Should I Carry Nursing Malpractice (Liability) Insurance?

Malpractice (liability) insurance provides essential legal and financial security. Many Nurses go "bare" and never really consider Liability insurance as important. Be sure you are well informed before you make any final decisions about your future. Nurses Career Support Video Knowledge

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This question comes up frequently and is asked of me quite often, "should I carry malpractice protection?"

What is Malpractice?

Simply put, it is a failure to adhere to a standard of care or conduct by a professional such as a Physician, Nurse, Attorney, etc. Malpractice occurs when it can be proven that the professional had a duty to provide a standard of care/conduct, breached that duty, an injury or damage resulted, and the injury/damage was caused by the breach.

No matter how educated, confident, and careful the Nurse is, unintentional mistakes can and will happen. Accidents will occur. And, unfortunately, willful neglect can be an issue. Injury and death very often are the results of mistakes, accidents, and neglect. Families want to know what happened. Even in the best scenario, the Nurse feels embarrassed and ultimately fears what the damage could do to a perfect professional reputation. Nurses must have the option of protecting their professional reputations and personal assets. Having individual is a smart solution.

Nurses will often make the following statement

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My employer covers me so I don't need my own malpractice/liability policy.

Yes, your employer's policy may cover you, but only up to a point. Remember: Your employer's policy is created to fit their specific needs and protects them first. You may even be told (by your employer HR) that you do not need your own policy. What they do not tell you is that they want you to be represented by their attorneys. They do not want "outside" representation for they know that their best interests will not be first and foremost.

All malpractice liability insurance policies have limits of liability. If you are only covered by your employer's insurance, other defendants employed at your entity may and probably do share your liability limits under the same policy. If you, as well as others, are named in a suit, your legal costs, including any settlement, could exceed your employer's shared liability limits. This would mean out-of-pocket expenses for you.

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What type of policy and how much coverage do I need as a Nurse?

These are questions that are very important when considering a policy.

Two Popular Policies

  • Occurrence-based - any covered incident occurring while the policy is in effect even if the policy is now canceled and/or you have retired
  • Claims-made - any covered incident only while the policy is in effect

The cost of a policy is economical and reasonable. For example, the annual premium could cover the first hour billed by Attorney. $1,000,000/$6,000,000 coverage premiums are approximate $100/year in most states for the Registered Nurse (RN) as well as for the Licensed Practical/Vocational Nurse (LPN/LVN).

Links of Interest

One major benefit of an individual policy that is often overlooked or taken for granted when considering coverage is license protection. Nurses need to be aware that this will extend beyond their employer's coverage and includes discipline issues that can be brought up by the individual Nurse's Board of Nursing (BON). Many Nurses do not have the financial ability to go against the BON, therefore, license protection is a must.

Another all-important beneficial consideration is that policies normally will include coverage regarding libel, slander and patient confidentiality, including HIPAA issues. These issues can be troublesome and include a great cost for the Nurse.

Finally, a common statement that is incorrect and based on myth ...

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Malpractice liability insurance will make me a target and I'll be named in a lawsuit.

When being named in a lawsuit, no one knows you have your own personal policy unless you have revealed this information. Only after a lawsuit is filed and only during the period of the discovery phase is this information available.

So, do you carry your own individual malpractice/liability insurance? In the end, the question of whether or not the Nurse should carry malpractice/liability insurance is a personal one and should be seriously considered.

The peace of mind knowing that you are covered is overwhelming.

The peace of overwhelming reassurance.

Most nurses seem to use NSO without much thought. I couldn't stand to not know what the other options are, so I did some research.

I found that there are really only three widely-available companies that sell for nurses. The first post of this thread has a lot of links that turn out to be different names for the same insurance policies.

NSO/HPSO are the same (CNA Insurance). Marsh, Proliability, and CPH are the same. Then there is CMF Group.

It turns out that they are all pretty similar in price and coverage. All of them give very quick online price quotes and you can get coverage instantly online with a credit card.

NSO is slightly more expensive than the others (and has a $2 nonsense membership fee to boot). The NSO policy is written with a lot of legalese but is very comprehensive. You can't pick your own lawyer if you have to go to a deposition and the $500 cap for a license hearing seems low. NSO does not offer a high-limit $2 million per incident/$4 million total policy like the other two.

