---
title: "Who pays tail coverage when I leave?"
canonical: "https://www.joinandwise.com/answers/tail-coverage"
checked: "2026-10-21"
claim: "andwise:answer/tail-coverage@2026-10-21"
license: "CC BY 4.0"
---

# 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.

## The rule

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.

## 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)

## Actions

- 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. — https://www.joinandwise.com/contracts/clauses/malpractice

## What could change this

- 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.

## Sources

- [Andwise: malpractice and tail clause](/contracts/clauses/malpractice)
- [Andwise: specialty malpractice and wRVU benchmarks](/data/specialty-benchmarks.json)

Checked 2026-10-21. General information, not legal, tax or financial advice. The site describes what the law and rules say; it does not say whether a clause is enforceable or what you should do.