How to Choose Between Claims-Made and Claims-Occurrence Medical Malpractice Insurance

Are you currently exploring your options for Medical Malpractice cover? You may have come across the two most popular and distinctive types of policies available for Medical Malpractice cover: Claims-Made and Claims-Occurrence.

Choosing which type of medical malpractice cover you need is an essential consideration, yet it is often overlooked. Many healthcare professionals are still left in the dark about the differences in claims-made and occurrence cover, which can lead to confusion and have a financial impact in the event of a claim. The topic of medical malpractice is complex, and no two cases of a claim are the same. Some healthcare professionals could receive a medical malpractice claim years after the event had taken place, or even during a professional’s retirement.

Whilst it is always best practice to refer to a specialist healthcare insurance adviser who can advise on your specific circumstances, below we will explain the differences between claims-made and claims-occurrence medical malpractice cover, and factors which may impact your choice between the two.

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Claims-occurrence

A claims-occurrence policy will respond to claims arising from incidents that occurred during the period of insurance, regardless of when the claim is made. For instance, if a patient wanted to claim for a treatment made years ago but you had a claims-occurrence policy in place, it would be able to compensate you for this claim.

Example:

You have a claims-occurrence policy in place between 2020-2025. A patient makes a claim for a treatment from 2021. The claims-occurrence policy in force at that time would respond.

These types of policies are widely used by Medical Defence Organisations (MDOs), making them popular amongst healthcare professionals. If you like to value day-to-day support ran by experienced doctors and allied health professionals from your field, this might be the option to consider. However, it is also good to be aware of the limitations of cover offered by MDOs.

Assistance from an MDO can vary on a case-by-case basis, as support for claim payments is generally discretionary rather than contractually guaranteed.

Claims-made

A claims-made policy will generally only respond to claims that are made and notified whilst the policy remains in force.

Example:

You hold a claims-made policy between 2020-2025 before subsequently cancelling the policy. You are only covered by the policy for a claim that is made within this time frame. If a patient makes a successful claim between 2020-2025, your policy will be able to reimburse your legal defence costs, court fees and compensation awarded to the claimant. The policy will not be able to support you if a claim was made by a patient in 2026 as the cover would no longer be active.

Unlike claims-occurrence policies, a claims-made policy is bound by insurance law. They are considered contract-certain and insurers are legally obliged to pay your claim if it falls within the defined policy limits of your contract.

One limitation to choosing a claims-made policy is that you may have to purchase additional protection for your policy so that you are adequately covered for claims before your live cover or following a cancellation. This is known as retroactive cover and run-off cover.

If you prefer the certainty of knowing that valid claims falling within your policy terms must be met by the insurer, this may be the right option for you.

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Your provider matters

For some niche healthcare providers, such as ADHD specialists, freelance locums or even medical recruitment companies, choosing between claims-made and claims-occurred medical malpractice is not always straightforward. There are many medical malpractice providers available to healthcare professionals and researching what support you would like to accompany your cover is just as important as the type of policy you choose.

As detailed previously, healthcare professionals who prioritise advice from those already in the industry are likely to choose a Medical Defence Organisation. Using a specialist insurance broker, such as MIAB, is becoming an increasingly popular choice for healthcare professionals and their businesses as it supports greater flexibility of cover and more suitable for those who are working to contract.

MIAB has access to a wide panel of specialist insurers, can assist in finding cover which is tailored to your scope of practice and provides support throughout the life of your policy.