Key takeaways
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Most PAs select 1,000,000 per claim and 3,000,000 aggregate limits.
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Claims-made policies dominate PA malpractice; know how tail coverage works.
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Employer policies may exclude board complaints, telehealth, or moonlighting.
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Cost drivers: state, setting, specialty, procedures, hours, claims history.
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Add ons to evaluate: license defense, regulatory defense, HIPAA defense, cyber, HNOA.
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What is Physician Assistant malpractice insurance?
TLDR: PA malpractice (professional liability) defends clinical allegations like misdiagnosis, medication errors, and documentation gaps, and pays covered settlements up to your limits.
Physician Assistant malpractice insurance—often called professional liability—protects you against claims of negligence tied to patient care. It funds defense counsel and, if necessary, pays settlements or judgments within your policy limits.
Professional vs General Liability:
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Professional Liability: Misdiagnosis, prescribing errors, documentation issues, procedural complications.
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General Liability: Non-clinical bodily injury or property damage, like a visitor slip and fall.
Why Physician Assistants need tailored coverage
TLDR: Risk varies by state, setting, supervision, and procedures. A tailored policy matches your real work and closes gaps left by employer coverage.
PAs practice across hospitals, urgent care, ER, dermatology, orthopedics, and telehealth. Each carries different exposures. State supervision laws, prescriptive authority, and board oversight vary widely. A personal, tailored policy ensures that all your roles, including moonlighting and telemedicine are protected. A tailored policy should match your day to day realities:
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Expanded responsibilities: ordering tests, prescribing, minor procedures.
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Supervision variance: state rules differ.
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Multi-site work: hospital shifts plus urgent care or telemedicine.
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Regulatory scrutiny: board complaints, license actions, documentation audits.
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Core coverages to look for:
TLDR: Start with professional liability; add license defense, regulatory defense, HIPAA defense, general liability, cyber, and HNOA based on your practice model.
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Professional liability
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Defense and indemnity for clinical allegations.
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License and board defense sublimit for complaints and investigations.
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Regulatory proceeding defense for administrative actions.
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HIPAA defense for privacy allegations where included.
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Good Samaritan and personal injury where included.
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General liability
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Premises and operations exposures in clinics, suites, and shared spaces.
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Often required by landlords and facility agreements.
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Cyber liability
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Breach response, forensics, patient notification, and business interruption.
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Complements any HIPAA defense embedded in malpractice.
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Hired and non-owned auto
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If you or staff use personal vehicles for work errands or mobile visits.
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Consent-to-settle clause
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Pure consent means the carrier cannot settle without your written approval.
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Hammer clauses can reduce the carrier contribution if you decline a recommended settlement.
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Key policy variables to confirm: defense costs inside or outside the limits, deductibles or retentions, coverage territory, retroactive date, and excluded procedures.
Claims-made vs occurrence and tail
TLDR: Claims-made is more cost effective early on and is common to see for PAs. Keep your retro date intact when switching. Occurrence avoids tail but often costs more up front. Either option through our quoting portal should be very competitively priced.
Claims-made
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Responds when a claim is made, provided the incident occurred after your retroactive date and during the covered period.
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If you cancel or change carriers and do not carry prior acts, you must secure tail coverage to keep prior work protected.
Occurrence
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Responds based on the date of treatment. No tail is required.
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Less common for PA malpractice and can be more expensive initially.
Tail coverage
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One-time extended reporting period for your expiring claims-made policy.
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Useful when retiring, taking extended leave, or moving to a carrier that will not honor your retro date.
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Ask about free retirement tail provisions based on age and continuous years insured.
TLDR: Job changes, retirement, carrier switches, and leaving employer-only coverage are the most common tail triggers. Avoid gaps and compare tail vs carrying your retro date.
Practical tips: align tail effective date exactly with cancellation, keep proof of continuous coverage, and save all declarations pages.
Tail Triggers Matrix
TLDR: Job changes, retirement, carrier switches, and leaving employer-only coverage commonly trigger tail. Avoid gaps; compare tail vs carrying your retro.
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New job + new carrier → Prior claims-made ends → Ask new carrier to carry retro date; if not, buy tail.
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Retiring or long leave → No new care but past acts remain → Request retirement tail or limited tail.
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Moving states → Venue/licensing change → Confirm new carrier honors retro and territory.
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Leaving employer-only coverage → No personal policy prior → Ask employer’s carrier about tail; secure your own going forward.
Practical tips: Align tail start exactly with cancellation; keep all declarations pages; document continuous coverage.
Consent-to-Settle and Hammer Clauses
TLDR: Consent to settle gives you control. Hammer clauses can shift significant costs to you if you decline a recommended settlement.
Illustrative example
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Proposed settlement: $300,000
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You decline in order to protect reputation
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Trial verdict: $500,000
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Hammer at 70% → carrier may cap indemnity at $210,000; you may owe the rest (policy specific)
Ask your carrier
Do I have pure consent or a hammer clause? If hammer, what percentage? Are defense costs affected? Any exceptions for unilateral settlement?
