The Annual Malpractice Insurance Checkup: 10-Point Review to Ensure Your Policy is Adequate
Most physicians read their malpractice policy the day they buy it and never again. This is how coverage gaps grow. Retroactive dates drift, specialty classifications go stale, side gigs creep in, and defense costs quietly eat into limits no one re-checked. This 10-point review takes about 20 minutes at renewal and surfaces almost every gap that costs members of our online physician community money or sleep. Below, we'll cover how to ensure that your policy is still a good fit for your current practice, that it is competitively priced, and that it provides appropriate coverage.
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Why a 20-minute malpractice insurance checkup once a year matters to ensure your coverage is adequate
The policy you bought five years ago may not be adequately covering the practice you have today. Your scope may have shifted. You may have added a telehealth panel. The state legislature may have changed the damage cap. Your carrier potentially got downgraded. Each one of these is a small thing. Together, they're how a coverage gap opens.
Claim risk isn't theoretical. The AMA's career-frequency data puts roughly one in three physicians on the wrong end of a malpractice claim at some point in their career, and Health Affairs research from Seabury, Chandra, and Jena found physicians spend about 11% of a 40-year career with an open, unresolved claim. The cost of a 20-minute annual review is small. The cost of finding a gap during a claim is not.
Our partners at Docshield recommend running this review once a year, ideally about 30 days before your renewal date. That's enough lead time to fix anything that needs fixing (an endorsement, a limit change, a real reshop conversation) before the new policy period locks in.
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If you need to reshop a policy, explore medical malpractice insurance agents
The 10-point malpractice insurance review
When you're judging whether your malpractice insurance is adequate, it's important to approach evaluation methodically. Each point below has a one-line "why this matters," as well as the question to bring to your broker. Some items you can answer yourself from your declarations page; others require a phone call. None should take more than a few minutes.
Benchmark any premium increase
Premium increases happen for reasons that often have nothing to do with your individual practice: state-level rate filings, carrier-portfolio shifts, and severity trends in the broader market. The way to know whether your renewal increase is in line with the market is to pull a benchmark. A broker who works directly with med mal carriers has live premium data across the market and can usually tell you within a single email whether you're in line, without putting your file through a full underwriting submission. The point isn't to switch carriers reflexively. It's to make sure you're not overpaying when an increase runs materially above the market.
Ask: How does my renewal premium compare to broader rate-filing changes in my state and specialty? When increases run materially above the market average, that's the moment to pull comparative quotes.
If the benchmark surfaces a real reason to consider moving carriers (not just an urge to know the number), our piece on when to reshop your malpractice policy walks through which triggers warrant a real reshop and which don't.
Confirm your retroactive date
If you have a claims-made policy, your retroactive date is the line that decides which incidents are covered. Anything before that date isn't, regardless of when the claim is reported. Retro dates can quietly reset when you switch carriers, change employers, or have a coverage lapse, and a reset retroactive date strips coverage for every patient encounter before the new date.
Ask: What's my current retroactive date, and does it cover every patient encounter since I started practicing in this setting?
If your retroactive date has moved or is at risk of moving, nose coverage is usually the fix. Our piece on claims-made vs. occurrence malpractice policies covers the broader trade-off.
Confirm your specialty classification is current
Carriers price by specialty class, and the gap between classes can be large. If your scope has shifted in the last year (added procedures, took on inpatient work, started reading after-hours imaging, etc.), your classification may not reflect what you're actually doing. That cuts both ways: you may be overpaying, or you may be underinsured for work the carrier didn't know about.
Ask: Is my listed specialty exactly what I'm doing today, including any procedural or scope changes since my last renewal?
Confirm every state and location where you see patients is listed
This is the point most often missed by physicians who've added telehealth. Many policies require explicit state listing for telemedicine, locum, and per-diem work. A patient encounter in a state your policy doesn't list is, in many policy forms, an uncovered encounter.
Ask: Are all states where I see patients, in person or virtually, listed on my current policy?
Review your state's damage cap
Non-economic damage caps shift. State legislatures raise them, repeal them, or index them. State supreme courts strike them down on constitutional grounds. The cap in your state today may not be the one in place when you bought your current policy, and the cap is one of the inputs that should drive your limit selection.
Ask: Has my state's non-economic damage cap changed in the last year, and does my limit still leave the right margin above it?
