Buying medical malpractice insurance

Buying malpractice insurance is not a search for the lowest premium. It is a comparison of the physician and practice the carrier agreed to insure, the dates on which the policy may respond, the limit and defense structure available for a claim, and the price for those terms. The policy-reading sections apply nationally. The filed-rate, damage-cap, settlement-reporting, and market examples are specific to California.

At a glance

Compare the same people, entities, services, locations, dates, limits, and defense treatment in every quote. A lower price can describe a different policy.
For claims-made coverage, check the effective date, retroactive date, claim and reporting definitions, prior-acts terms, related-claim language, and any ERP or tail option before prior work loses its reporting path.
Read the declarations, insuring agreement, limits, exclusions, conditions, and endorsements together. An application or broker email does not replace the issued policy, and a certificate does not amend, extend, or alter coverage.
Use historical filed rates to understand a premium input, not to predict a current quote. Underwriting, eligibility, later filings, taxes, fees, endorsements, and the issued quote control.

The Doctors Company figures below come from its California physician rate manual approved in August 2014. They are historical filed-manual examples, not current quotes, product availability, or coverage terms.

Choose the policy limits

A medical malpractice policy usually states two limits. The per-claim limit is the most the policy pays for one covered claim, subject to how defense expenses, deductibles or self-insured retention, and endorsements apply. The aggregate is the most it pays for covered claims during the stated policy period, subject to the same terms.

The Doctors Company filing uses $1 million per claim and $3 million aggregate as its base limit pair. Check each employment, facility, and payer contract for its required limits.

What a higher limit costs in one California filing

The filed limit table applies a multiplier to the $1M/$3M base premium:

Per claim / aggregate	Factor	Internal Medicine, Territory B (LA/Orange)	Obstetrics & Gynecology, Territory B
$500K / $1.5M	0.880	$7,281	$43,828
$1M / $3M	1.000	$8,274	$49,804
$2M / $5M	1.250	$10,343	$62,255
$3M / $6M	1.396	$11,551	$69,526

Factors: The Doctors Company, California Rate Pages, Edition 10/14, p. CA-R-2 (Limits of Liability table); CDI filing DCTR-129531290, approved 2014-08-07. Base rates: same filing, p. CA-R-1. Premium columns are the base rate times the factor, rounded to the dollar. These are 2014-manual mature claims-made base rates before any credits or debits.

For this internal medicine example, moving from $1M/$3M to $2M/$5M adds $2,069. Moving from $2M/$5M to $3M/$6M adds $1,208. Each option changes both the per-claim and aggregate limits.

Reducing the limits from $1M/$3M to $500,000/$1.5 million reduces the premium by 12 percent. It reduces the per-claim limit by 50 percent. In this historical table, the $500,000/$1.5 million option is available; the lowest listed options have different availability rules.

When to consider higher limits

An employment, hospital, surgery-center, or payer contract can set the minimum limit. The declarations and endorsements state which insureds share the per-claim and aggregate limits. The quote states the premium for each available option.

Request the exact premium for each limit option. Compare the additional cost with the contract requirements, number of insureds, procedure volume, and personal exposure.

California Civil Code section 3333.2 applies separate collective caps to the provider, institution, and, in limited qualifying circumstances, unaffiliated categories; affiliation and facts control. The 2026 limits are $470,000 for injury and $650,000 for wrongful death. Economic damages, such as medical costs and lost earnings, remain uncapped. Read the California medical malpractice payment trends.

Compare California filed rates by specialty and territory

TDC uses five California territories defined by county. Territory A includes Riverside and San Bernardino. Territory B includes Kern, Los Angeles, Orange, and Ventura. Territory C includes Imperial and San Diego. Territory D includes the listed Bay Area and central coast counties. Territory E includes the remainder of the state.

