Claims-Made vs Occurrence for Physician Assistants

Jeff Schmidt
Oct 6
6 min read

At a glance: claims-made vs occurrence for physician assistants

Many physician assistant malpractice policies are claims-made. They cover you only if the claim is filed while your policy is active and the incident occurred on or after your retroactive date. If you cancel or switch without protecting prior acts, you likely need tail coverage. Occurrence policies are simpler—no tail required—but are less common for PAs and typically cost more up front.

Fast links:

Why this choice matters

The structure you pick—claims-made vs occurrence for physician assistants—affects your premium today, your risk when you change jobs, and your exposure to late-reported claims. Get it right and you’ll maintain seamless protection across roles, employers, and states. Get it wrong and you could be paying out of pocket for defense and settlements years after an encounter.

Key definitions

Claims-made policy: Covers claims made and reported during the policy term for incidents that occurred on or after your retroactive date. When you stop or switch coverage, you may need tail coverage to protect prior acts.
Occurrence policy: Covers incidents that occur during the policy term—regardless of when the claim is filed. No tail is needed.
Retroactive date (retro date): The earliest date your claims-made policy will cover acts. Keeping your retro date when switching carriers preserves coverage for prior acts.
Tail coverage (Extended Reporting Period): A one-time endorsement that lets you report claims after a claims-made policy ends for acts that happened while it was active.
Prior acts coverage: When a new carrier accepts and lists your existing retro date, effectively carrying your prior exposure forward so you may avoid buying tail.

Claims-made vs occurrence for physician assistants: the short answer first

Claims-made is the norm for PAs because it is widely available and cost-efficient at common limits like $1,000,000/$3,000,000 and $2,000,000/$4,000,000.
You typically need tail coverage when you cancel or switch carriers and the new policy does not carry your retro date.
Occurrence is simpler—no tail required—but can be less available and often costs more per year.

Deep dive: claims-made for physician assistants

How it works in practice

A claims-made policy responds when both are true:

The alleged incident happened on or after your retro date, and
The claim is filed while your policy is in force (or during an extended reporting period you purchased).

Example: You assisted in a procedure in March 2024. The patient files in June 2026. If your policy is still active in 2026 (or you bought tail) and your retro date predates March 2024, you’re covered. If you canceled in 2025 and didn’t buy tail or secure prior acts, there’s likely no coverage.

Why many PAs choose claims-made

Availability: Most carriers serving PAs offer claims-made as their standard option.
Cost curve: Premiums typically “step up” over the first few years, then level off.
Flexibility: If you maintain your retro date across carriers, you can change employers without buying tail.

When claims-made gets risky

Switching carriers and losing your retro date.
Employer changes where the new coverage won’t carry prior acts.
Career breaks (sabbaticals, maternity/paternity leave, relocation) where you cancel coverage entirely.

Deep dive: occurrence for physician assistants

Why some PAs want it

Simplicity: If an incident happened during your policy term, you’re covered—even if the claim surfaces years later.
No tail: You can cancel or move on without buying tail for past acts.

Tradeoffs to expect

Price: Occurrence policies are often more expensive at the same limit.
Availability: Some markets simply don’t offer occurrence to PAs.
Less control over options: With fewer occurrence carriers, you might have fewer choices on endorsements or defense provisions.

Tail coverage for physician assistants: what to know

The basics

Tail is usually a one-time premium, commonly referenced as 150–200% of your expiring annual premium (ranges vary by market and tenure).
Tails can be time-limited (e.g., 3 years, 5 years) or unlimited.
Some carriers offer free or discounted retirement tails after you meet a combination of age and continuous coverage years.

When tail is typically required

The new carrier won’t accept your retro date.
You’re retiring or taking an extended break and do not plan to maintain an active policy.
An employer’s group policy terminates and does not extend tail to individual clinicians.

Practical tips

Negotiate tail in your employment contract before you accept the role.
If switching, ask if the new carrier will endorse prior acts and explicitly list your retro date on the declarations page.
Time your cancellation and new effective date to avoid gaps measured in hours—not just days.

Cost comparison (illustrative)

Policy structure	Typical availability for PAs	Premium dynamics	Tail needed?	Good fit
Claims-made	High	Lower early years; steps up; levels off	Yes, if retro date not carried	Early career, job changes, broader carrier options
Occurrence	Moderate/low	Higher per year	No	Long-term stability, simplicity preference

Defense, limits, and the fine print that actually matters

When comparing claims-made vs occurrence for physician assistants, structure is only half the equation. Also check:

Consent to settle: Do you control settlement decisions, or can the insurer settle without your consent? Watch for “hammer” clauses.
Defense costs: Are legal fees inside your liability limits (eroding) or outside (in addition)?
Shared vs individual limits: Employer policies may share aggregate limits across many clinicians.
Board/licensure defense: Does your policy include administrative defense if a complaint is filed with your state board?
Telemedicine and multi-state work: Confirm you’re covered across state lines and for virtual care.
Endorsements: HIPAA defense, deposition expense, subpoena assistance, cyber/privacy—know what’s included and what’s extra.

Employer coverage vs your own policy

Employer coverage is useful, but it’s built around the employer’s risk. Common gaps include:

Moonlighting or telemedicine outside the employer’s facility.
Shared aggregates that can be exhausted by another claim.
No tail for you when you leave.
No board defense for administrative complaints.

Many PAs carry a personal policy to control limits, defense, and continuity across roles.

Real-world scenarios

Switching jobs without prior acts. You move from Hospital A to Clinic B. Clinic B’s carrier declines your retro date. Without buying tail from Hospital A’s carrier, you have a gap for all prior work.

Shared aggregate exhausted Your employer’s policy is hit by multiple claims in a policy year. By the time you’re named, there may be little or no aggregate limit left. A personal policy can mitigate this.

Telemedicine expansion You add weekend telehealth shifts in a neighboring state. The employer’s policy may not extend or may exclude out-of-facility work. Your own policy can schedule multi-state coverage and telemedicine endorsements.

Choosing like a pro: a quick decision framework

Map your next 24 months. Are you likely to change jobs, add telemedicine, or relocate?
Compare policy structures side by side. Claims-made vs occurrence, including total 3-year cost with potential tail.
Get the retro date in writing. If a new carrier accepts your prior acts, confirm the retro date on the dec page before canceling the old policy.
Clarify tail responsibility. Employer, employee, shared, or waived at retirement. Put it in the offer letter.
Check defense and endorsements. Consent to settle, defense inside/outside limits, board defense, HIPAA, cyber, telehealth.

Frequently asked questions

Is occurrence always better because it avoids tail? Not always. Occurrence may be more expensive and less available. Many PAs get excellent outcomes with claims-made plus prior acts continuity.

If I keep my policy active during a job change, do I still need tail? If your retro date is preserved on the new policy and there’s no lapse, you typically do not need tail.

How big is a typical tail premium? Ranges vary. A common reference is 150–200% of the expiring annual premium, but your figure depends on tenure, carrier, and whether you qualify for retirement provisions.

Can I buy tail later if I skip it now? Tail usually must be purchased immediately after cancellation (or within a short window defined by your carrier). Miss that window and it may not be available.

Do I need my own policy if my employer covers me? Many PAs still choose a personal policy for moonlighting, board defense, non-employer work, and independent control of limits and settlement.