our Top 25 Medical Malpractice Insurance Carriers for Doctors in 2026.

Switching from occurrence to claims-made is typically easy and affordable because it doesn’t require the purchase of tail coverage. In contrast, if you switch from claims-made to occurrence, you will need to purchase tail insurance.

Before making any switch, an independent policy review can help you understand your current coverage and whether the change makes sense for your situation. MEDPLI’s risk assessments provide an unbiased 3rd party review of your policy, evaluating: 

  • Limits of liability 
  • Cost-prohibitive deductibles 
  • Exclusions 
  • Key clauses, including consent-to-settle and hammer clauses 
  • Out-of-state and telehealth coverage 

Contact MEDPLI today for a policy review and free quote. 

We typically recommend these A-rated carriers, but the “best” carrier will differ depending on your circumstances. MEDPLI’s brokers can help you understand your options and compare policies from multiple carriers to find the best coverage for your needs and budget. 

MEDPLI offices are located in Carbondale, IL, and we work with physicians and surgeons across all 50 states — including those in high-risk specialties such as bariatric surgery, general surgery, OB-GYN, neurosurgeons, plastic surgeons, and otolaryngologists. 

We’re paid by the insurance carriers, which means you get expert, unbiased advice and dedicated advocacy at no cost to you. We forgo charging fees to our clients because our sole focus is on medical malpractice insurance. We are committed to fostering long-term relationships founded on trust and exceptional service.

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Max Schloemann

About the Author

Max Schloemann is a medical malpractice insurance broker helping physicians and surgeons secure Medical Professional Liability coverage. A Magna Cum Laude graduate of Southern Illinois University’s College of Business, he was named Outstanding Management Senior.

Max began his career in 2008 at an industry-leading firm and founded MEDPLI in 2017 to guide private practice doctors and physicians in transition through the complexities of malpractice insurance.

Outside of work, Max, his wife Kristen (a Physician Assistant), and their four kids enjoy the outdoors and attending the kids’ sporting events. For malpractice insurance questions, you can contact Max here.

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