Physician Assistant Malpractice Coverage: A Practical Guide

July 11, 2019 •

As a physician assistant, one of your responsibilities is to work closely with patients and doctors to determine the best course of treatment. In many situations, you’re left entirely to your own devices to diagnose and medicate the patient properly. It’s a job with heavy responsibilities, and PAs are rewarded handsomely with a high salary and strong job security. The downside to this responsibility is that one mistake can cost you tremendously. For this reason, it is extremely important for physicians assistants to have a malpractice policy.

Malpractice lawsuits have an average court settlement well over $400,000. Paid out of pocket, this will send even the most frugal PA well into debt and possibly ruin their career. To avoid this, you need malpractice insurance.

Why Do You Need Physician Assistant Malpractice Insurance

You might think that as long as you practice carefully and stay on top of your patients, malpractice lawsuits won’t come your way. Unfortunately, this view is now a signal of naivete among medical professionals.

Only 13% of physicians were not surprised when the lawsuit reached them, according to a survey of over 4,000 doctors taken by Medscape. The other 87% were either somewhat surprised or very surprised. Additionally, a doctor can make a mistake and feel surprised when a claim comes in, especially if the damages are delayed after treatment. This means that there are other reasons these malpractice suits are coming in, other than a healthcare mistake.

There are, according to a paper published by Baylor University Medical Center, four reasons these malpractice suits are becoming increasingly detrimental.

  • Clarification about injury – When patients feel that there was information withheld from them, they have the option to sue for clarification. This type of medical malpractice lawsuit can be prevented by better patient-physician communication.
  • Preventing a mistake from happening to someone else – When something negative happens to us, it’s only natural to think of others who’ve suffered the same. This proves double when a doctor or physician assistant makes a mistake. Many lawsuits have boiled down to the patient not wanting the same mistake to happen to someone else.
  • Financial compensation – Injuries have immediate financial implications for a lot of patients. It may prevent them from working or cause damage to future prospects. Also, many serious injuries come with lifelong medication and treatment. For this, patients will sue doctors for financial compensation.
  • Desire to hold doctors accountable – Nobody is above the law, and that includes doctors and physician assistants. Patients feel that if there was a mistake in their healthcare, then that medical professional should be held accountable.


What Can PAs do to Lower the Risk of a Malpractice Suit

To lower the risk of a malpractice suit, the number one suggestion is better communication.

  • Align Expectations – It’s common knowledge that no surgery is a “safe” surgery. Every operation comes with risks, and every time you’re put under anesthesia, there’s a chance you won’t wake up. However small these risks may be, they need to always be communicated with the patient. The same should be true for any diagnosis or treatment ramifications. Doctors should always align expectations with reality before proceeding.
  • Disclosing medical errors – Disclosing unfortunate news is one of the toughest parts of a physician assistant’s job, especially when they made the error. Some professionals find that experience helps. Others say it never gets easier. Either way, it must be done. Otherwise, when complications arise, your patient will be confused and scared, and they will have even more grounds to sue.
  • Diffusing angry patients – Patients who are exceptionally difficult to manage and prone to anger present specific challenges to communication. However, avoiding these patients or arguing back are surefire ways to start a lawsuit. The best advice when dealing with difficult patients is to listen, empathize, and disclose everything in a straightforward manner.
  • Apologize – Apologizing isn’t always a form of admitting fault. Apologizing is a way to empathize with patients. It’s a way to let the patient know that if there was anything more they could have done, they would have done it. It’s what patients expect after suffering bad news—whether what they’re experiencing is circumstantial or not.


When Communication is Not Enough

In the end, despite truthful communication and double-checking all your work, there is still a chance you will be sued. More and more, patients are suing not because they believe a physician made a mistake, but because they had adverse outcomes. Although, it’s important to keep in mind that doctors are required to be honest and cannot be sued solely for telling a patient the truth about their diagnosis. What’s particularly troubling about this notion is that doctors can be sued for offering the truth about an unfortunate diagnosis and be sued for withholding the truth (although, withholding the truth is admittedly worse).

For this, there’s only one recourse. Having a strong defense.


Malpractice Insurance for Physician Assistant

So far, this has been a grim picture. But much like physicians dealing with their patients, it’s better to speak truthfully and directly. Malpractice suits can trudge on for months, taxing your personal and professional life. And with the costs of a trial astronomical, every medical malpractice lawsuit is high-risk however unlikely it is to win.

That’s why medical personnel, including physician assistants, nurses, and med students, all need to have malpractice insurance. The next question is then, which insurance policy do PAs need? To answer this, let’s dive into the two different types of policies.

  • Claims-made policies
  • Occurrence policies


Claims-Made Policy

Having claims-made insurance offers you what you expect from an insurance policy. If you have the insurance and you are sued over an incident that’s within your coverage, you are protected. This policy, however, does not protect you if the incident is outside your coverage policy or if you terminate the policy and then get sued.

It’s a pay-as-you-go insurance for healthcare professionals that’s cheaper than an occurrence policy but does require more oversight.

