In my years of working with Physician Assistants (PAs), both as an advisor and through direct consultation with healthcare legal teams, I’ve noticed one common thread: most PAs, even those well into their careers, are under-informed or dangerously misinformed about the depth and complexity of their insurance needs. This isn’t because they’re careless. It’s because the field they operate in is growing and evolving at a pace that outstrips even the most diligent professional’s ability to keep up. The problem? An incomplete or outdated understanding of insurance leaves PAs exposed, not only financially, but professionally and reputationally as well. My goal here is not to give you a surface-level overview but to lay out, in detail, the insurance landscape you’re navigating, highlight the risks that are specific to your role and setting, and equip you to evaluate and structure your coverage with the same precision you bring to patient care.

The first truth I want to underscore is that the liability profile for PAs has evolved far beyond what it was a decade ago. If you’re still operating under the assumption that your risk is a shadow of your supervising physician’s, you’re operating with blinders on. In fact, PAs have increasingly become primary targets in litigation. Plaintiffs’ attorneys have become adept at identifying every provider who touched a patient’s care path, and the PA’s involvement is no longer seen as peripheral. You are held to the same standard of care as physicians within your defined scope, and when ambiguity arises, and it often does. You’re judged on whether your actions meet that same bar.

The data backs this up. In reviewing closed claims over the past decade, both frequency and severity of malpractice cases involving PAs have increased. The average indemnity payment in PA malpractice cases is climbing closer to what we see in certain physician specialties. Why? Because the scope of practice for PAs has expanded dramatically, both in terms of clinical decision-making and procedural involvement. In states that have broadened PA autonomy or loosened supervision requirements, I’ve seen a direct correlation with rising claim values. This doesn’t mean PAs shouldn’t embrace expanded roles. It means your insurance strategy needs to grow alongside your scope.

Complicating this risk landscape is the rapid integration of telemedicine. Many PAs have pivoted to virtual care, often without fully understanding how this changes their liability profile. Misdiagnosis and failure to follow up, already common litigation triggers in in-person care, become magnified when you’re working across state lines or relying on limited virtual examinations. Add in the variability of patient compliance and data security issues, and it becomes clear that a policy designed for traditional brick-and-mortar practice will not protect you in the telehealth arena unless specifically endorsed. I’ve reviewed policies for clients that, on paper, appeared comprehensive, only to find exclusions that invalidated coverage for remote consultations, a potentially career-ending oversight.

Finally, collaborative practice models introduce their own set of complexities. You may be working alongside other mid-levels, multiple physicians, and even independently contracted specialists. In litigation, that creates multi-defendant scenarios where lines of liability blur. The question of who is responsible for what becomes central, and if your policy isn’t structured to address both direct and vicarious liability exposures, you risk becoming the weak link. The party with coverage gaps that plaintiffs’ attorneys will exploit. I advise all my PA clients to not only secure individual policies but to have them reviewed in the context of their collaborative agreements and institutional affiliations.

When I consult with PAs, one of the first things I ask is, “Where do you practice, and what do you do?” Because insurance needs are not one-size-fits-all, and where you work can alter your risk profile dramatically.

If you’re hospital-based, chances are you have employer-provided coverage. But if you think that’s sufficient, I urge you to think again. Institutional policies are often structured to protect the hospital first and the provider second. While they may carry large aggregate limits, they frequently apply those limits across hundreds of providers. I’ve seen cases where a major claim involving multiple defendants within the same institution has rapidly depleted those shared limits. Worse, consent-to-settle clauses in these policies rarely give the individual provider a say. Risk managers and legal counsel will make decisions based on institutional interests, not yours. That’s why I tell hospital-based PAs to carry supplemental individual malpractice insurance, with clear consent-to-settle provisions and tail coverage that extends beyond institutional employment termination.

For surgical assistants and procedural PAs, the stakes are even higher. The OR is one of the most litigation-prone environments in medicine. Errors or complications, even those outside your control, can easily pull you into a claim. Insurers underwrite these policies differently, often placing procedural PAs into a higher risk tier that carries higher premiums but more tailored coverage. It’s not just about coverage limits. It’s about ensuring that intraoperative complications, co-surgeon liability, and delegation missteps are explicitly covered. I have represented clients who believed they were covered, only to find out post-incident that their policy did not apply to specific procedures performed under supervision agreements that weren’t clearly documented.

