Some physicians and healthcare organizations do not get the best malpractice insurance premiums available to them. Make sure your carrier has the most beneficial information about your risk.

  • Volunteer information that might not be known to the carrier.
  • Claims history is most important, but improvement efforts also matter.
  • Inquire about the carrier’s quality and patient safety programs.

If you are too modest about your patient safety efforts, you may not be getting the best premiums for your medical malpractice insurance. Sometimes you have to toot your own horn to make sure the insurer gives you the rate you truly deserve.

Insurers can have a false impression of the risk they’re covering if clinicians and healthcare organizations let their accomplishments go unnoticed, says Robin Diamond, JD, RN, senior vice president for patient safety and risk management at The Doctors Company, the largest liability carrier for physicians in the country. The insurance company will seek out information on relative risk and patient safety initiatives, but don’t assume they know all that you have done, she says.

“I don’t think most people do the best job of presenting themselves in a good light,” Diamond says. “Some do, and it usually depends on the physician or risk manager having a good understanding of the quality and safety programs they are involved in, and the data that show them in the best light.”

Be proactive in putting your best foot forward, she says. Don’t sit back and assume the insurer has an accurate, current, and complete picture of your patient safety efforts.

“That can include anything from government-required metrics such as breast cancer screenings and other population health metrics, to initiatives that you’re taking on your own to improve patient safety, even if you don’t yet have complete data to show on the results,” Diamond says. “Let them know that you’re addressing these things and trying to improve. You have to speak up and not assume the carrier knows everything that you’re doing as far as patient safety and quality.”

Inquire About Carrier’s Programs

Risk managers also should inquire about what patient safety initiatives and assistance are available from the carrier. The insurance company probably will volunteer that information as part of the dialogue, but don’t be afraid to ask what is available and for assistance in a particular area if needed, Diamond says. That will help ensure you get the most from your coverage, but it also will show your conviction in improving patient safety, she says.

“Without asking, you may not know there are programs you can participate in that will get you a better price,” Diamond says. “In the same way, some people are unaware that something they’re already doing will get them a lower premium, but only if the carrier knows about it. We want to reward good medicine and good patient care, so we want you to speak up and get credit for everything you’re doing.”

Particularly in a field like obstetrics, where the premiums are so high in most states, Diamond says you should be very open to asking what programs there are to participate in. You also should be willing to ask outright for credit for your efforts, she says. Tell the carrier, “I’m involved in this improvement program, so would you be willing to reward me for my efforts?”

The most influential factor when determining premiums will be loss history, so focus on that if you have a good history with fewer claims than average, or a clear trend of decreasing claims, Diamond advises. Claims outcomes also can make a real difference in premiums, she says.

Across the country, medical malpractice insurance premiums are stable and even decreasing in some cases, Diamond says. The claims history of the individual physician or organization can prompt increased premiums, but remember that carriers tailor coverage and premiums carefully for individual physicians, practices, and hospitals, she says.

“We don’t say to all obstetricians, for instance, that if you’ve had no claims you’re going to get a 10% discount,” she explains. “It’s very tailored to their specific losses and whether we have a program that can truly affect their losses. It also depends on their state insurance rates, and lots of technical underwriting factors are determined by where they are located.”


  • Robin Diamond, JD, RN, Senior Vice President For Patient Safety And Risk Management, The Doctors Company, Napa, CA. Telephone: (800) 421-2368, ext. 1243. Email: patientsafety@thedoctors.com.