A nurse practitioner (NP) in urgent care saw a patient with a severe headache following a fall. Initial testing and symptoms suggested a concussion, leading to discharge. However, when the patient’s worsening condition later revealed an elevated white blood cell count, they were rushed for further evaluation—but it was too late. The patient succumbed to bacterial meningitis. The NP, who had followed a logical diagnosis path, still faced liability for the missed diagnosis.

This case highlights a critical reality: Even the most conscientious clinicians can find themselves in legal trouble. Do you have the right malpractice coverage to protect yourself?

Why should NPs have their own liability insurance?

Many NPs are underinsured, often relying on their employer’s policy—if they have one at all. While 28 states and Washington, D.C., allow NPs to practice independently, their coverage often lags behind the protections physicians receive. Even without a deviation from the standard of care, malpractice claims can arise.

Case in point: An NP co-owned a geriatric home health practice with a physician. When a patient under the NP’s care died while being treated for a urinary tract infection, a board complaint was filed—not against the NP directly, but against the physician partner. The complaint triggered an investigation of the NP, but their employer’s coverage didn’t extend to licensing board proceedings. With no personal liability insurance, the NP had to mortgage their home to cover legal fees.

What gaps exist in employer-provided coverage?

A major gap in employer policies is that they often exclude board complaints. These investigations can take years and cost thousands of dollars, putting an NP’s license at risk. Additionally, employer coverage may have shared liability limits, meaning an NP is covered under the same policy as the employer or colleagues—potentially reducing the funds available in the event of a claim.

What’s the difference between occurrence and claims-made coverage?

Understanding the timing of coverage is key when selecting a policy:

• Occurrence coverage protects against claims related to events that happened during the policy period, even if the claim is filed after the policy ends.
• Claims-made coverage applies only if both the incident and the claim occur while the policy is active—making additional coverage essential when switching policies.

What are tail coverage and nose coverage, and why do they matter?

• Tail coverage extends a claims-made policy, covering claims filed after the policy ends for incidents that happened during coverage.
• Nose coverage (prior acts coverage) protects against claims from before the start of a new claims-made policy.

Without these add-ons, an NP switching jobs or carriers could be left exposed to legal action from past patients.

How can NPs protect themselves with strong documentation?

A well-documented patient encounter is an NP’s best defense against legal trouble.

• Follow SOAP note standards: Clear, concise documentation ensures continuity of care and creates a defensible legal record.
• Avoid premature conclusions: Ruling out multiple possibilities prevents diagnostic errors. If something feels off, revisit the patient’s full story.
• Close the gaps: Missing details in medical records can create risk. Ensure each step of assessment and care planning is documented.
• Engage with challenging patients: Clearly explain treatment plans and ensure patients feel heard to prevent misunderstandings and potential complaints.

Peace of mind for your career

Malpractice insurance isn’t just about lawsuits—it’s about protecting your license, career, and financial stability. As an NP, securing comprehensive coverage ensures you can focus on what matters most: providing quality care with confidence.

Surani Hayre-Kwan, DNP, MBA, FNP-BC is a nurse practitioner, West County Health Centers, president-elect, California Association for Nurse Practitioners, and member, TDC Group APC Advisory Board.

Founded and led by physicians, The Doctors Company is relentlessly committed to advancing, protecting, and rewarding the practice of good medicine. The Doctors Company helps hospitals and practices of all sizes manage the complexities of today’s healthcare environment—with expert guidance, resources, and coverage—and is the only medical malpractice insurer with an advocacy program covering all 50 states and the federal level. The Doctors Company is part of TDC Group, the nation’s largest physician-owned provider of insurance and risk management solutions. TDC Group serves the full continuum of care.