License and Regulatory Playbook
TLDR: Preserve records, notify your carrier, cooperate with counsel, and provide a clean chronology. Early organization improves outcomes.
Day 0
• Do not alter records. Preserve EMR, messages, imaging, referrals, audit trails.
• Notify your carrier per policy conditions.
• Do not contact the complainant directly.
Days 1–7
• Provide a concise chronology.
• Gather chart notes, orders, prescriptions, results, phone logs, triage forms, consent forms, discharge instructions, referral confirmations.
• Identify witnesses and involved staff.
Days 7–30
• Follow counsel’s strategy for the board response.
• Complete recommended CME or remedial steps.
• Notify employer and credentialing bodies as required by contracts.
Top Claim Scenarios and Prevention
TLDR: Most losses arise from escalation misses, follow-up failures, med errors, and documentation gaps. Standardize your workflows.
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Triage error or delayed escalation → Intake red flags, vitals thresholds, warm handoffs
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Missed or delayed diagnosis → Document differential, safety-net instructions, timed follow-up
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Medication error → Allergy and interaction checks, weight-based dosing, teach-back
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Failure to follow up on abnormal results → Central results worklist, documented outreach attempts, escalation plan
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Procedure complication → Timeout checklist, sterile technique, consent covering risks and alternatives, post-procedure instructions
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Documentation gaps → Standardized note template, explicit return precautions
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Telemedicine boundary issues → Confirm identity and location, licensure verified, platform with logs, emergency protocol
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Referral breakdown → Reason and urgency documented, receiving provider confirmation, patient instructions
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Cross-setting communication breakdown → Shared care plan, read receipts, tasking
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Cosmetic or aesthetic complications → Product tracking, pre and post photos, complication kit readiness, clear risk counseling
Documentation Gold Standard Template
TLDR: Your note must show clinical reasoning, close the loop on results, and make next steps unambiguous. Chart what you thought, what you did, what the patient understood, and how you will ensure follow-up.
1) Core principles
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Be specific and timely; if it isn’t documented, it didn’t happen.
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Capture red flags asked/answered and patient understanding (teach-back).
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Translate plans into plain language with exact time frames.
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2) Fast SOAP + MDM template
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Subjective: onset, duration, severity, key negatives, prior treatments.
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Objective: vitals, pertinent exam tied to HPI; brief test interpretation.
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Assessment: working diagnosis + 2–3 differential items with “because” notes.
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Plan: tests (who reviews/by when), meds (dose/route/duration + counseling), referrals (to/urgency/who schedules), follow-up interval, return precautions, shared decision.
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Tasks: create result-review and outreach tasks with due dates.
3) Results and follow-up (close the loop)
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Daily worklist → review → act → document contact attempts.
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If abnormal/urgent: same-day call; second attempt + portal; certified letter if critical.
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Note “Result reviewed with patient on __; plan adjusted: __.”
4) Consent and procedures (one line each)
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Consent: “Indication, risks/benefits/alternatives reviewed; questions answered; teach-back OK; patient consented.”
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Procedure skeleton: indication; site/side; timeout; anesthesia; technique; findings; complications none; instructions given; follow-up __.
5) Telemedicine essentials
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“Identity/location verified in __; licensure verified; platform __; consent obtained; remote exam limits noted; ED plan given.”
6) Refusal/AMA shorthand
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“Discussed risks of declining __ including __; alternatives offered; teach-back OK; capacity intact; return precautions provided; patient declined to sign AMA form.”
7) One-minute checklist
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Differential shown
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Specific follow-up time set
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Return precautions in plain English
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Teach-back documented
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Tasks created for results/callbacks
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Abnormal results closed with patient notified
Telemedicine Safeguards
TLDR: Venue = patient location. Prove licensure, informed consent, audit trails, and escalation thresholds in every note.
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Confirm venue and authority: Document the patient’s state and physical location at start; chart your licensure or authorization for that state on every tele-encounter.
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Explicit telehealth consent: Obtain and document telemedicine consent (risks/limits, privacy, recording status); renew annually or when scope changes.
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Audit-ready platform: Use a platform that time-stamps, logs IP/session IDs, captures consent, and exports access logs for discovery. Avoid consumer apps lacking audit trails.
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No “silent recording” risk: State whether the encounter was recorded. If recording is off, document “no recording” to prevent discovery disputes.
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Remote exam limits + thresholds: Spell out what you could not examine and list red-flag thresholds for in-person evaluation or ED transfer (e.g., O2 < 94%, new neuro deficit).
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Emergency protocol on file: Keep a one-click nearest ED list by ZIP; document what the patient should do after hours and how to reach you.
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Cross-state practice controls: Maintain a licensure/compact map, disable scheduling for non-licensed states, and disclose cross-state practice to underwriting.
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PHI handling: Use BAAs with vendors, restrict copy/paste of PHI into chat tools, and set data retention that matches your state’s medical record rules.
Underwriting Transparency and Pricing Ladders
TLDR: A complete, clean submission lowers friction and price; risk credits exist if you can prove disciplined workflows.