Urgent care and emergency medicine are equally fraught. These settings are defined by high patient turnover, limited documentation time, and diagnostic uncertainty. PAs working in urgent care settings face some of the highest diagnostic error claim rates. The defense costs alone in these cases can bankrupt a provider if the policy has insufficient legal defense allocations. That’s why I always recommend occurrence-based coverage in these settings, paired with defense costs outside policy limits. The latter ensures that your legal defense expenses don’t erode your indemnity coverage, something that’s especially important when you’re dealing with complex multi-defendant cases.

For outpatient and primary care PAs, don’t make the mistake of assuming lower severity means lower risk. Primary care involves managing chronic conditions, prescribing long-term medications, and coordinating care. Errors of omission, missed diagnoses, or medication interactions are common litigation triggers. These claims can stretch on for years, and if your policy isn’t structured to account for long-tail exposure, you’ll be left without recourse. Annual reviews of coverage limits and retroactive dates are critical. Your policy should be evolving along with your patient panel and clinical responsibilities.

Independent contractors and locum tenens PAs face unique challenges. If you’re working through a staffing agency, confirm whether coverage is provided and, if so, whether it is claims-made or occurrence-based. I have reviewed dozens of locum contracts with hidden clauses that shift tail coverage costs onto the provider after contract termination. If you’re not reading these agreements carefully, or having them reviewed by a healthcare attorney. You are exposing yourself to gaps that could cost you six figures in tail premiums alone.

Finally, for PA-owned practices, the complexities multiply. You are both provider and business owner. That means you need not only robust individual malpractice coverage but entity-level professional liability insurance that covers vicarious liability for employed or contracted clinicians. Employment Practices Liability Insurance (EPLI), cyber liability, and even directors and officers insurance become part of your portfolio. And if you have partners, your buy-sell agreements need to be funded and backed by appropriate key-person life insurance coverage. Without these structures, a single claim can bankrupt not just your practice but your personal finances as well.

When we talk about physician assistant insurance, the conversation usually starts and stops at malpractice insurance. But that’s a mistake I see repeatedly in both new and seasoned PAs. Malpractice is only one part of a multi-layered strategy that should protect your professional, personal, and business assets. Let me break down each coverage line with the same care you would give to a differential diagnosis, because overlooking the nuances here can be catastrophic.

This is the core, and I cannot stress enough how critical it is to go beyond simply “having coverage.” First, you must understand whether your policy is claims-made or occurrence-based. Claims-made policies are cheaper on the front end but can trap you if you leave a job or retire without purchasing tail coverage. I have seen far too many PAs blindsided by a $50,000 tail premium they didn’t budget for, triggered by changing employers or stepping back from clinical practice. If you’re on a claims-made policy, negotiate who will pay for the tail coverage in your employment contract before you sign.

Occurrence-based coverage is more expensive but cleaner. The incident itself triggers coverage, regardless of when the claim is filed. If you’re in a high-risk specialty or nearing retirement, occurrence policies are worth the premium. Another detail that often gets missed is retroactive coverage. If your policy has a retroactive date that doesn’t match the start of your career or is reset when changing carriers, you could lose protection for work performed in prior years. I counsel clients to ensure their retro date is as far back as possible and carried forward with each policy renewal.

Consent-to-settle clauses are another critical element. Policies without these clauses, or worse, with hammer clauses, allow the insurer to settle claims without your consent. That might sound minor until you realize that settlements, even those without admission of guilt, become part of your professional record and can impact hospital credentialing, state licensure, and future underwriting. You want a policy that requires your written consent to settle and protects you from the insurer’s financial penalty if you refuse a settlement offer.

If you run your own practice or operate independently in any setting, general liability coverage is mandatory. This is not professional liability; rather, it covers bodily injury, property damage, and personal injury claims that happen on your premises or as part of your business operations. Imagine a patient’s family member slipping and falling in your clinic’s waiting room and sustaining a severe injury. That is not covered by your malpractice insurance. I advise all PA business owners to carry at least $1 million per occurrence in general liability coverage, with an umbrella policy that layers additional protection on top.

If you have employees, even if they are part-time or contractors, you may be required by state law to carry workers’ compensation insurance. But compliance aside, this coverage protects your practice from employee injury claims that can quickly escalate. I’ve seen practices face litigation because they misclassified workers as independent contractors to avoid this expense, only to be hit with back premiums, fines, and lawsuits. It’s not just about protecting your staff; it’s about protecting your business from regulatory scrutiny and financial ruin.

Disability coverage is often overlooked until it’s too late. You are your most valuable asset, and your ability to earn an income is what supports everything else. The mistake I see most often? PAs buy generic disability policies that only pay out if they are completely unable to work in any occupation. You want an own-occupation policy, one that pays benefits if you cannot perform the specific duties of your current clinical role, even if you could theoretically work in another capacity. Additionally, residual disability riders are critical. These provisions allow partial benefit payouts if you suffer a disability that reduces your earning capacity but doesn’t render you completely unable to work.

