Protect Your Advanced Practice Provider Career With Malpractice Coverage Designed for Your Needs

Advanced practice providers (APPs)—including nurse practitioners, physician assistants/associates, certified registered nurse anesthetists, and midwives—face unique and substantial liability risks, and strong clinical care does not always provide full protection.

The Doctors Company's review of 1,259 APP malpractice closed claims with loss years between 2010 and 2024 shows the reality of the risk. Nearly half of claims (46 percent) resulted in an indemnity payment. Among paid claims, the average indemnity was approximately $535,000, and average claim expenses across all APP claims were just under $100,000, highlighting that malpractice claims can carry significant financial consequences, even when an indemnity payment is not made.

Malpractice claims may be filed even when no medical error occurred, and most healthcare professionals are named in a lawsuit at some point during their careers. Still, many APPs are unsure what liability coverage they have—and whether that protection is enough for the way they practice.

The strongest professional liability policy for an APP is one that offers broad protection while aligning with the clinician’s practice setting, professional path, and long-term financial well-being.

Individual vs. Shared Limits of Liability

When APPs receive professional liability coverage through an employer, that coverage may not fully address their personal exposure, especially as the dollar amounts of medical malpractice jury awards keep climbing.

Many APPs believe an employer’s malpractice coverage will be enough, but the scope and terms of that coverage can differ widely.

As an APP, when you review your employment agreement, look carefully at the liability limits that apply:

• Individual limits: Coverage is assigned specifically to you. For instance, if a practice has a policy with a $1,000,000 per claim limit and the practice, a physician, and an APP are all named in the same claim, each party would have a separate $1,000,000 limit available for that claim.

• Shared limits: Coverage is divided among multiple practitioners or entities, such as APPs, physicians, or the employer. Using the same example under a shared limit policy, the practice, physician, and APP would all draw from the same $1,000,000 pool of coverage.

Shared limits may heighten your financial risk when more than one claim or party is involved under the same policy.

Supplemental, or excess, malpractice insurance can add another layer of protection by working alongside your employer’s policy. Potential advantages include:

• Liability protection beyond the limits supplied by your employer
• Legal counsel dedicated to your individual interests
• Additional financial support for defense expenses
• Confidence that your professional reputation and livelihood have added protection

If a claim is filed, your personal insurer and your employer’s insurer generally coordinate defense and settlement strategy, helping provide more complete protection when it is needed most.

Coverage for Licensing Board Complaints

Licensing board complaints present another key area of risk. Employer-provided coverage is designed to protect the organization, but it may not fully address an APP’s exposure to board complaints—exposure that can exist regardless of whether the APP was at fault. A single board investigation may take years to resolve and cost tens of thousands of dollars, while also placing the APP’s license and reputation in jeopardy.

Tail and Nose Coverage

Another important issue is tail coverage, or extended reporting period (ERP) coverage, for a claims-made policy. Tail coverage responds to claims arising from professional services provided while the claims-made policy was active but reported after that policy ended. Nose coverage, or retroactive coverage, is similar to tail coverage as it covers claims arising from prior acts. However, nose coverage is provided by the current or active policy.

Even if an employer supplies adequate protection for claims made during employment, APPs should still consider possible coverage gaps before and after a job and protect themselves with nose or tail coverage. An unexpected lapse in coverage could affect hospital employment or limit other professional opportunities, even when no lawsuit has been filed.

How to Choose a Malpractice Policy

Individual malpractice insurance can help you close coverage gaps. Because this coverage can move with you throughout your career, it offers dedicated protection for malpractice claims, licensing board matters, and other professional liability exposures. Just as important, it helps ensure the policy is designed to protect your professional interests—not only your employer’s.

Professional liability insurance policies are not all the same. When comparing malpractice insurance options, consider more than price by reviewing the coverage, service, and resources that come with the policy.

Important factors to review include:

• Coverage limits: Confirm that limits fit your specialty, practice setting, and level of risk exposure.
• Occurrence vs. claims-made coverage: Know how each coverage type works and whether you may need tail coverage later.
• Licensing board defense coverage: Make sure the policy helps protect you in regulatory investigations and licensing board proceedings.
• Consent-to-settle provisions: Some insurers can resolve claims without your agreement. Seek policies that allow you to participate in settlement decisions.
• Carrier financial strength: Select an experienced insurer with the financial capacity to defend claims and pay covered losses.
• Claims support and legal defense: Review the insurer’s claims reputation, defense capabilities, and access to experienced legal counsel.
• Tail coverage options: If you choose a claims-made policy, understand whether tail coverage is available and what it may cost when you change jobs or retire.
• Risk management resources: Training, patient safety tools, and expert consultation can help lower liability risks before claims arise.

Types of APP Coverage—Get Exactly the Protection You Need

• Primary: For APPs who have employer-provided medical professional liability coverage but want their own policy to help protect their professional reputation, or for independent contractors, self-employed clinicians, and practice owners.
• Excess: For APPs who want their primary policy to serve as the first line of defense but would like additional coverage to reduce the risk of out-of-pocket costs after primary policy limits are exhausted.
• Supervising and collaborating physicians: For APPs with a formal agreement involving a collaborating physician, surgeon, or anesthesiologist, vicarious liability coverage may be added to either policy.

Industry-Leading Malpractice Coverage for APPs

TDC Group, through medical professional liability insurer The Doctors Company and its affiliate The Doctors Company Risk Retention Group, has provided APPs with superior coverage since 1976. Our national perspective and local experts help us identify emerging risks and offer practical solutions—for example, our APP liability policy includes automatic protection for regulatory actions. However you practice, we are ready to support you with expert guidance, resources, and coverage.