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Submission pack (wins credibility): Current CV, loss runs (5–10 yrs) or “no known losses” letter, procedure list (with volumes), site list (addresses, hours), supervision framework, telemed policy, and any CME certificates (risk, prescribing, injectables).
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Common debits to know about: high-severity venues, after-hours solo coverage, injectable/cosmetic volume spikes, poor follow-up workflows, open board matters, gaps in coverage.
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Common credits available: risk-management CME, closed-loop results tracking, standardized consent templates, photo/lot tracking for aesthetics, clean loss runs, defined escalation thresholds.
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Underwriter “green flags”: retro date continuity, stable hours, limited high-risk procedures, peer review or chart audits, and documentation snippets that show differential + return precautions.
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Pricing ladders (illustrative, not quotes):
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New-grad clinic FT, low risk → low hundreds (yr 1–2).
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Derm/aesthetics PT (injectables) → low–mid thousands.
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ER or urgent care multi-site → mid thousands (procedure mix, venue).
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Telemed multi-state with good controls → upper hundreds–low thousands.
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How Much Physician Assistant Insurance Costs
How to Use This Pricing Estimate Table:
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Pick your row first (work status + tier). This captures ~80% of pricing reality in one move. Tier is about clinical exposure:
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P1 (primary care / low-risk): Routine outpatient, limited procedures, standard supervision, predictable volumes.
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P2 (moderate-risk ER/UC/procedural): ER/urgent care, hospitalist, orthopedics with injections, minor invasive procedures, variable acuity.
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P3 (higher-risk trauma/aesthetics/complex): Trauma exposure, aesthetics/cosmetics or more complex procedures, multi-site/high volume, tighter underwriting.
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Then pick your column (limits). Limits are a straightforward lever: in this dataset, stepping from $1M/$3M → $2M/$4M adds about 20%, while dropping to $500k/$1M reduces ~15%, and $100k/$300k cuts price roughly in half.
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Venue still matters. These are average rates. Expect upward drift in high-severity venues and downward drift in low-severity markets.
Choosing Limits:
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Common default: $1M/$3M is the most typical choice for PAs.
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When to consider $2M/$4M: Higher-risk procedures (P2/P3), litigious venues, or hospital privileging requirements. Expect ~+20% increase in price.
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When $500k/$1M can be rational: Low-risk P1 roles in low-severity venues with tight budgets—provided institutional requirements allow it.
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Why $100k/$300k is rare: It halves premium but may not meet facility or contract minimums and meaningfully reduces protection.
Employer Policy vs
Personal Policy for Physician Assistants
TLDR: Employer coverage protects the entity; your own policy protects you.
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Whose limits? Employer policies often have aggregate limits shared across many clinicians; a personal policy gives you dedicated limits.
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Who controls settlement/counsel? Employer: entity first, possible hammer clause. Personal: seek pure consent to settle and defense outside limits.
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Moonlighting/telemed: Commonly excluded under employer policies. A personal policy can schedule multiple sites, include telemedicine, and issue COIs.
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Tail on exit: Leaving employer-only coverage can require employer-paid tail; confirm in writing. Personal policies can carry retro to avoid tail buys.
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License/regulatory defense: Personal policies more often include board/OPR sublimits with earlier triggers.
Coverage Selection Checklist for Physician Assistant Malpractice Insurance
TLDR: Choose terms that protect your Physician Assistant license and reputation, not just price.
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Defense costs outside limits for PA liability claims
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Consent to settle = pure consent (or know hammer %)
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Physician Assistant license/board defense ($25k–$100k+) and regulatory defense
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Telemedicine wording that follows patient location for PA telehealth
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All PA practice sites/DBAs listed; COIs available
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Cyber, HNOA, aesthetics/procedure endorsements if your PA practice needs them
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Retro date correct on the PA dec page; tail eligibility understood
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Exclusions reviewed (experimental procedures, punitive damages in some states)
Switching Carriers: Physician Assistant Prior Acts vs Tail Coverage
TLDR: Preserve Physician Assistant prior acts (retro date) or buy tail—never leave a gap.
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60–90 days: Request quotes; ask each to carry your PA retro date.
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30 days: Pull PA loss runs; resolve open/closed status.
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Bind with same PA retro date; verify on your declarations page.
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If retro not carried, buy PA tail coverage; align times precisely.
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Save a credentialing pack (old/new PA dec pages, tail endorsement, loss runs, COIs).
Moonlighting Compliance for Physician Assistants
TLDR: Disclose PA sites and services, match coverage to reality, keep COIs moving.
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If you are covered by an employer's policy, you most likely need to purchase your own, separate professional liability policy
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Tell underwriting your Physician Assistant sites, procedures, hours, 1099/W-2 status, and telemedicine states.
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Schedule each PA location/procedure; update mid-term if exposure changes.
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Provide PA COIs (and additional insured language) to contracting groups.
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Keep a simple Physician Assistant activity log (site/hours/procedures).
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Cross-border PA work: confirm licensure and policy territory per state.
50 State Specific Links
The below links will take you to state specific physician assistant insurance pages. Click your state to learn more about rules and regulations, pricing, best practices and more: