Insurance language in CRNA contracts is often where financial risk is quietly assigned. When a case results in a claim, malpractice policy structure, tail obligations, indemnification clauses, and employment classification determine whether liability remains with the employer or shifts to the CRNA.

These provisions are frequently buried in standard contract language and are easy to gloss over during negotiations, yet they have long-term implications that extend well beyond day-to-day clinical practice.

Key Insurance Clauses CRNAs Should Review Carefully

Malpractice Policy Type (Claims-Made vs Occurrence)

Every CRNA contract should clearly identify whether malpractice coverage is claims-made or occurrence-based. This distinction directly affects exposure after leaving a position and is one of the most consequential insurance terms in any agreement.

• Claims-made: Coverage applies only if the policy is active at the time the claim is filed. Once employment ends and the policy terminates, tail coverage is required to protect against future claims related to prior work.
• Occurrence: Coverage applies to incidents that occur during the policy period, regardless of when the claim is filed. Coverage remains in place permanently for work performed during that time, eliminating the need for tail.

Many CRNAs underestimate how often claims arise years after a case, particularly in obstetric, pediatric, and complex surgical settings.

Tail Coverage Responsibility

When claims-made coverage is used, tail insurance becomes the mechanism that preserves protection after the policy ends. Contracts must explicitly state who is responsible for purchasing tail coverage and under what circumstances.

• Is tail coverage paid by the employer regardless of how the contract ends?
• Does responsibility shift if the CRNA resigns versus being terminated?
• Is tail coverage provided at retirement, or only after a minimum term of service?

Because tail premiums can reach tens of thousands of dollars, ambiguity in this section represents a real financial risk.

Coverage Limits

Contracts should specify malpractice coverage limits in clear, numeric terms. A commonly cited minimum is $1 million per claim / $3 million aggregate, but adequacy depends on practice environment, case mix, and state-specific factors.

CRNAs working in independent practice models, higher-acuity settings, or jurisdictions with higher claim severity may require limits that exceed baseline minimums to align with actual exposure.

Indemnification Clauses

Indemnification provisions determine whether the CRNA can be held financially responsible for losses that extend beyond insurance coverage. Broad or poorly limited clauses may obligate the CRNA to defend or reimburse the employer for claims arising from routine clinical care.

This language is particularly important in 1099 and locum tenens contracts, where indemnification terms are often drafted to prioritize facility protection.

W-2 vs 1099 Insurance Requirements

Employment classification drives both insurance responsibility and risk exposure, and assumptions in this area are a common source of problems.

• W-2 CRNAs: Malpractice coverage is typically employer-provided, but CRNAs should still confirm policy type, limits, and tail responsibility.
• 1099 CRNAs: Responsibility for malpractice coverage often rests with the CRNA, along with potential requirements for business liability, disability, and other supplemental policies.

Definition of Covered Duties

Coverage language should reflect the actual scope of clinical work expected. Gaps between listed duties and real-world responsibilities can create coverage disputes.

• Regional anesthesia and advanced blocks
• Obstetric, trauma, or other high-acuity services
• Practice across multiple facilities or locations

Common Pitfalls CRNAs Encounter

• Assuming employer-provided insurance eliminates personal exposure
• Failing to account for tail obligations tied to claims-made policies
• Accepting broad indemnification clauses without defined limits
• Relying on verbal assurances instead of written contract terms

Practical Considerations Before Signing

• Obtain written confirmation of malpractice policy type and coverage limits.
• Clarify tail coverage responsibility for all termination scenarios.
• Confirm coverage applies to all clinical duties and practice locations.
• Consider review by a healthcare attorney familiar with anesthesia contracts.

This content is provided for general educational purposes only and is not intended as legal, financial, or insurance advice. Contract terms and insurance requirements vary by state, insurer, and individual circumstances. CRNAs should review contracts and coverage details with qualified professionals before signing.