What is the difference between claims-made and occurrence-based indemnity coverage?
Why the trigger for your cover matters more than the first-year price, and what to check before you sign.
The short answer
Occurrence-based cover protects you for incidents that happened while you were covered, whenever the claim arrives, even after you have left or retired. Claims-made cover only responds if the claim is reported while the cover is still in force, so when you stop, switch provider or take a long break you need run-off cover (the MDU calls it extended reporting rights). Claims-made is often cheaper at first, but compare the whole-career cost, including run-off, before you choose.
Key points
- Occurrence-based cover follows the date of the incident. Claims-made cover follows the date the claim is reported.
- Claims often arrive years after the consultation. Medical Protection puts the average delay at over five years.
- With claims-made cover you need run-off (extended reporting) when you retire, switch or stop, and it usually costs extra.
- Most MDO membership for individual doctors is occurrence-based, while insurance policies and some organisation-level products are claims-made.
- Moving from claims-made to occurrence-based cover leaves a gap for past incidents unless you buy run-off or your new provider picks up past liabilities.
The difference in one example
Say you see a patient privately in March 2027 and miss a diagnosis. The patient makes a claim in 2032, by which time you have changed provider or retired.
- Occurrence-based: the provider you had in March 2027 can help, because the incident happened while you were covered by it. Nothing more to buy.
- Claims-made: the provider you had in 2027 only helps if you still have cover with it in 2032, or you bought run-off that is still in force. Otherwise you may have no cover for that claim.
The gap is real. Medical Protection says the average delay between an incident and the reporting of a claim is currently over five years.
Side by side
| Occurrence-based | Claims-made | |
|---|---|---|
| What triggers cover | The incident happened during your cover | The claim is reported during your cover (and the incident is after any retroactive date) |
| When you retire or leave | Past incidents stay covered | You need run-off or extended reporting |
| Early-career cost | Usually higher | Often lower, rising over the first years |
| Typical providers | Individual MDO membership | Commercial insurance, some MDO products |
How it works in practice in the UK
Medical Protection describes its GP membership as occurrence-based: you can request help with an incident from your membership period even if you only become aware of it after your membership ends. Its corporate associate membership, which covers a company rather than individuals, is claims-made.
The MDU offers occurrence-based membership, but it moved GP members in Northern Ireland to claims-made membership from 1 August 2021. Under that membership you must report an incident while you are a member, or apply for extended reporting rights (ERR) within 30 days of leaving. ERR needs an additional subscription, renewable each year, except in set cases: permanent retirement at NHS pension age after ten years of continuous claims-made membership, death in membership, or ill-health retirement.
Commercial insurance for doctors is usually claims-made. It is a contract with set limits and terms, regulated by the Financial Conduct Authority, whereas MDO help is discretionary. See where to get private GP indemnity for that trade-off.
Two separate questions: trigger and certainty
Claims-made versus occurrence-based is about which claims are covered. It is a different question from whether the cover is discretionary or contractual.
- Discretionary MDO membership gives you the right to ask for help. The MDO decides whether to give it, and it is not an insurance company.
- An insurance policy is a contract. It pays what the terms say, within its limits, and the insurer is regulated.
You can have occurrence-based discretionary cover, claims-made discretionary cover (as with the MDU’s Northern Ireland GP membership) or claims-made insurance. The Department of Health and Social Care consulted in 2018 on requiring regulated cover for professionals outside the state schemes and said in December 2022 that it preferred that option. At the time of review we found no legislation making that change, so discretionary MDO cover remains lawful. Check the current position before you rely on it.
When the difference matters most
- Switching provider. Leaving claims-made cover without run-off leaves every unreported past incident uncovered. Ask any new provider whether it will cover incidents from before you joined, and get the answer in writing.
- Retiring or leaving practice. This is when claims-made run-off costs most, and when you are least likely to want a new bill.
- Career breaks and parental leave. With claims-made cover you may need to keep paying something to keep reporting rights. Ask before you go.
- Closing a company. If your practice company holds claims-made cover and you wind it up, arrange run-off for the company first.
- Working abroad or moving to a clinic. A new employer’s cover rarely picks up your previous private work.
How to choose
Don’t compare first-year prices alone. For each option, ask:
- Is this occurrence-based or claims-made? If claims-made, what is the retroactive date?
- What does run-off or extended reporting cost, and when must I buy it?
- Are there free run-off terms, for example on retirement, death or ill health?
- Are there limits on the amount paid per claim or per year?
- Does it include help with GMC investigations, inquests and complaints, or only claims?
Then compare the likely total cost across the years you expect to practise privately, including run-off at the end. For more on what drives the price, see the costs of indemnity for private GPs.
Where the NHS schemes fit
CNSGP in England and GMPI in Wales cover clinical negligence claims from NHS GP work, and they do not cover private work. The occurrence or claims-made question therefore applies to the cover you arrange for private work, and for all your work in Scotland and Northern Ireland. See indemnity for private GPs.
Frequently asked questions
Is occurrence-based cover always better?
Not always. It avoids run-off costs and gaps, but claims-made cover can suit a short, defined period of work if you budget for run-off from the start.
What is a retroactive date?
It is the earliest incident date a claims-made policy will cover. Incidents before that date are excluded, so check it matches the start of your private work.
How do I find out which type I have now?
Check your membership certificate or member guide, or ask your provider directly. Ask it to confirm the answer in writing.
Do I need run-off if I stop private work but keep NHS work?
If your private cover was claims-made, yes, for the private work. The NHS schemes will not pick up claims from past private consultations.