Life insurance may not seem directly related to professional liability, but if you’re a practice owner or have family who relies on your income, this is a non-negotiable piece of your financial safety net. Beyond personal protection, life insurance is crucial for funding buy-sell agreements between business partners. I’ve sat across the table from surviving partners who were forced into litigation with the heirs of a deceased co-owner because there was no funded buy-sell in place. Don’t leave that mess behind.

If you employ even a small team, you need EPLI. This covers claims of discrimination, harassment, wrongful termination, and other employment-related allegations. What most people don’t realize is that even baseless claims can cost tens of thousands of dollars in legal defense. Without EPLI, those costs come out of your pocket or your business’s operating capital. And keep in mind, traditional business liability policies do not cover these scenarios. You need a standalone EPLI policy, and if you have independent contractors or regularly interact with vendors, make sure your policy includes third-party coverage extensions.

The healthcare industry is a prime target for cyberattacks. If you’re handling patient data electronically, and let’s be honest. You are at risk. HIPAA violations resulting from data breaches carry not just financial penalties but reputational damage. Cyber liability coverage should include first-party costs (data recovery, breach notification, public relations management) and third-party liability (legal defense and settlements). In addition, look for coverage that includes protection against ransomware attacks and social engineering fraud, which are becoming alarmingly common.

If you own a practice, business overhead expense (BOE) insurance is something I strongly advise. This policy covers your practice’s fixed expenses, rent, utilities, payroll, if you become temporarily disabled. Without BOE coverage, your practice’s financial health depends entirely on your personal savings or credit capacity. This is not an area where I recommend gambling.

Finally, for PAs with substantial income or personal assets, umbrella insurance is essential. This is a secondary layer of liability coverage that sits on top of your existing policies and provides additional protection in case of catastrophic claims. Umbrella policies are surprisingly affordable, and I recommend coverage limits of at least $2 million, especially for those in high-risk specialties or who own real estate and other sizable assets outside of retirement accounts.

In my work with PAs and healthcare attorneys, I’ve found that one of the most misunderstood aspects of insurance planning is the legal and regulatory framework that shapes how coverage functions in real life. Insurance policies do not exist in a vacuum. They interact with state laws, federal statutes, and the often overlooked clauses buried in your employment or independent contractor agreements. If you don’t understand this interplay, you are almost certainly leaving yourself exposed.

Each state has its own scope-of-practice laws for physician assistants. Some allow near-complete autonomy; others impose strict supervision requirements. Here’s where many PAs get caught off guard: your insurance carrier underwrites your policy based on the information you provide about your scope and practice location. If your clinical activities drift beyond what’s allowed in your state, even inadvertently, your insurer can deny coverage on the basis that you were acting outside the law. I’ve consulted on claims where this exact scenario resulted in uncovered losses. If you practice in multiple states or via telemedicine across state lines, you need explicit multi-state endorsements, and your coverage needs to be re-evaluated each time the state board changes its statutes.

Many states have laws that prohibit certain indemnification clauses in healthcare employment agreements. These statutes are designed to prevent employers from shifting liability onto providers in ways that public policy deems unfair. However, I frequently see employment contracts that either deliberately or carelessly include language that violates these statutes. If you sign such an agreement and your insurer discovers it, you could be left footing legal bills that should have been covered. The presence of anti-indemnification statutes also means that certain contract terms are unenforceable, but unenforceable terms can still drag you into expensive litigation. Before you sign anything, have it reviewed by a healthcare attorney who understands your state’s laws and how they interact with your insurance coverage.

This is an area where many PAs, and even some healthcare attorneys who do not specialize in insurance law, get tripped up. Employers and contracting entities will often ask you to name them as additional insureds on your professional liability policy. At first glance, this seems harmless, but in practice, it can dilute your coverage and create conflicts in the event of a claim. If your policy provides coverage for both you and the entity that employs you, and both are named in a lawsuit, you could find yourself competing with your employer for limited policy funds. Worse yet, indemnity clauses may require you to reimburse your employer for legal costs if the insurer denies coverage to the entity. I have seen this clause turn into a financial nightmare for practitioners who did not fully understand what they were agreeing to.

Many PAs operating in group practices or hospital settings assume they are protected by the so-called “corporate shield”, the idea that liability flows through the employer. While this can be true in theory, in practice, plaintiffs’ attorneys are increasingly piercing the corporate veil to go after individual assets, especially when the individual provider’s actions form the core of the alleged negligence. If your employer’s policy becomes exhausted or is structured to protect the institution first, you will find yourself exposed. Having robust individual coverage, separate from your employer’s policy, is not just advisable, it’s essential.

