Underwriting Guide
What Underwriters Ask About Healthcare Practices
Healthcare accounts — from medical offices to clinics to home health agencies — require professional liability (medical malpractice) as the primary coverage, alongside general liability and property. Underwriters scrutinize the clinical procedures performed, provider credentials, and malpractice claims history with exceptional care.
Medical Malpractice / Professional LiabilityGeneral LiabilityWorkers' CompensationCyber Liability / HIPAABusiness Income
Practice & Providers
What type of healthcare practice — primary care, specialty, urgent care, behavioral health, home health?
Why they ask: Specialty type determines the malpractice risk class. Surgeons, OBGYNs, and emergency medicine carry the highest rates.
How many licensed providers practice at this location (MDs, DOs, PAs, NPs)?
Why they ask: Malpractice premium is calculated per provider. Each provider's specialty, credentials, and claims history are evaluated individually.
What clinical procedures are performed in the office?
Why they ask: Invasive procedures, anesthesia administration, and surgical procedures significantly increase malpractice risk.
Does the practice have hospital privileges? At which hospital?
Why they ask: Hospital privileges indicate the provider's credentialing level and scope of practice.
Does the practice perform any procedures under sedation?
Why they ask: Anesthesia and sedation create the highest malpractice risk and may be ineligible under standard policies.
Claims History
Provide 5 years of malpractice claims history for each provider.
Why they ask: Malpractice claims history is the primary underwriting factor. Multiple claims or severity patterns can result in declination or individual provider surcharges.
Have any providers had medical board actions, license suspensions, or hospital privilege revocations?
Why they ask: Regulatory actions are material to underwriting. Disclosure is required; failure to disclose is grounds for rescission.
Is the practice currently in litigation on any matter?
Why they ask: Open litigation affects current coverage and must be disclosed. New carriers may exclude ongoing matters.
Data & Cyber
How many patient records does the practice maintain?
Why they ask: PHI (protected health information) volume drives cyber liability exposure. HIPAA breach costs scale with the number of affected individuals.
Is patient data stored on-premises or in the cloud?
Why they ask: Cloud-based EHR systems with reputable vendors can reduce cyber risk. On-premises servers without proper security are higher risk.
Has the practice experienced any data breaches or HIPAA violations?
Why they ask: Prior breaches indicate security vulnerabilities. HIPAA penalties can reach $1.9M per violation category per year.
Answers that raise red flags
⚠Surgical procedures performed in-office without a surgery center license
⚠Multiple malpractice claims in a 3-year period, especially with similar fact patterns
⚠Provider with prior board action or license restriction
⚠Practice offering aesthetic/cosmetic procedures (high-risk category for malpractice)
⚠No cyber liability for a practice storing thousands of patient records
⚠Claims-made policy with a gap in coverage (retroactive date issue)
Tips for presenting this risk favorably
✓List every provider separately with their specialty, NPI number, and claims history — do not bundle providers
✓Confirm the retroactive date on claims-made policies matches the provider's first date of coverage
✓Document EHR system used and any HIPAA compliance certifications or audits
✓Explain any prior claims with the outcome (dismissed, settled, amount) and any practice changes made
✓Confirm whether tail coverage is needed for any departing providers
Collect all this information automatically
AgencyAssist sends your client a plain-English intake link and maps every answer to the correct ACORD fields — including all the questions above.