Locum tenens work is often viewed as one of the simplest anesthesia arrangements from an insurance standpoint. In many cases, malpractice coverage is provided by the staffing agency, and CRNAs are not required to purchase a separate professional liability policy for each assignment. The risk arises when “agency coverage” is assumed rather than verified, particularly around policy type, tail provisions, and state-specific requirements.

Locum malpractice is usually straightforward—until it isn’t. Most problems surface at contract termination, early exit, or when coverage does not align with state law or scope of practice.

Who Covers What in Locum Tenens Arrangements

Agency-Provided Malpractice Coverage

In most locum tenens arrangements, the staffing agency provides malpractice insurance as part of the contract. These policies commonly carry limits such as $1 million per claim and $3 million aggregate and are intended to cover clinical services performed during the assignment.

Agency coverage typically applies only to services performed within the defined scope of the locum assignment and only at facilities approved under the contract.

Facility-Provided Coverage

Less commonly, a hospital or facility may cover locum CRNAs under its own malpractice policy. This should never be assumed. When facility coverage is used, the same questions still apply regarding policy type, limits, defense costs, and tail responsibility.

Claims-Made Coverage Is the Norm

Most locum tenens malpractice policies are claims-made. This means coverage must be active both when care is provided and when a claim is reported. Understanding how tail coverage is handled is essential, even when coverage is agency-provided.

Tail Coverage and Extended Reporting Risk

What Tail Coverage Does in Locum Work

Tail coverage, formally known as an extended reporting endorsement, allows claims related to past clinical work to be reported after a claims-made policy ends. Because anesthesia claims may arise months or years after care is delivered, tail coverage is a critical safeguard.

When Agencies Commonly Include Tail Coverage

Many locum tenens agencies include tail coverage as part of their malpractice policy. When this is confirmed in writing, it significantly reduces one of the largest financial risks associated with claims-made coverage.

When Tail Responsibility Can Shift to the CRNA

Tail responsibility may shift to the CRNA if a contract is terminated early, if work falls outside the agreed assignment terms, or if tail coverage is excluded or limited in the agreement. For this reason, tail inclusion should always be explicitly confirmed.

State-Specific Malpractice Considerations

Patient Compensation Funds

Some states operate patient compensation or excess liability funds that affect how malpractice claims are paid and how coverage limits apply. Participation rules, surcharges, and reporting obligations vary by state and can affect locum assignments differently than permanent employment.

State-Specific Coverage Limits

While $1M/$3M limits are common, some states, facilities, or credentialing bodies require higher limits. Locum CRNAs should verify that agency-provided coverage meets all local requirements before beginning an assignment.

Multi-State Practice Alignment

Locum work frequently involves practicing in multiple states. Malpractice coverage must align with the state where care is provided, and coverage does not replace proper licensure. Policy declarations should reflect the correct state and approved scope of practice.

Common Insurance Gaps in Locum Assignments

• Assuming tail coverage is included without written confirmation
• Coverage limited to specific facilities or assignments
• Policy limits that do not meet state or facility requirements
• Unclear responsibility for defense costs versus indemnity
• Exclusions for work performed outside contract terms

What to Confirm Before Starting a Locum Assignment

• Request a Certificate of Insurance for each assignment
• Confirm whether malpractice coverage is claims-made or occurrence-based
• Verify in writing that tail coverage is included and under what conditions
• Ensure coverage applies to the correct state, facility, and scope
• Understand how defense costs are handled under the policy

How Locum Insurance Compares to Other Work Models

Locum tenens arrangements often feel simpler than PRN or 1099 work because malpractice coverage is commonly bundled through the agency. That simplicity can mask areas where responsibility still shifts based on contract language, state law, or assignment structure.

This content is provided for general educational purposes only and is not intended as personalized financial, insurance, or legal advice. Malpractice requirements, tail obligations, and state laws vary by jurisdiction, contract, and insurer. Locum tenens CRNAs should review agreements and coverage documentation and consult qualified professionals before making decisions.