According to our experts, the major carriers that provide coverage for nurse practitioners are Evanston, CNA, USLI, Admiral, Fireman’s Fund, Hiscox, MedPro, Markel, RSUI, Nurses Service Organization and Healthcare Providers Service Organization. According to Richard J. Sullivan, Jr. chief executive officer at CM&F Group, Inc., AIG was a major player until recently.

According to Don Tejeski, senior vice president at AmWINS Healthcare, coverage is written on both an admitted and nonadmitted basis, on both occurrence and claims-made forms. Beginning in 1987, nurse practitioner policies were occurrence-based and on an admitted basis, according to Mr. Sullivan. As time went on and their losses tracked with those of other health care delivery systems, the occurrence approach was re-examined and many carriers adopted the claims-made approach. Now that the market is more stable, it is more of a blend of the two but he believes that occurrence-based coverage is the preferred option.

Nurse practitioners are involved in many different health care disciplines. As a result, there is no one set market or premium for the entire category. Joseph Schneider, professional liability manager of Jimcor Agencies, explains, “Nurses who specialize in more difficult areas of practice go to the wholesale level markets. Examples are OB/GYN and pediatric." Mr. Sullivan says, “There is a trend among competitors to not write coverage for self-employed advanced practice nurses. They prefer to write those employed by hospitals.”

The frequency and severity of losses varies according to the type of practice. According to Tony Armor, commercial underwriter at Roush Insurance Services, Inc., "Nurse practitioners within the family practice and adult/geriatric areas tend to have more frequency issues, probably due to the fact that these practitioners most often provide health care services on a primary care basis and see more patients.” Mr. Schneider and Mr. Tejeski agree that OB/GYN is where claims are historically more severe than in other areas.

Mr. Sullivan's personal observation is that failure to diagnose is the major exposure. As a result, he believes the greatest exposure lies with family practice nurse practitioners. An example of this is the person who comes in with back pain that turns out to be lung cancer but is sent home with ibuprofen..

Gail Pierce, senior commercial underwriter at Roush Insurance Services, Inc., suggests that, “All nurse practitioners should purchase medical professional coverage with general liability.” Mr. Armor agrees but also recommends adding “personal liability protection for covered claims resulting from incidents at the practitioner’s residences that are not related to business activities.”

Another important gap can occur when the nurse practitioner relies on the employer’s professional coverage. Mr. Armor says “Gaps in an employer’s malpractice insurance coverage may leave nurse practitioners exposed to significant financial ramifications. Most employers' policies protect the practitioner’s action only while he or she acts on the employer's behalf.” Many carriers offer coverage to fill that gap.

Along the same line, Mr. Schneider says, “Coverage for good samaritan activities and services that may be performed away from the normal workplace should be negotiated. In addition, HIPAA regulations should also be addressed.”

The most common limits of liability for this class are $1 million/$6 million but some markets offer higher limits.

Pricing varies by specialty but appears to be relatively flat and stable. Mr. Sullivan explains, “A lot of nurse practitioners wear more than one hat. They'll work in a hospital emergency department on weekends or they’ll work in two practices. They get more of a blended rate to reflect their different exposures.”

According to Ms. Pierce, the minimum premium for this is class of business is around $2,500.

It is important to remember that definitions of nurse practitioner vary from state to state. This can increase or decrease exposure significantly. In addition, liability protections established for physicians may not extend to nurse practitioners.

Mr. Sullivan provided two examples. In Florida, liability protections for physicians did not extend to nurse practitioners. Consequently, physicians carry low limits and the nurse practitioner’s liability provides the deep pockets of protection for the plaintiff. New York state has major problems due to assessments and company ratings which is causing nurse practitioners to turn to risk retention groups.

Ms. Pierce points out that Indiana law permits nurse practitioners to belong to the Indiana Patient Compensation Fund, which provides a liability cap.

Nurse practitioners' exposures are changing right along with changes in the health care industry. What once was a limited care profession that functioned as a supplement to physician care is now expanding into new specialties. This can be seen as competition to the traditional physician care model in some areas.

Regardless of the direction of future developments in this area, the insurance industry will be there to provide the coverages these professionals need.