What is Tail Coverage Medical Malpractice?


Medical malpractice insurance is replete with intricacies, and one of its most nuanced aspects is “tail coverage.” Understanding this coverage is crucial for healthcare professionals navigating potential gaps in their insurance protection. This article seeks to elucidate the specifics of tail coverage in medical malpractice, tailor-made for an attorney-focused audience in the U.S.

1. Understanding the Basics of Tail Coverage

Tail coverage, formally known as an Extended Reporting Period (ERP) endorsement, provides insurance protection for claims reported after a claims-made policy has been terminated but stem from incidents that occurred while the policy was in effect.


2. The Necessity of Tail Coverage

To understand the significance of tail coverage, one must first grasp the nature of claims-made policies:

  • Claims-made policies only provide coverage for incidents that occur and are reported while the policy is active.
  • Once the policy ends (due to cancellation, non-renewal, or switching insurers), there’s no coverage for claims reported after that—even if the alleged malpractice occurred during the policy period.
  • Tail coverage fills this gap, ensuring that professionals are protected from late-reported claims tied to their prior policy period.

3. Duration and Scope of Tail Coverage

The specifics of tail coverage can vary based on the insurer, but commonalities include:

  • Duration: Many tail policies offer indefinite coverage, meaning they’ll cover any claim reported in the future as long as the incident occurred during the original policy period. Some offer limited-duration tails, lasting 1-5 years.
  • Coverage Limits: Typically, the limits of the tail policy mirror the boundaries of the original claims-made policy.

4. When is Tail Coverage Needed?

Tail coverage becomes paramount in various scenarios:

  • Retirement: When a medical professional retires, they no longer need an active malpractice policy but protection from potential future claims tied to their years of practice.
  • Changing Jobs: If a healthcare provider moves to a new employer with a different insurance carrier or policy type, tail coverage can cover the transition period.
  • Switching Insurance Types: Transitioning from a claims-made to an occurrence policy necessitates tail coverage to bridge the coverage gap.

5. Cost Implications

Tail coverage is renowned for being pricey, often costing:

  • Between 100% to 300% of the annual premium of the claims-made policy.
  • However, some insurers offer “free” tail endorsements after a policyholder has been insured for a specified period (e.g., five years).

6. Alternatives to Tail Coverage

While tail coverage is the most direct way to address post-policy claims, other alternatives include:

  • Nose Coverage (Prior Acts Coverage): When switching to a new insurer, some professionals opt for a policy that includes coverage for prior acts, eliminating the need for a separate tail policy.
  • Occurrence Policies: These policies cover any incident that occurred while the policy was active, regardless of when the claim is reported, thus sidestepping the need for tail coverage. They tend to be more expensive than claims-made policies but can be cost-effective in the long run.

7. Negotiating Tail Coverage in Employment Contracts

Healthcare professionals, especially when joining larger institutions or groups, should:

  • Clarify Tail Responsibilities: The employment contract should specify who—employer or employee—is responsible for purchasing tail coverage upon the termination of employment.
  • Seek Legal Counsel: Given the financial implications of tail coverage, seeking legal advice during contract negotiations is advisable.

8. Tail Coverage: Not Just for Physicians

While physicians are the most discussed in tail coverage, other healthcare professionals—including nurses, therapists, and physician assistants—should also consider its protections, especially if they carry individual malpractice policies.


Tail coverage, with its intricate layers and stipulations, is a pivotal facet of medical malpractice insurance. By comprehending its nuances, healthcare professionals can ensure continuous protection, safeguarding their careers and financial futures.