Occurrence vs claims-made
Occurrence covers any incident that happened while the policy was active, no matter when the claim arrives. Once the assignment ends, incidents from that period stay covered. Nothing further to buy.
Claims-made covers a claim only if the policy is still active when the claim is filed. Since malpractice claims routinely surface years later, a claims-made policy that ends with your assignment leaves everything after it uncovered — unless tail coverage fills the gap.
Ask which one you have, in writing, before your first shift. "We provide malpractice" is not an answer.
What tail really costs
Tail coverage — a reporting endorsement — typically runs 100% to 200% of the annual premium, as a single payment when the policy ends. For a physician in a higher-risk specialty that is a substantial one-off cost.
Who pays is negotiable and belongs in the contract. Three acceptable outcomes:
- The agency carries occurrence coverage, so no tail is needed.
- The agency's claims-made policy includes tail at no cost to you.
- The contract states in dollars what you will pay, and when.
Anything else is an open liability.
The gap between agency and facility policies
Agency policies cover assignments booked through that agency, and generally end when the assignment does. Facility policies cover the facility's employees, and you are a contractor. Both statements can be true at once, which is how a physician ends up covered by neither.
Get declarations pages, not summaries. Confirm limits per claim and in aggregate, confirm your name or class is included, and confirm the coverage period against your actual start and end dates.
The market standard is $1M per claim / $3M aggregate. Some New York facilities require $1.3M per occurrence and $3.9M aggregate per provider, and Virginia mandates higher limits than the standard. Short-term and pro-rated locum policies exist, some as brief as 30 days, so a single short assignment does not require a full annual policy.
Three gaps that catch working physicians
- Your employer's policy almost certainly excludes moonlighting and outside patient care. Being covered at your day job does not cover a weekend locum shift.
- One agency's policy does not cover work placed through another agency. Each relationship needs its own confirmed coverage, in writing.
- Arranging directly with a facility usually means you secure and pay for your own coverage. Price that in before comparing a direct rate to an agency rate; the higher headline number can be the worse deal.
Before your first shift
- Declarations page from the agency policy.
- Written confirmation from the facility of what its policy does and does not cover.
- Coverage type, limits, and tail obligation stated in your contract.
- A copy of everything stored somewhere that is not the agency's portal.
Sources
- Wapiti Medical Staffing — locum coverage structure, tail obligation, and short-term policy terms.
- LocumTenens.com — market standard limits and agency-vs-facility coverage boundaries.
- Barton Associates — coverage exclusions for moonlighting and directly arranged work.