Who pays tail coverage when I leave?
On a claims-made policy, someone must pay the tail when you leave, so the real question is who pays for each exit. A clause that says 'tail provided' without naming the exit and the payer is not a promise. Size it before you negotiate: roughly 2× the mature annual premium, which at benchmark premiums is $76,000–$170,000 for orthopedic surgery, $90,000–$220,000 for OB/GYN, $16,000–$40,000 for internal medicine and $10,000–$26,000 for psychiatry.
All answers · Protection · checked October 21, 2026
An occurrence policy covers incidents that happen while it is in force, whenever the claim is filed, so there is no tail to buy. A claims-made policy covers claims filed while it is in force, so leaving ends coverage for later claims unless you buy an extended reporting endorsement — the tail.
Tail is usually priced as a multiple of the mature annual premium; the specialty benchmarks use about 2×. Quotes move with carrier, claims history, part-time status, and whether the employer's policy already includes an extended reporting endorsement. Ask for a quote in your specialty rather than relying on the benchmark.
Read the clause once per exit, not once for the contract. The four exits are termination without cause, resignation, non-renewal, and termination for cause. The common market outcomes: employer-paid tail on a without-cause exit, physician-paid on resignation, often employer-paid on non-renewal, and physician-paid on a for-cause exit. A vesting schedule of 25–33% per year is a common compromise.
Nose coverage is the cheaper alternative when it is available: the next employer's policy picks up prior acts, so no tail is bought. It is not automatic, and it is worth asking about before you accept a resignation tail.
Three cases get discovered late: the practice is sold or closes, you die or become disabled, and the policy converts from claims-made to occurrence. Each needs a named payer in the contract. 'Tail will be provided' does not say who pays when the practice no longer exists.
The numbers
- Orthopedic surgery
- $76k–$170k
- median ≈$110k; premium $38k–$85k × 2
- OB/GYN
- $90k–$220k
- median ≈$136k; premium $45k–$110k × 2
- Internal medicine
- $16k–$40k
- median ≈$26k; premium $8k–$20k × 2
- Psychiatry
- $10k–$26k
- median ≈$16k; premium $5k–$13k × 2
- OB/GYN
- ≈$136,000
- Orthopedic surgery
- ≈$110,000
- Internal medicine
- ≈$26,000
- Psychiatry
- ≈$16,000
Actions that follow from the numbers
- Read the malpractice clause for each exit: without cause, resignation, non-renewal, for cause.
- Ask the employer to pay tail on a without-cause exit, or to vest it by year.
- Ask whether the next employer's policy covers prior acts, so no tail is needed.
- Get a real tail quote for your specialty before signing. Tail clause
What could change this
Each condition below would change the conclusion above. If one applies, re-run the numbers before acting on this answer.
- Your policy is occurrence rather than claims-made — there is no tail to buy.
- The clause names who pays for each exit — that clause, not this general answer, decides.
- Your next employer accepts nose coverage — prior acts can be covered without buying a tail.
- Your employer's policy already includes an extended reporting endorsement — the tail may be paid for.
- You work part-time — carriers often price tail on the part-time premium, so the estimate falls.
- Your mature premium differs from the benchmark — the estimate scales with your actual premium, and quotes vary.
When the numbers aren't enough
- You are in a surgical or obstetric specialty with a large tail.
- The employer will not state who pays on each exit.
- The practice is being sold or closed and the policy's fate is unclear.
- You are leaving and the carrier will not quote tail without the employer's authorization.