If you’ve ever had the misfortune of sitting through a malpractice deposition, you know how thoroughly opposing counsel will dissect your employment contracts and insurance provisions. Every clause, every omission, becomes a tool for them to shift blame and liability onto you.

I always advise PAs to review the section in their employment contracts that stipulates minimum required coverage. If it simply states that you must “maintain adequate insurance,” that’s a red flag. Adequate according to whom? What is adequate for the employer may not be adequate for you. Insist on specific language that defines the minimum coverage limits and the type of policy, including whether tail coverage is mandatory and who is responsible for its purchase.

This is the part most professionals gloss over: what happens after your contract ends? Do you retain responsibility for claims that arise later from work performed during your tenure? In most cases, yes. I advise clients to negotiate “survival clauses” that clearly outline their ongoing liability exposure and who bears the cost of tail coverage. Failure to do so can leave you vulnerable to claims that come in years after you have left a position or moved on to another role.

The worst clauses are the ones that look harmless. Indemnification provisions that require you to “hold harmless and indemnify” your employer can force you to pay for the company’s defense costs if the claim involves your actions. That means paying legal fees, settlements, and judgments out of pocket if your employer’s insurer denies coverage. I have reviewed contracts for highly experienced PAs that contained these clauses, and in nearly every case, the PA was unaware of their significance. Do not sign without a full legal review.

Another subtle but dangerous provision is the choice of venue clause, which dictates where any disputes will be litigated. If your contract specifies a jurisdiction that is plaintiff-friendly or far from where you live and work, you could face expensive and complicated legal battles on unfamiliar turf. I recommend that PAs negotiate for local jurisdiction clauses whenever possible and ensure that their insurance policies are structured to provide legal defense in those venues.

No insurance policy, no matter how well-structured, can substitute for solid risk management practices. In my experience, the most well-insured providers are also the most proactive about reducing risk on the front end.

Documentation is your first line of defense in any malpractice claim. But good documentation goes beyond charting what happened. It’s about anticipating future scrutiny. When I advise clients, I encourage them to chart defensively: include differential diagnoses you ruled out, rationale for decisions made, and documentation of patient education. A comprehensive note may seem time-consuming, but it becomes invaluable when you’re sitting in a deposition explaining why you made a particular choice under pressure.

Annual policy reviews are critical. I recommend that every PA work with both a healthcare attorney and a specialized insurance broker to conduct an annual audit of coverage and contract language. Policies change, and what was adequate last year may not be this year. New clinical responsibilities, additional procedures, or changes in scope should all trigger policy reviews. The goal is to align your professional evolution with your coverage structure.

Your insurance policy is your first defense; asset protection planning is your last. For high-net-worth PAs or practice owners, the use of irrevocable trusts, family limited partnerships, and carefully structured LLCs can shield personal assets from plaintiffs’ attorneys looking to pierce the corporate veil. These structures are not a replacement for insurance but a complementary strategy that can protect your wealth if the worst-case scenario materializes.

If you’re practicing in 2025 and you’re not at least partially engaged in telemedicine, chances are you soon will be. The demand for virtual care has exploded, and PAs are increasingly on the front lines of this movement. But with opportunity comes complexity, and I cannot stress enough how poorly understood the insurance landscape is for telemedicine providers.

First, you need to recognize that telemedicine changes the entire jurisdictional question. If you’re treating a patient who resides in a state other than the one in which you’re licensed or physically located, you’re stepping into a legal minefield. Your malpractice policy may be state-specific and exclude claims that arise from practice in states where you don’t hold licensure. Multi-state coverage endorsements are not an afterthought, they are an absolute requirement. I’ve worked with clients who assumed their “national” carriers would cover them across state lines, only to learn that coverage was limited to their state of residence unless specific multi-state endorsements were added. Do not assume. Verify.

Technology-related exclusions are another area where many policies fall short. Some policies include broad exclusions for services rendered via electronic communication. I’ve seen this language buried deep in policy documents, in sections most providers never read. If your insurer excludes telemedicine by default, you’re uninsured for every virtual consult you conduct. Make sure your policy language includes affirmative coverage for telemedicine services, not simply an absence of exclusions.

Then there’s the question of patient follow-up and continuity of care. I’ve reviewed claims where a PA provided appropriate advice during a virtual consult, but the patient failed to follow up in person. When adverse outcomes occurred, the litigation targeted not just the advice given, but the adequacy of the follow-up instructions. Many carriers are now underwriting telemedicine risk with an emphasis on follow-up documentation and state-specific informed consent requirements. If you’re practicing telemedicine, your documentation and patient education protocols need to be even more bulletproof than in-person care.