Annual mature claims-made base premium at $1M/$3M, ten representative specialties:

Specialty	A	B	C	D	E
Psychiatry	$6,650	$6,741	$4,712	$3,049	$3,505
Internal Medicine	$14,427	$8,274	$9,730	$5,765	$6,622
Family/General Practice (No Surgery)	$11,009	$9,158	$7,447	$4,735	$5,284
Anesthesiology	$17,051	$12,128	$10,472	$5,987	$7,698
Emergency Medicine	$36,507	$23,742	$19,993	$11,257	$15,754
Plastic Surgery	$34,468	$29,738	$23,641	$17,592	$17,592
Orthopedic Surgery (No Spinal)	$43,208	$34,021	$28,342	$17,120	$19,917
General Surgery (All Other)	$51,183	$41,775	$35,273	$19,860	$24,223
Obstetrics & Gynecology	$67,235	$49,804	$41,128	$25,190	$29,447
Neurosurgery	$85,898	$68,380	$55,364	$33,770	$37,173

Source: The Doctors Company, California Rate Pages, Edition 10/14, pp. CA-R-1 to CA-R-2; CDI filing DCTR-129531290, approved 2014-08-07. Public record, California Department of Insurance. These are historical 2014-manual mature claims-made base rates before claims-free, new-to-practice, part-time, and risk-management credits and before schedule rating. They do not establish a current rate or quote.

The full 48-class physician table is also available as an interactive county lookup: California malpractice rates by specialty and county.

The four-carrier comparison shows ten specialties for Los Angeles and Orange, San Diego, and San Francisco. It identifies each manual date and leaves a cell blank when no comparable filed rate exists.

The tail estimator applies filed factors by carrier and claims-made maturity year.

Within one territory, the neurosurgery base rate is about thirteen times the psychiatry rate. The OB-GYN base rate is $67,235 in Riverside and $25,190 in San Francisco. The same specialty can therefore have a 2.7-to-1 rate difference between these territories.

Ten years of unchanged California manual rates

The American Medical Association series tracks manual premiums from the Medical Liability Monitor annual rate survey. Its California series includes one insurer's Los Angeles and Orange County manual rates:

Specialty (LA/Orange, $1M/$3M)	2016	2019	2022	2025
Internal Medicine	$8,274	$8,274	$8,274	$8,274
General Surgery	$41,775	$41,775	$41,775	$41,775
Obstetrics/Gynecology	$49,804	$49,804	$49,804	$49,804

Restated from AMA Policy Research Perspectives (April 2026), Exhibit 4; underlying data from the Medical Liability Monitor Annual Rate Survey. (c) 2026 American Medical Association. Values shown for four of the ten surveyed years; the intervening years are identical.

These figures equal TDC's Edition 10/14 Territory B rates. The AMA survey shows the same Los Angeles and Orange County manual rates from 2016 through 2025. That historical series does not establish current availability or pricing.

California requires prior approval for admitted rates. A later rate change would appear in a public filing.

You can compare a historical base premium for a specialty, county, and limit against the public manual. A renewal difference can reflect maturity, credits, claims history, limits, practice changes, a later filing, taxes, fees, assessments, endorsements, form changes, or other underwriting facts.

California rate factors for clinicians who are not physicians

The same rate pages use percentages of a physician rate for advanced practice clinicians and other professionals. A physician assistant, surgeon assistant, or certified nurse practitioner with separate limits uses 15 percent of the applicable physician rate. In Los Angeles or Orange County, 15 percent of the family practice rate is about $1,374.

A certified nurse midwife uses 8.7 percent of the OB-GYN rate under direct supervision and 17.5 percent under indirect supervision. A certified registered nurse anesthetist uses 15 percent of the anesthesiology rate under anesthesiologist supervision. The rate is 27 percent under surgeon supervision.

Confirm whether each clinician has separate or shared limits. Read how per-claim, aggregate, shared, and separate limits work.

Check the claims-made policy dates

The declarations page states the named insured, policy period, retroactive date, limits, and premium. These terms determine how a claims-made policy applies. Read how claims-made and occurrence policies differ.

