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Insurance for Hard to Place Physicians

Insurance for Hard To Place Physicians 

Hard-to-place physicians include doctors who have prior claims, board actions, gaps in practice, high-risk procedural backgrounds, or unconventional employment structures. These situations don’t make a physician unsafe—but they do place them outside the appetite of many standard carriers. As a result, these doctors face higher scrutiny, limited carrier options, and stricter underwriting requirements when seeking malpractice coverage.

Insurance for hard-to-place physicians needs to reflect the realities of their situation: past litigation, disciplinary remediation, high-exposure procedures, or practice models that fall outside traditional settings. Policies must account for prior acts, limited scopes of practice, supervised return-to-work arrangements, and non-admitted market placements when necessary.

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Insurance for Hard to Place Physicians can include:

Malpractice or liability insurance can provide essential protection against these risks:

  1. Professional Liability (Malpractice)

    1. Protection for common malpractice exposures, including misdiagnosis, delayed diagnosis, surgical error, medication-related harm, and failure to follow clinical guidelines.
    2. Support for physicians with prior claims, board complaints, disciplinary actions, practice gaps, or complex employment histories.
    3. Available for physicians in plastic surgery, pain management, bariatrics, correctional health, urgent care, addiction medicine, concierge medicine, and telemedicine.
    4. Coverage for physicians transitioning back into practice, including re-entry programs, probation-linked supervision, or restricted scope arrangements.
    5. Entity-level protection for incorporated practices, wellness brands, concierge models, or hybrid med-spa/medical practices.
    6. Flexible structures for part-time, moonlighting, locums, 1099 contracting, or multi-state practice.
    7. Options for consent-to-settle provisions, limited procedural scopes, mandatory peer review involvement, or excess layer participation when required by hospitals.
    8. Case-by-case underwriting with attention to remediation efforts, updated training, quality-of-care improvements, and active patient safety protocols.
    9. Limits typically available up to $1,000,000 per claim / $3,000,000 aggregate, including tail coverage, prior acts coverage, and non-admitted market solutions when needed.

  2. General Liability Insurance

    1. Protection for accidents involving patients, visitors, or vendors inside the practice, such as slips, falls, or waiting-room hazards.
    2. Coverage for property damage to third-party belongings (e.g., wheelchairs, vehicles, equipment).
    3. Liability for incidents involving signage, lighting, clinic layout, accessibility, or lobby security.
    4. Personal and advertising injury protection, including defamation or reputational claims not tied to patient care.
    5. Options for additional insureds, landlord requirements, or multi-suite medical offices.
    6. Standard limits of $1M per occurrence / $3M aggregate, with umbrella options for higher-risk locations or large clinics.

 

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How difficult is it to source Insurance for Hard to Place Physicians?

Navigating the complex terrain of medical malpractice insurance can be particularly challenging for physicians who have faced board actions or have a claims history. These professionals, often termed as “hard to place” or high-risk physicians, may find themselves in a precarious position when seeking the necessary insurance to practice medicine.

Understanding the Challenge

Medical malpractice insurance is a critical component for physicians, offering protection against legal claims regarding their professional practice. However, insurers often assess the risk of insuring a physician based on past claims, disciplinary actions, or board sanctions. This risk assessment is crucial, as it influences the insurer’s decision on whether to offer coverage and at what cost. Physicians with a history of legal challenges or claims are frequently deemed high-risk, making it difficult for them to obtain traditional malpractice insurance. This classification as “hard to place” stems from the insurer’s perspective that past incidents may predict future claims, thereby increasing the insurer’s risk exposure.

The Impact of Being Hard to Place

The designation of being a high-risk physician has significant implications. First, traditional insurance carriers may outright refuse coverage, leaving these professionals in a vulnerable position without the necessary protection against potential claims. In the event that coverage is offered, it may come at a prohibitively high cost, reflecting the increased risk.

Homewood Insurance understand these challenges and have a wealth of experience in sourcing suitable insurance for medical professionals in the ‘hard to place’ category. Contact us now and let’s get started in finding a suitable solution for you. Contact us now.