International patient exposure is another subtle but increasingly relevant risk. Some telemedicine platforms connect you to patients who reside outside U.S. borders. Most U.S.-based malpractice policies exclude claims arising from care provided to non-U.S. residents, or from actions litigated in foreign jurisdictions. If you’re on one of these platforms, review your contractual terms carefully, and verify with your carrier that no international exposure exclusions apply.

Understanding how your insurance premium is priced is not just academic; it empowers you to manage your risk factors strategically. Carriers don’t pull premiums out of thin air. They use increasingly sophisticated underwriting algorithms that take into account factors far beyond specialty and geography.

Your claims history, obviously, plays a significant role. But what many PAs don’t realize is that even closed claims with no indemnity payment can increase your perceived risk. Every claim on your record, regardless of outcome, raises a flag. I advise clients to obtain and carefully review loss-run reports before applying for new coverage or switching carriers. If there are closed claims on your record, prepare a detailed narrative explaining the circumstances and demonstrating what risk management measures you’ve taken since. A well-written claims narrative can reduce your premiums by thousands of dollars annually.

Practice focus and volume also matter. Procedural specialties, orthopedic surgery assists, dermatologic procedures, emergency medicine, carry higher base rates. But carriers also consider encounter volume. If you’re seeing an exceptionally high patient load, that’s a red flag. It suggests rushed care, documentation shortcuts, and higher error potential. Some underwriters are now requesting production reports as part of the application process. If your volume seems excessive, be prepared to explain how you manage quality and oversight.

Revenue banding is another underwriting factor. Higher grossing practices are perceived as higher risk, not necessarily because they’re less careful, but because larger practices present more opportunities for claims. If you own a practice or bill significant revenue as an independent provider, carriers will factor that into your pricing. Here’s where having a broker who understands healthcare underwriting makes a difference. They can help you package your data and documentation to tell a proactive risk management story, rather than allowing raw numbers to paint you as a liability magnet.

Discounts and surcharges are frequently misunderstood. Carriers offer claims-free discounts, loyalty credits, and sometimes CME participation credits. But they also apply surcharges for lapsed coverage, non-renewals by prior carriers, and even late payments. I advise my clients to manage insurance renewals with the same professionalism they bring to clinical recertifications: on-time, with complete documentation, and through stable relationships with top-tier carriers.

Finally, for PA-owned group practices, the possibility of forming a captive insurance entity is worth exploring. Captives allow practices with strong financial positions and clean claims histories to self-insure and potentially profit from their risk management discipline. This is not a beginner’s strategy, it requires capital reserves, regulatory compliance, and robust management. But for larger groups, captives can offer lower premiums, tailored coverage, and retained underwriting profits.

At Collaborating Docs, we understand firsthand how complex the professional landscape has become for physician assistants. Throughout this article, I’ve emphasized the critical importance of not only having the right insurance protections in place, but also ensuring that every aspect of your practice, from your contracts to your collaborations, is built on a foundation of compliance and risk management. That’s exactly why we exist.

Founded in 2020 by Dr. Annie DePasquale, Collaborating Docs was built with professionals like you in mind. We know that securing state-mandated physician collaborations is not just a regulatory checkbox. It is a key part of your professional reputation, your license protection, and ultimately, your ability to practice with confidence. Just like having the right insurance coverage can protect you from catastrophic liability, having the right collaborating physician relationship can protect you from compliance pitfalls and regulatory scrutiny.

Our network of over 2,000 collaborating physicians allows us to do more than make introductions. We make perfect matches that align with your specialty, your patient population, and your professional goals. We go beyond transactional matching services by ensuring that every physician we connect you with is committed to providing meaningful clinical support and guidance, not just a signature on paper. We have facilitated over 5,000 successful collaborations between NPs, PAs, and collaborating physicians across the United States, and we take pride in helping PAs like you protect your license and practice with confidence and peace of mind.

At Collaborating Docs, we don’t believe in shortcuts. We believe in doing it right, quickly, efficiently, and with full transparency. With 97% of matches completed in under seven days, and a guarantee of finding the right fit in 14 days or less, we help you focus on patient care without getting bogged down in regulatory stress.
If you’re reading this article and are serious about protecting your career, not just with comprehensive insurance but with compliant, supportive collaborations that stand up to legal and regulatory scrutiny, we’re here to help.

Let’s protect your license and set you up for success. Visit our website today and get matched with the right collaborating physician, quickly, correctly, and with confidence.