Claims-made premiums increase during maturity

A claims-made premium can increase as the policy reaches its mature step. The issued declarations, retroactive date, claim definition, and reporting provisions determine which prior care and claims are in scope. Ask the carrier for the exact maturity schedule for the quote.

A maturity increase is not a manual rate increase. Do not compare a second-year premium directly with a mature rate.

The retroactive date line

The retroactive date is the earliest date of an act, error, omission, or professional service that the claims-made policy uses for this condition. On the first policy, it often equals the effective date.

When coverage changes, compare the new retroactive date with the old declarations page. An earlier date is only one condition; prior-acts, known-matter, related-claims, reporting, and insured-status terms also matter. Read about tail coverage, prior-acts coverage, and retroactive dates.

The California mature rate is the filed base

The limit factors above apply to the mature base rate. Filed tail factors also use a stated annual premium. The $8,274 Los Angeles internal medicine example is a mature rate. The carrier still determines the issued premium and tail quote.

Under the same filing, a policyholder who cancels during the policy term receives unearned premium less a 10 percent short-rate fee. A carrier cancellation or nonrenewal uses a pro rata refund. A change at renewal avoids the short-rate fee.

Identify each California filed premium adjustment

The base rate is the starting premium. TDC's approved California rules apply specified credits to specified facts. Schedule rating can also increase or decrease the premium.

Rating adjustment	Filed amount	Main filed condition
New to practice	50% in year one; 25% in year two	First entry into private practice within three years after specified training or service; claims-made policy
Part time	50%	20 hours or less each week, or 26 weeks or less each year
Quarter time	75%	10 hours or less each week after at least two years in practice
Claims-free renewal	5% to 25%	Three full TDC policy years; amount follows open reserves and paid claim expense during the three-year review period
Claims-free, new to TDC	15% or 7.5%	Five-year prior-carrier history; amount follows the number and payment status of reported claims
Risk management	5% or 10%	Eligible association membership or completion of a company-approved program
Defense within limits	1.5%	Defense expense reduces the liability limit

Source: The Doctors Company, California General Rules Exception Pages, Edition 10/14, pages CA-E-2 through CA-E-5; CDI filing 14-4043 / SERFF DCTR-129531290, approved August 7, 2014. The part-time credit excludes certain surgical specialists in groups with fewer than 15 physicians.

The credits do not all apply together. The new-to-practice credit excludes the claims-free, part-time, and risk-management credits while it applies. Part-time and quarter-time credits also exclude those credits. Schedule rating can change the result again. A change greater than 25 percent requires what the filing calls "convincing factual evidence."

An Orange County OB-GYN has a $49,804 mature base rate. A 50 percent first-year new-to-practice credit reduces it by $24,902 before the maturity factor and schedule rating.

A San Diego internist with a $9,730 mature base and a 15 percent claims-free credit has an adjusted amount of $8,270.50. Other rating factors can change the final premium.

Check the specialty, county, limits, and policy maturity first. Then identify every credit and debit. Ask the carrier to explain each difference from the filed calculation.

Compare the terms that control a claim

Read the settlement, defense, and claim-reporting provisions before you buy the policy.

For the California licensees covered by Business and Professions Code section 801.01, an insurer may not settle without the insured's written consent. Data Bank reporting and California reporting rules depend on the payment and licensee facts. Read about consent to settle and hammer clauses.

The hammer clause

Some policies combine consent with a hammer clause. If the physician rejects a settlement, the clause can limit the carrier's later payment. It can also assign some later defense costs to the physician. Read the complete clause.

Defense costs: inside or outside the limits

With defense outside the limits, defined defense expenses may not reduce the liability limit. Whether a $200,000 expense leaves the full $1 million available depends on the exact expense definition, per-claim limit, aggregate, prior payments, and other terms.

With defense inside the limits, defined expenses can reduce the available limit. This is also called an eroding or wasting limit.