Check your consent-to-settle clause
A consent-to-settle clause governs who decides whether a claim against you gets settled. Some policies require your written consent. Others let the carrier settle without your sign-off, often subject to a "hammer clause" that shifts excess defense costs to you if you refuse. A settled claim is generally reportable to the NPDB and follows you for the rest of your career, so read both clauses together.
Ask: Does my policy require my written consent before the carrier can settle a claim against me? Is there a hammer clause?
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Check whether defense costs are inside or outside your limits
If defense costs are inside your limits, every dollar your carrier spends on attorneys, expert witnesses, and depositions reduces what's left for an indemnity payment. A complex defense can run several hundred thousand dollars over multiple years. On a $1M limit, that erosion can leave very little headroom by trial.
Ask: Are defense costs paid in addition to my limits, or do they erode them?
Check your carrier's AM Best financial rating
A malpractice claim can take four to seven years to resolve, so your carrier's financial strength matters for the entire window, not just the day they issue the policy. AM Best is the rating agency the industry runs on. A- or better is the functional bar most brokers apply. A downgrade is news you want to hear from your broker, not from a press release.
Ask: What's my carrier's current AM Best rating, and has it changed in the past year?
Confirm your tail-funding plan
For claims-made coverage, tail (the extension that keeps you covered for claims reported after your policy ends) is one of the largest single insurance costs of your career, typically 150–200% of mature claims-made premium. Who pays (you, your employer, or a free-tail-at-retirement clause) is the question to settle now, not at separation.
Ask: If I left this position tomorrow, who pays for the tail, and is that commitment in writing?
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Confirm your side gig coverage
If you do any clinical work outside your primary employer (moonlighting, locum, telehealth across state lines, expert witness work, a small private panel, etc.), your primary policy probably doesn't cover it. Most group and employer policies are scoped to the named employer's work.
The fix is usually a separate policy for the side work, or a specific endorsement; the gap is usually expensive to discover at claim time.
Ask: Does my current policy cover all the clinical work I'm doing, including any side gigs, locum days, or telehealth? If not, do I have separate coverage?
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When should you run the malpractice insurance checkup off-cycle?
You should run this checkup any time one of the events below resets one of the 10 points above. The default cadence is annually, about 30 days before renewal. Several mid-year changes can warrant an off-cycle pass:
You change states or add a state of practice (including telehealth)
You change employers, or your employer changes carriers
Your scope changes (added procedures, sub-specialty work, or a new clinical setting)
You start a side gig (locum, moonlighting, telehealth, expert witness)
You receive a claim, an incident notice, or a request for records that could become one
Your carrier's AM Best rating changes
Your state passes a tort-reform or damage-cap change that affects your jurisdiction
Each of these resets one or more of the 10 points above. Don't wait for the next renewal cycle to address them.
Conclusion
An outdated retroactive date, an unlisted telehealth state, or an unclear tail obligation may not matter for years — until it matters all at once. Running a structured checkup helps ensure your policy still matches the way you practice today, not the way you practiced when you first signed the application. A 20-minute review before renewal is one of the simplest ways to reduce the risk of an avoidable coverage surprise later. If the review uncovers gaps, unusual premium increases, or uncertainty around your current coverage structure, it may be worth speaking with a specialized malpractice broker to benchmark your options before renewal locks in.
Additional malpractice insurance resources for physicians
Reshop your coverage with our partnered medical malpractice insurance brokers.
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Sources
Medical Liability Market Research — AMA Policy Research Perspectives — career claim frequency by specialty and state
Malpractice Risk According to Physician Specialty — Jena et al., NEJM 2011 — cumulative career-risk estimates
On Average, Physicians Spend Nearly 11% Of Their 40-Year Career With An Open, Unresolved Malpractice Claim — Seabury et al., Health Affairs 2013 — open-claim time across a career
NPDB Public Use File and Data Analysis Tool — HRSA — practitioner reporting context for the consent-to-settle and claims-handling points
NAIC — Market Share & Competition — carrier landscape and financial-stability framing
Miller & Zois — 50-State Medical Malpractice Damage Cap Tracker — reference for state non-economic damage caps
Physicians Prone to Malpractice Claims — Studdert et al., NEJM 2016 — concentration of paid claims, context for the carrier-relationship point