The Cost of Insurance for Hard to Place Physicians:

Malpractice pricing for hard-to-place physicians varies dramatically depending on:

  • Prior claims (number, severity, payout amounts)
  • Board or licensing actions
  • Specialty type and procedure mix
  • Practice setting (hospital, outpatient, correctional, telemedicine, or locums)
  • Geographic location and local litigation environment
  • Hours worked (full-time vs part-time vs moonlighting)

Professional Liability Insurance– Estimated Ranges

  • Low-risk hard-to-place specialties (e.g., internal medicine with past disciplinary issues): $12,000 – $25,000 annually
  • Moderate-risk specialties (urgent care, addiction medicine, telemedicine with prior claims): $18,000 – $45,000 annually
  • High-risk or surgically oriented specialties (pain management, bariatrics, plastics, OB involvement): $45,000 – $120,000+ annually
  • Severely impaired risk (multiple payouts, probation, revoked license, reinstatement): $75,000 – $200,000+ via E&S or RRG markets

General Liability Insurance – Estimated Ranges:

General Liability is usually not dramatically impacted by disciplinary history.

  • Typical range: $750 – $2,500 per year, depending on practice size and foot traffic.

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High-Risk Procedures and their Impact on your Premiums

While chemotherapy and standard radiation are widely covered, carriers closely review other services that carry elevated risk:

Procedure / Specialty Description & Risks Insurance Impact
High-Risk Cosmetic & Elective Surgery Body contouring, complex revision surgery, liposuction, or silicone-based procedures with high dissatisfaction and infection rates. Often declined by standard carriers; E&S required with 50–200% surcharges and procedure-specific exclusions.
Pain Management with Controlled Substances High opioid prescribing, spinal injections, nerve blocks, or implantable pain devices with overdose and neurologic injury risks. Significant premium increases; DEA or board history pushes providers into non-admitted markets.
Bariatric & Weight-Loss Surgery Gastric bypass, sleeve gastrectomy, and revision work with leak, infection, and long-term complication exposure. High severity claims; premiums 8–12× primary care baseline, tail coverage often mandatory.
Correctional Healthcare High litigation environment; delayed care allegations, medication lapses, and constitutional rights claims. Higher deductibles and facility-specific exclusions; often requires RRG or specialty carriers.
Telemedicine Across Multiple States Jurisdictional complexity, cross-state licensing challenges, missed diagnoses without in-person assessment. Premium increases 20–50%; carriers require proof of multi-state licensure and compliant protocols.
Experimental,
Off-Label, or Integrative Treatments		 Stem-cell infusions, unapproved implants, regenerative therapies, or investigational protocols without strong evidence basis. Often excluded entirely; requires specialized E&S coverage and strict disclosure.

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The Options Available for Hard to Place Physicians

 
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Risk Retention Groups

RRGs are liability insurance companies owned by its members. For physicians who are hard to place, joining an RRG can be an effective solution. These groups can sometimes accept hard to place physicians.
 
 
Surplus Lines Insurers

Surplus Lines Insurers

These insurers specialize in covering risks that standard insurers refuse. While they may offer coverage to high-risk physicians, it’s important to note that their premiums can be significantly higher, and they are not always subject to the same regulations as standard insurers.
 
 
Tailored Solutions

Tailored Solutions

Working with brokers like Westwood who specialize in high-risk profiles can sometimes yield customized insurance solutions. These brokers have the expertise and connections to negotiate coverage terms with insurers that might not be widely advertised.
 
 
State High-Risk Pools

State High-Risk Pools

Some states have established high-risk pools as a safety net for physicians unable to secure insurance through the private market. These pools can provide a viable option, though they often come with higher premiums and may have limited coverage.
 
 
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Professional Liability Trusts

In some cases, joining a professional liability trust can offer an alternative to traditional insurance. These trusts, often set up by professional associations or similar groups, provide a collective self-insurance mechanism for members.
 

Why Work With Homewood

Hard-to-place physicians require a different level of strategy and advocacy. At Homewood, we help you:

  • Match with carriers willing to insure physicians with prior claims, litigation, or board actions, including non-admitted and RRG markets.
  • Strengthen your submission by reviewing disciplinary orders, remediation steps, CME documentation, and updated risk-management protocols.
  • Negotiate realistic premiums and coverage terms, even when standard markets decline due to claims history or high-risk procedures.
  • Protect your ability to practice with tailored structures for part-time work, telemedicine, surgical restrictions, or re-entry supervision.
  • Avoid hidden exclusions that can remove coverage for core procedures or create gaps that expose you personally.
  •  — our access to specialty carriers allows quoting that many general brokers simply cannot obtain.
Homewood positions hard-to-place physicians for a successful underwriting review, helping them return to practice with confidence and proper protection.

Call 947-274-3093 or
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Ralph Schiller

Ralph Schiller

Ralph specializes in sourcing the most suitable insurance for Hard to Place Physicians at the best price. You can call him or fill out the form and he will get your message directly.