  • Tail coverage – If you plan on switching hospitals, switching insurers, taking a break from practicing, or retiring, you must purchase tail coverage to stay insured. If you do not and are sued (even after you retire), you will be liable to front the court costs, legal fees, and any settlement that arises. Tail coverage can range from expensive long-term tails to free retirement tails. It depends on the insurance company and malpractice history.
  • Nose Coverage – On the flip side, if you are switching policies, you may need to purchase nose coverage to cover all prior acts. If you don’t, all incidents before the new policy date will suddenly be uninsured.


Occurrence Policy

The other type of insurance you can obtain is an occurrence policy. Having an occurrence policy in 2012 means that the insurance company will cover any incident that arises from malpractice in 2012. It doesn’t matter if the lawsuit comes in 2013, 2023, or 2073. As long as the insurer is in business, it is covering you.

For many people, occurrence policies are less of a headache because there’s never any question whether you have coverage or not. However, this peace of mind is afforded with a more expensive policy. This is just one of the few downsides of occurrence policies.

  • Unforeseeable future – It’s hard to know what medical advancements will take place in a matter of five years. In some five-year chunks not much happens. Other times, massive explosions of technological advancement fill a hospital. When this happens, a resurgence of malpractice suits arises due to new knowledge that could have prevented some error in a patient’s healthcare. This isn’t always covered in older insurance policies, making occurrences riskier.
  • Statute of limitations – The reason most physician assistants choose claims-made policies is that states now have a relatively short statute of limitations. In some states, it’s as little as two years, in others six. The original appeal of occurrence policies is that after 40 years, you could still be covered. Now, that’s an unnecessary amount of coverage.


Sources of Coverage

It’s generally considered safe practice to have two forms of physician assistant malpractice coverage. The first is a group policy enacted by your employer, while the second is personal insurance.


Group Policy

When you join a hospital or private practice, one of the benefits of working full-time is usually malpractice coverage. Always, always, always request a full copy of the insurance policy to ensure that it covers the litany of incidences. Also, confirm that your name is registered under the policy—any mistake and you could be uninsured without knowing it.

Some things to know about group policies:

  • The interests lie in the organization instead of the individual
  • Attorneys will have your best interest in mind unless it negatively affects the hospital
  • The premiums will be covered by the hospital
  • Deciding who takes priority when you have both individual and group policies can be a headache


Individual Policy

If you want an additional safety net, there are individual policies available. Depending on your employer, you may be able to get them covered or at a reduced price. With a personal plan, you are able to decide what coverage you receive and how the policy is written. Those who are risk-averse can pay extra to have comprehensive coverage.

Additional points about individual policies:

  • They can cover you when working part-time or volunteering at clinics
  • Attorney will have your best interest in mind
  • Individual and group policies always stack, never conflict


Insurance Carriers

Insurance carriers can be rated in a number of different areas. The most important thing to keep in mind is its financial security rating. This can be denoted by A++, A+, A, A-, B++, and all the way down the alphabetic chain.

Remember that an insurance company can only cover you if it has the funds to do so. If the insurance carrier goes bankrupt, you will suddenly find yourself uninsured.


Special Coverage

The average cost of physician assistant malpractice coverage settles around thousands of dollars annually, depending on the state and your prior history. However, this number can be reduced in circumstances where you are qualified for special coverage. The three most common cases are:

  • Student Coverage
  • Newly Graduated Coverage
  • Gap Coverage


Student Coverage

While a student, you’re likely to have clinicals. This is when you shadow other physician assistants as they tend to patients. You will be given simple tasks and eventually work with real people. When this happens, you are liable for any malpractice mistakes. Although it’s unlikely that you’ll be put into a situation where you will be at fault, there’s no reason not to be covered.

Student malpractice insurance can be as low as $35 annually or free through some insurance companies.


Newly Graduated Rates

When purchasing claims-made coverage, new grads will often receive discounts for the first three to five years. This is because the premiums haven’t matured to cover the statute of limitations (the number of years depends on the state).

Be sure to take advantage of these premiums while you can.


Gap Coverage

The last discount commonly found is special rates when jumping between jobs or insurers. Gap coverage, otherwise known as asset guard, keeps you protected during these gaps of no formal insurance.


Job Duties

The reason physician assistants desperately need malpractice coverage is because of their job responsibilities. In smaller towns where doctors take weekends and half-days, physician assistants are there to cover the remaining hours. In larger hospitals, PAs can cover patient loads and diagnose patients as needed.

For this alone, malpractice insurance should be a must-have. If additional reasons are needed, here are other areas where a PA’s job demands coverage:

  • Conducts physical exams for patients
  • Writes prescriptions and fills out medication
  • Diagnoses illness and plans treatment
  • Assists surgeon in operating room
  • Leads emergency room when physician is not on call.


  1. Medscape. Malpractice: When to Settle a Suit and When to Fight
  2. Medscape. Medscape Malpractice Report 2017
  3. NCBI. Communication gaffes: a root cause of malpractice claims
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