Marsh doesn't have any policy documents available online before purchase, so I don't have any particular comments. Marsh does offer a 10% discount for nurses working in a magnet hospital or for having certain certifications.

CMF Group has a low-cost $500k per incident/$1 million total policy option that would be a good choice for younger nurses without many assets to protect. The insurance also includes a personal liability component which is good if you don't have homeowner's or renter's insurance. CMF has smaller limits on extra coverages (coverages beyond basic liability) than the other two companies.

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Here are the coverage details for the three companies when I was looking for insurance for Maryland recently. The link in Caffein's post above has explanations for some of the terminology.

NSO/HPSO (CNA)

  • Type of coverage: Occurrence
  • 1 mil/6 mil: $108
  • 1 mil/3 mil: $104
  • 500k/2.5 mil: $90
  • (prices include annual membership fee)
  • Defendant & Lost wages coverage: 25k limit
  • License defense protection: 10k/25k (capped at $500/hearing)
  • Assault protection: 10k/25k
  • Property damage: 500/10k
  • Deposition representation: 10k

MARSH/PROLIABILITY/CPH

  • Type of coverage: ??
  • 1 mil/6 mil: $98
  • 2 mil/4 mil: $114
  • Defendant & Lost wages coverage: 10k limit
  • License defense protection: 10k/25k
  • Assault protection: 10k/25k (includes 10k property damage)
  • Deposition representation: 5k

CMFGROUP (AIG)

  • Type of coverage: Occurrence
  • 1 mil/6 mil: $99
  • 2 mil/4 mil: $114
  • 500k/1 mil: $58
  • Defendant & Lost wages coverage: 5k limit
  • License defense protection (administrative hearings): 5k
  • Assault protection: 5k
  • Property damage: ?
  • Deposition representation: 2500
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As a nurse turned attorney working in a plaintiff's law firm in malpractice matters...I have been asked this question several times about whether to carry . My answer to them is always no (based on the way things work in the area I practice law). Let me share a little bit about the legal process and what happens when we sue practitioners...

Most of the time, we sue physicians and not nurses. They are usually the one who missed a diagnoses or ordered the wrong med. That being said, the mistake is sometimes on the nurse for not following doctors orders correctly or by not reporting signs/symptoms in a timely manner.

Now as a nurse attorney, I am the one in my firm the delves in to the medical records and bills. Our clients are sometimes severely devistated and rack up the medical bills. I have seen countless clients with medical bills from $200,000 to over 1 mil in charges. So as attorneys our job is to recover enough to pay back their bills, pay our fee, and set them up to be covered the rest of their life. You can imagine that this sum can add up. Frequently our life care plans will dictate that our clients will need $5,000,000 to $20,000,000 to make it through the rest of their life (depending on the type of injury and client).

Most doctors/nurses do not have enough insurance to cover nearly that amount. So our main goal....to get the hospital involved (assuming the incident occurred while the patient was inpatient.) We go for the hospital not because they have "deep pockets" but because they employ the persons who committed the negligence and because they are the only ones who can realistically help the patient pay for condition for the rest of their life (ie, brain damage, paralysis, loss of limb...we have all of these types of cases).

So why do I say RNs do not need malpractice insurance? Well I dont know if this is just my law firm, but I rarely see a nurse sued personally, meaning that we expect to hold the nurse liable for the damages so that she'd have to pay out of her pocket and lose her house becuase of it. I mean seriously, how many nurses have you heard of that happening to? We sue the nurse to bring in the hospital...point blank thats it. Once we establish legally that the nurse was acting under her scope of employment at her employing hospital (which is almost always the case unless the nurse committed some sort of assault or sexual abuse), we let the nurse out of the suit and continue with the hospital. We know that nurses can't afford to pay for the damages of our client and we quite frankly do not like suing nurses period because we appreciate the work they do. All that having malpractice insurance for a nurse does is give us a reason to keep you involved with the case instead of letting you out.

Just my perspective as a nurse attorney doing plaintiff's work. It is true that a hospital hires lawyers for its own benefit, but there is no way they will argue that the nurse should be liable alone and blame it all on the nurse to pay for all of the damages alone. Most of the time, they will argue for the nurse to prove that she did nothing wrong and even if she did, that the wrong had no affect on the patient outcome.

