How to Explain a Prior Malpractice Claim to Underwriters
A previous malpractice claim does not tell the whole story. A factual, complete claim narrative can help an underwriter understand what happened, how the matter was resolved, and how you practice today.
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What should you say about a prior malpractice claim?
Give underwriters a clear, chronological, accurate account. Identify the clinical circumstances and allegations, your involvement, the claim’s current status and outcome, and any meaningful changes to your practice. Support the explanation with available loss runs and carrier documentation. Distinguish facts from allegations and avoid unsupported conclusions.
Six elements of a useful malpractice claim narrative
1. Basic claim details
Identify the date of the alleged incident, date reported, medical specialty, and claim or case reference if requested.
2. Clinical context
Describe your role, setting, treatment or procedure, and relevant circumstances without disclosing unnecessary patient identifiers.
3. Allegations versus facts
Summarize what was alleged and what is known. Clearly separate the claimant’s position from your account.
4. Disposition and payments
State whether the claim is open, dismissed, settled, or adjudicated. Include paid amounts or reserves only when verified and appropriate to disclose.
5. Practice changes
Describe actual, relevant changes in documentation, protocols, supervision, training, or clinical scope—without inventing corrective actions.
6. Supporting records
Provide loss runs, requested claim summaries, policy details, updated CV, and other materials the underwriter reasonably requests.
Illustrative claim narrative structure
The following is a fictional outline, not a real client case or a script to copy word-for-word. Adapt it only to facts you can substantiate.
Incident and role: “In [month/year], I provided [type of care] at [type of facility]. My role was [accurate description].”
Allegation: “A claim was filed alleging [brief, neutral summary]. The allegations remain disputed / were resolved as follows: [accurate status].”
Outcome: “According to available carrier records, the matter [remains open / was dismissed / settled / proceeded to judgment] on [date]. The verified indemnity payment was [amount, if applicable and known].”
Current practice: “Since that event, my current practice involves [actual scope and setting]. Relevant changes include [documented changes, if any].”
Documentation: “I can provide loss runs and additional non-privileged information requested for underwriting review.”
Do not include patient names, protected health information, or attorney-client privileged material in a public form or email. Use a secure, approved submission method for sensitive documents.
Common mistakes that can complicate underwriting
- Leaving out older claims: Disclose all matters required by the application, including those that did not result in payment.
- Confusing a settlement with an admission: Describe the documented outcome without making unsupported legal conclusions.
- Guessing payment amounts: Confirm figures against carrier loss runs when possible.
- Using defensive or emotional language: Keep the narrative factual, concise, and professional.
- Contradicting official records: Reconcile discrepancies before submission and explain any unresolved differences accurately.
- Omitting current practice details: Underwriters need to understand your present-day procedures, workload, and exposure—not only the historical claim.
What if you have multiple claims or an open lawsuit?
Prepare a separate, consistent summary for each claim. Underwriters may look for patterns in allegations, clinical activities, severity, and timing. An open claim may require periodic updates about its status. Do not speculate about an unresolved claim’s outcome.
See our resources on malpractice insurance after multiple claims and insurance with an open malpractice claim (once those pages are published).
Complete the Physician Underwriting Assessment →Frequently asked questions
Can I get malpractice insurance if I previously settled a claim?
Possibly. A settlement alone does not determine eligibility. Underwriters assess the underlying circumstances, specialty, claim pattern, amounts, and current practice, subject to carrier rules.
Should I explain a claim that was dismissed?
Yes, when the application requests it. A dismissed claim may still be reportable. Include the verified disposition and supporting records.
Do underwriters read claim narratives?
Many insurers request claim explanations, particularly for prior-claim or complex risks. Requirements vary by insurer and type of coverage.
What if my account differs from the carrier’s loss runs?
Do not alter either account to force agreement. Identify the discrepancy, seek clarification or corrections from the source, and explain it accurately.
Should I include patient records in my explanation?
Do not submit identifiable patient records unless specifically requested through an appropriate secure process and legally permitted. Ask your legal or compliance adviser if uncertain.
Will a well-written narrative guarantee coverage?
No. A clear explanation helps an underwriter evaluate the risk but does not guarantee acceptance, terms, pricing, or binding.
Explore Island Insurance Group resources
Learn more about specialty malpractice coverage and difficult underwriting situations at IslandInsuranceGroup.com. Our physician underwriting assessment helps organize initial information for review; it does not replace a completed insurer application or underwriting decision.
Have a prior malpractice claim? Prepare your next submission.
Start with the physician underwriting assessment, or contact Island Insurance Group to discuss what information may be needed for carrier review.
Start Free Physician Underwriting Assessment →Samuel Bennett · Licensed Insurance Agent
954-804-8144
sam@islandinsurancegroup.com
IslandInsuranceGroup.com
Educational information only; not legal advice, an offer of insurance, a binder, or a guarantee of coverage. Eligibility, terms, and premiums are subject to insurer underwriting and applicable law. Consult defense counsel about active litigation or privileged material.