Working as a 1099 independent contractor offers CRNAs flexibility, autonomy, and often higher gross compensation. The tradeoff is responsibility. Unlike W-2 employment, nearly all insurance and risk-management obligations shift to the clinician. There is no employer safety net, and assumptions that apply in traditional employment often fail in independent practice.

For 1099 CRNAs, insurance decisions are no longer peripheral benefits—they are part of the operating structure of the work itself.

How 1099 Insurance Responsibility Differs From W-2 Employment

As a 1099 CRNA, you are not an employee. Even when working at a single facility, you are functioning as an independent business entity. That distinction affects who carries insurance, how claims are handled, and where financial risk ultimately resides.

Benefits commonly associated with employment—workers’ compensation, group disability insurance, health coverage, and administrative protection—are typically not included in 1099 arrangements. Coverage gaps can develop quickly if policies are not coordinated intentionally.

Core Insurance Policies for 1099 CRNAs

Malpractice Insurance

Most 1099 CRNAs are responsible for carrying their own professional liability insurance. Policies may be claims-made or occurrence-based depending on insurer options and contract requirements. Policy selection, limits, renewals, and compliance obligations generally rest with the CRNA.

Facilities or agencies may require specific limits, additional insured endorsements, or proof of tail coverage as a condition of credentialing.

Tail Coverage and Prior Acts Exposure

When claims-made malpractice policies are used, tail coverage or prior acts coverage becomes relevant when changing insurers, leaving a contract, or retiring from practice. In 1099 arrangements, tail responsibility is commonly assigned to the CRNA unless explicitly negotiated otherwise.

Because tail premiums can be substantial, this obligation should be identified before—not after—contract termination.

Long-Term Disability Insurance

1099 CRNAs do not have access to employer-sponsored disability insurance. Individual long-term disability coverage is often used to protect income against illness or injury. Definitions of disability, benefit duration, elimination periods, and partial disability provisions vary widely and materially affect real-world protection.

Health Insurance

Health insurance is not provided through 1099 contracts. CRNAs typically secure coverage through individual marketplace plans, spouse-sponsored coverage, or association options. Continuity across contract changes and multi-state work should be considered, particularly for mobile practices.

Business Insurance

Operating as an independent contractor can create exposure beyond clinical care. Depending on contract structure and business setup, this may include general liability, business property protection, or coverage tied to contractual disputes and operations.

Common Insurance Gaps for 1099 CRNAs

• Unclear or assumed responsibility for malpractice tail coverage
• Disability policies that do not reflect anesthesia-specific risk
• Health insurance gaps during contract transitions
• Limited coverage for licensing board complaints
• Business liability exposure unrelated to patient care

Contract Language That Shapes Insurance Risk

Insurance obligations for 1099 CRNAs are defined as much by contract language as by policy terms. Indemnification clauses, insurance minimums, additional insured requirements, and tail provisions can materially shift financial responsibility.

These clauses should be reviewed with the same care as compensation terms.

Practical Checklist for 1099 CRNAs

• Confirm malpractice policy type and required limits.
• Identify tail coverage responsibility before signing contracts.
• Secure individual disability coverage appropriate for anesthesia practice.
• Maintain continuous health insurance independent of contracts.
• Review insurance and indemnification clauses carefully.

This content is provided for general educational purposes only and is not intended as personalized financial, insurance, or legal advice. Insurance requirements and contractual obligations vary by state, insurer, and individual circumstances. CRNAs should review policies and agreements and consult qualified professionals before making coverage decisions.