CRNA Malpractice Insurance: Policy Types and Tail

Malpractice insurance (professional liability insurance) pays for your legal defense and any settlement or judgment if a patient claims you were negligent. Every CRNA needs to know who covers them, with what kind of policy, and what happens when that coverage ends.

The most important choice is occurrence vs claims-made. It decides whether you need tail coverage when you change jobs or retire.

Occurrence vs claims-made

	Occurrence	Claims-made
What triggers cover	The incident happened while the policy was active	Both the incident and the claim happen while the policy is active
Claims after the policy ends	Covered, with no time limit to report	Not covered unless you buy tail coverage
Limits	A fresh set of limits each policy year	One continuous aggregate limit that does not grow
Premiums	Typically stable over time	Start lower and rise over several years

Source: AANA Insurance Services.

Why this matters

A claim can be made long after the case. With an occurrence policy, a later claim is covered by the policy that was in force on the day of the case.

With a claims-made policy, a later claim is covered only if you still have that policy, or bought tail coverage. That is why tail is the term to check in every job change.

Tail coverage

Tail coverage (an extended reporting endorsement) gives you more time to report claims after a claims-made policy ends. AANA Insurance Services says you may need it if you leave an employer, retire or change coverage.

When you compare policies, include the cost of tail in the total. A cheap claims-made policy can cost more overall once the tail is added.

Who pays for the tail?

That depends on your contract. If your employer provides claims-made cover, confirm in writing who buys the tail when you leave.

Try to negotiate employer-paid tail, at least if the employer ends the contract without cause. See CRNA contract negotiation.

Limits of liability

Limits are written as two numbers: per occurrence and aggregate.

Per occurrence (per claim): the most the policy pays for one claim
Aggregate: the most it pays for all claims in the policy period

AANA Insurance Services says many CRNAs carry $1 million per occurrence and $3 million aggregate. Facilities and states may set their own minimums, so check before you buy or sign.

Employer policies vs your own policy

Employer-provided coverage

If your employer covers you under its policy, ask:

Is it occurrence or claims-made?
What are the limits, and are they shared with other clinicians or the group?
Who pays the tail if I leave?
Does it cover licensing board complaints?

Your own individual policy

Some CRNAs buy their own policy, especially 1099 contractors and locum CRNAs. Some employed CRNAs buy one as well, for extra protection or license defense. Talk to an agent about whether it makes sense for you.

Policy features to compare

AANA Insurance Services says policy terms can differ a lot between insurers. Compare these:

Consent to settle. Whether the insurer needs your consent before settling a claim
License defense. Coverage for licensing or disciplinary proceedings
Defense costs. Whether legal costs are paid inside or outside your limits
Who the insurer is. Coverage may come from admitted carriers, non-admitted carriers, captives or risk retention groups

Work with an agent who knows CRNA practice, and read the actual policy wording.

Reporting to the NPDB

When an insurer or other entity pays a malpractice claim for your benefit, federal rules require it to report the payment. The report goes to the National Practitioner Data Bank (NPDB) and the state licensing board.

Credentialing staff may check the NPDB when you apply to a facility or payer. See APRN credentialing.

What about premiums?

Premiums depend on your state, practice setting, policy type, limits and claims history. We do not publish price estimates. Get quotes for your own situation.

AANA reports that the average 2023 premium for self-employed CRNAs was 25% lower than in 1996. Adjusted for inflation through 2020, it reports a 71% reduction.

AANA resources

AANA Insurance Services offers malpractice coverage and plain-language articles for CRNAs. Topics include choosing a policy, occurrence vs claims-made, and coverage for 1099 CRNAs.

FAQ

Do I need my own malpractice insurance if my employer covers me?

Not always. Check the type, limits and tail terms of the employer's policy, then decide with an agent.

What happens if I skip tail coverage?

If your claims-made policy ends without a tail, a later claim from that period may not be covered. Check your policy before you let it lapse.

Is occurrence always better?

It removes the tail problem, but it can cost more each year. Compare total cost, including tail.

This page is general information, not legal or insurance advice. Read your policy and talk to a licensed agent.

CRNA Malpractice Insurance: What You Need to Know