In conclusion, I do not believe nurses need malpractice insurance though I would recommend speaking with an attorney in your particular state. I am in the Washington DC area in case you are wondering. I do not have any malpractice insurance and neither does my mother, an RN for over 30 years. We have sued many nurses with out malpractice insurance and I assure you they did not lose their house. We almost always let them out of the suit. hope this helps!!

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Nicole0822 said:
As a nurse turned attorney working in a plaintiff's law firm in malpractice matters...I have been asked this question several times about whether to carry malpractice insurance. My answer to them is always no (based on the way things work in the area I practice law). Let me share a little bit about the legal process and what happens when we sue practitioners...Most of the time, we sue physicians and not nurses. They are usually the one who missed a diagnoses or ordered the wrong med. That being said, the mistake is sometimes on the nurse for not following doctors orders correctly or by not reporting signs/symptoms in a timely manner. Now as a nurse attorney, I am the one in my firm the delves in to the medical records and bills. Our clients are sometimes severely devistated and rack up the medical bills. I have seen countless clients with medical bills from $200,000 to over 1 mil in charges. So as attorneys our job is to recover enough to pay back their bills, pay our fee, and set them up to be covered the rest of their life. You can imagine that this sum can add up. Frequently our life care plans will dictate that our clients will need $5,000,000 to $20,000,000 to make it through the rest of their life (depending on the type of injury and client). Most doctors/nurses do not have enough insurance to cover nearly that amount. So our main goal....to get the hospital involved (assuming the incident occurred while the patient was inpatient.) We go for the hospital not because they have "deep pockets" but because they employ the persons who committed the negligence and because they are the only ones who can realistically help the patient pay for condition for the rest of their life (ie, brain damage, paralysis, loss of limb...we have all of these types of cases). So why do I say RNs do not need malpractice insurance? Well I dont know if this is just my law firm, but I rarely see a nurse sued personally, meaning that we expect to hold the nurse liable for the damages so that she'd have to pay out of her pocket and lose her house becuase of it. I mean seriously, how many nurses have you heard of that happening to? We sue the nurse to bring in the hospital...point blank thats it. Once we establish legally that the nurse was acting under her scope of employment at her employing hospital (which is almost always the case unless the nurse committed some sort of assault or sexual abuse), we let the nurse out of the suit and continue with the hospital. We know that nurses can't afford to pay for the damages of our client and we quite frankly do not like suing nurses period because we appreciate the work they do. All that having malpractice insurance for a nurse does is give us a reason to keep you involved with the case instead of letting you out.Just my perspective as a nurse attorney doing plaintiff's work. It is true that a hospital hires lawyers for its own benefit, but there is no way they will argue that the nurse should be liable alone and blame it all on the nurse to pay for all of the damages alone. Most of the time, they will argue for the nurse to prove that she did nothing wrong and even if she did, that the wrong had no affect on the patient outcome.In conclusion, I do not believe nurses need malpractice insurance though I would recommend speaking with an attorney in your particular state. I am in the Washington DC area in case you are wondering. I do not have any malpractice insurance and neither does my mother, an RN for over 30 years. We have sued many nurses with out malpractice insurance and I assure you they did not lose their house. We almost always let them out of the suit. hope this helps!!

Some people make a claim that just by 'having' inurance that you are more apt to be sued by money grubbers looking to make a buck.

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Nicole0822 said:
As a nurse turned attorney working in a plaintiff's law firm in malpractice matters...I have been asked this question several times about whether to carry malpractice insurance. My answer to them is always no (based on the way things work in the area I practice law). Let me share a little bit about the legal process and what happens when we sue practitioners...

Yeah, sure, I'm going to take advice about carrying liability coverage from a plaintiff's attorney ...

:sarcastic:

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Specializes in oncology, MS/tele/stepdown.

It is interesting to hear both perspectives. A cousin of mine is a nurse attorney, so I will ask her what she thinks when I see her in a couple weeks.