TDC's historical 2014 California filing provides a 1.5 percent defense-within-limits discount. It does not establish a current quote or term. Compare any proposed savings with the possible reduction in the claim limit. Read about defense costs inside and outside the limits.

The policy definition of a claim

Claims-made coverage depends on when a claim begins and when the insured reports it. A policy can define a claim as a written demand for money. An incident-reporting provision can accept notice of a qualifying event before a demand arrives.

A valid notice of a known event under the current policy may have a reporting date. An unreported event can fall outside the old reporting period and inside the new carrier's known-circumstance exclusion. An incident notice does not automatically create a covered claim or bind a later insurer.

Use the policy's required reporting method before the current reporting period ends. Read when a claims-made policy recognizes a claim.

Identify the carrier and California market structure

California admitted or surplus lines placement

An admitted carrier has a license from the California Department of Insurance. It must obtain approval for its rates before use. It also participates in the California Insurance Guarantee Association, subject to statutory terms and limits.

A surplus lines carrier does not use this rate approval system or guarantee association. A licensed surplus lines broker can place coverage for risks that the admitted market does not accept. Check the carrier's financial strength rating and complete policy form.

Admitted insurers reported $450.3 million of California medical malpractice premium in 2025. The Doctors Company reported 42.4 percent, NORCAL reported 15.6 percent, and MIEC reported 7.0 percent.

A surplus-lines placement has its own diligent-search and disclosure rules, subject to exceptions. Ask the broker which placement path applied, confirm the insurer's identity and status, and obtain the signed nonadmitted-insurer disclosure required when applicable. Compare the limits, exclusions, defense terms, and settlement terms. Read about admitted and surplus lines coverage.

Mutuals, reciprocals, exchanges, and dividends

A mutual insurer is owned by its policyholders. A reciprocal exchange has subscribers who insure one another through an attorney-in-fact. TDC and MIEC are reciprocal exchanges.

Ask whether the policy is assessable. An assessable policy can require members to pay an additional amount. Read how carrier ownership affects a policy.

California interindemnity arrangements: CAP

The Cooperative of American Physicians and Mutual Protection Trust is an interindemnity arrangement under Insurance Code section 1280.7. It is not an admitted insurance company. It does not file Proposition 103 rate tables or report premium in the admitted market-share data.

Use the organization's documents to compare its costs, assessments, protections, and obligations with an insurance policy.

California public records behind the rates

The CDI filing search contains each admitted carrier's approved rate filings by company name or NAIC number. TDC's 2014 physician filing contains the rate pages used here. The CDI market-share workbooks publish each licensed carrier's annual premium. Together, those records let a physician compare approved manuals, market position, and a written proposal without relying on a brochure.

Exclusions and add-ons: what the base policy does not do

A medical malpractice policy can exclude or limit work outside its stated professional services:

Medical-director and administrative duties can require an endorsement or separate policy.
Licensing and regulatory proceedings can use a smaller defense sublimit.
Cyber and privacy events can require separate cyber insurance.
Undisclosed procedures, locations, or outside work can create a coverage dispute.

Compare the exclusions and sublimits with the practice's current work. Include administrative roles, outside work, patient data, and aesthetic procedures. Read what a medical malpractice policy can exclude or limit.

How underwriting reads an application

The application gives the carrier the facts used for underwriting. Specialty and procedures set the rate class. Hours can affect part-time credits. Locations set the territory. Claims history, prior carriers, licensing actions, and coverage gaps can affect the review.

A carrier change usually requires loss runs. Loss runs list prior claims and their status. Request them before the new carrier's application deadline. Confirm the delivery time with each prior carrier. Use a written addendum to explain a claim, licensing matter, or coverage gap.

Review the procedure questions when the practice adds new work. An internist who adds injections can need a different class. The same can apply to a family physician who assists in surgery or a dermatologist who adds liposuction.

Answer the application completely and accurately for the facts it requests, including current clinicians, procedures, locations, entities, outside work, and planned changes where asked. Compare the issued policy with the application before relying on coverage.