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Ok,

I have never heard of a nurse being sued, ever. I Know a few you have been brought into the risk managment to answer questions and give some sworn testimony and then the case just settles pre-trial or goes to court. My HR department insist that we should stick with the hospital coverage and not get our own. I always hear people say on all nurses and the nso website that your company wont cover you because they will find some ltlle infraction of policy and use it to throw you under the bus but that makes no since to me.... or to my risk manager at my hospital. As an hourly employee (most rns are) the facility is responsible for your actions. If they throw you under the bus that is just admitting that thier employee messed up(think bigger settlement for them). No Attorney is going sue just me for 3 million, because I don't have it. You could garnish my wages for 50 years and still wont get it. no judge is gonna let a hospital wash their hands of liability and pin the blame on a 20$/hr employee. A pretty typical case is a fast food restaurant employee spills hot coffee on a woman in her car, I'm sure its "not policy" (insert laugh track) to pour coffee on drive through customers but does that mean the billion dollar corporation is free from blame and the disfigured costumer has to wait for the 7-10$ employee to garnish her wages and pay medical bills? Yes we are professionals, but we are not independent contractors like many of the MDs and NPs. I have never, EVER met a nurse who was sued as an individual. I read some trial briefs and always see a hospital and MD listed as defendants. But not nurses. I also see that the majority of cases get settled out of court with hospital. The only place i have scene case write ups where nurses have to pay is (drum role please) the NSO website. And even in those examples the nurses pay 100Kish and no where close to 3 million dollar limits. Guess what protection my hospital has on me, you guessed it 100K plus a legal team. Seriously, if I'm wrong private message me. If you personally are an RN who is uninsured and sued and a couple 100k in the red PM me. I will send 20$ so you can buy a meal (seriously). Im an RN who wants to become a risk manager myself and am extremely interested in these stories. Unfortunately, I find more fear mongering and law suit legends than real examples of nurses being sued and actually having to payout (being called to testify does not count as being sued).

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addendum,

To be fair. I think that the nso is great for license protection. I can totally see why you would want to have an attorney in front of the BON. Everyone i know says they are pure evil. But again, the only people i have known to go before the board stole drugs or made a HUGE med error.

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Specializes in LTC, Memory loss, PDN.
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Most of the time we don't sue nurses

Rarely are nurses sued personally

We almost always let them out of the suit

What if I told my next patient

Most of the time, I administer the right medication

Rarely do I make my pt.'s life's miserable

I of almost always follow your physician's treatment plan

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Specializes in Complex pedi to LTC/SA & now a manager.

The policy is not just in case you are named in a court case but also in force if you are charged with a HIPPA violation (with NSO at least ), reported to the board of nursing for allegations of malpractice, allegations of violating the nurse practice act (by inaction, or acts of omission, commission, or failure to document properly), license defense, allegations of not meeting fitness for duty standards (substance abuse, drug diversion, mental or physical disability) Plus many policies are in effect and cover your time & expenses for depositions and interrogatories including an attorney to represent the insured and their interests.

Of course license defense is a more likely occurrence than being named in a personal civil suit. The same policy protects me for both situations.

The hospital or other employer protects their interests why shouldn't a nurse protect their own?

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I don't think that insurance is a total waste. In fact i have looked into it for myself many times. its dirt cheap and gives you peace of mind. Even if it does get you stuck in a suit longer its the insurance company footing the bill. I just don't like the culture of fear that develops around civil litigation. Do your job, do your best, and hope for the best. I like my 100K company plan as far as civil stuff is concerned. Its enough money to cover me. even the NSO website only list cases where the nurses payed around 100K (i wonder why they couldn't find more expensive settlements (I suspect, not a lot exist or nso couldn't sell insurance that cheap and make a profit)). And PS i don't have PM so if ur a nurse who has lost over 100K in civil suit and was not insured you can email me at [email protected]. I really wanna hear this story and send prayer and well wishes your way.

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toomany said:
My HR department insist that we should stick with the hospital coverage and not get our own. I always hear people say on all nurses and the nso website that your company wont cover you because they will find some ltlle infraction of policy and use it to throw you under the bus but that makes no since to me.... or to my risk manager at my hospital.

Your hospital wants you to only be covered by their insurance because, if something goes wrong, they want you to be dependent on their attorneys (who are being paid to represent the hospital's interests, not yours) for legal advice. It suits their interests for you to not have independent legal advice from someone representing your interests.

As for firing you for some minor variance from policy, it may not make "since" (sic) to you, but I saw it happen many times with my own eyes when I was working as a hospital surveyor.

However, as already noted, it's a free country and you are free to make whatever choice seems best to you.

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