Most physicians will never see the inside of a courtroom, but many will receive a claim at some point in their careers, and the steps taken in the first few weeks shape how it ends. A malpractice claim follows a fairly predictable path: notice, reporting to the carrier, investigation, expert review, litigation or negotiation, and resolution. Knowing that path, and the policy terms that control it, takes much of the uncertainty out of the process. This guide walks through each stage, the Washington timing rules, and the insurance provisions that matter most.
The claims picture today
American Medical Association research shows claim frequency has fallen over time. In 2024, 28.7% of physicians reported at least one claim during their careers, down from 42.2% in 2007 to 2008, and 1.8% reported being sued in the previous 12 months. Risk still varies widely by specialty and age: about 60% of obstetrician-gynecologists and 53.1% of general surgeons had been sued at least once. Between 2016 and 2018, 65% of claims against physicians were dropped, dismissed or withdrawn.
The cost of coverage is moving the other way. The AMA reported in May 2026 that 2025 was the seventh straight year of rising medical liability premiums, with nearly 40% of reported premiums increasing. That makes claim handling and claims history even more important at renewal.
How a claim begins
A claim rarely arrives without warning. Common early signals include an unexpected request for complete records from an attorney, a complaint to a licensing board, a patient's angry letter demanding money, or an adverse outcome that staff are already discussing. Under a claims-made policy, the difference between a "claim" and a "circumstance" matters:
- A claim is usually a written demand for money or services, or a lawsuit, alleging a professional error. Policy definitions vary.
- A circumstance is an incident that could reasonably lead to a claim. Many policies let you report circumstances, which locks the potential claim into the current policy period.
When in doubt, report. A late report can jeopardize coverage, while an early report of a circumstance generally costs nothing.
The stages of a malpractice claim
- Notice to your carrier. Report promptly, following the policy's notice provisions. Send copies of anything you received: the letter, complaint, summons or records request.
- Claim assignment. The carrier assigns a claims professional and, if a suit is filed or likely, defense counsel experienced in medical liability.
- Investigation. Defense counsel gathers the complete record, including EHR audit trails, and interviews you and involved staff in a privileged setting.
- Expert review. Independent physicians review the standard of care and causation. Their opinions drive the strategy.
- Pleadings and discovery. If a suit is filed, the parties exchange records and written questions and take depositions. Discovery is usually the longest phase.
- Resolution efforts. Mediation and settlement discussions may happen at several points. Settlement terms are subject to the policy's consent provisions.
- Trial or dismissal. Many claims end through dismissal or withdrawal; a smaller number go to verdict.
- Payment and reporting. If money is paid on your behalf to resolve a written claim, the payer must report it to the National Practitioner Data Bank within 30 days of payment.
Our article on malpractice claims management covers working with defense counsel, preparing for deposition and managing the personal side of a lawsuit.
Washington timing rules
Under RCW 4.16.350, a Washington medical negligence action generally must be filed within three years of the act or omission, or within one year of when the patient discovered or reasonably should have discovered that the injury was caused by it, whichever period expires later. Proof of fraud, intentional concealment or the presence of a foreign body tolls the period until the patient has actual knowledge, and the patient then has one year to sue. For minors, the knowledge of a custodial parent or guardian is imputed to the child.
The statute also contains an eight-year outer limit, but in Bennett v. United States (2023) the Washington Supreme Court held, 7 to 2, that the eight-year statute of repose violates the state constitution. Other states' rules differ, which matters for practices that treat patients across state lines. Your defense attorney will evaluate timing for any specific claim.
Never alter the record. Once a claim is anticipated, do not add, change or delete entries. EHR audit trails show every edit, a changed record can destroy an otherwise defensible case, and concealment can extend the time a patient has to sue. If a late entry is truly needed for care, label it clearly with the current date and time and tell defense counsel. See medical documentation best practices.
What to do, and what to avoid
- Report to your carrier, and to your employer or group if they hold the policy, as soon as you receive notice.
- Preserve everything: the chart, images, messages, schedules and audit trails.
- Keep communications with counsel separate and confidential; do not discuss the case with colleagues outside peer review or counsel.
- Do not contact the patient or family about the claim without counsel's advice. Continuing clinical care is a separate question to discuss with counsel.
- Do not admit liability, offer payment or waive a bill on your own. Most policies prohibit voluntary payments and assumed obligations without the carrier's consent.
- Answer licensing board inquiries through counsel; board matters can proceed on a different track from the lawsuit.
Policy provisions that shape the outcome
These terms vary by carrier and policy, and each can change how a claim plays out. Review them before you need them, using our medical malpractice insurance overview as a starting point.
| Provision | Why it matters |
|---|---|
| Claims-made vs. occurrence | Claims-made covers claims first made during the policy period for incidents after the retroactive date. Occurrence covers incidents during the policy period whenever the claim is made. |
| Retroactive date | Must be carried forward when you change carriers, or earlier work may be uncovered. |
| Tail (extended reporting period) | Needed when leaving a claims-made policy without prior-acts coverage from the next carrier. Who pays for it is often set in employment contracts. |
| Consent to settle | Some policies require your consent to settle; a "hammer" clause can limit what the carrier pays if you refuse a settlement it recommends. |
| Defense inside or outside limits | If defense costs erode the limit, a long case can shrink the money available to resolve it. |
| Licensing board and regulatory defense | Often a separate, smaller sublimit. Board actions can matter as much as the lawsuit. |
| Entity vs. individual coverage | The group, clinic and each provider may need their own limits; shared limits can be exhausted by one claim. |
Settlement has a reporting dimension too. A payment made for a named practitioner on a written claim is reported to the NPDB, regardless of the amount. A payment on a claim made only against an entity, without identifying an individual practitioner, is not. Our article on peer review and NPDB reporting explains the reporting rules.
After the claim closes
Expect to disclose the claim on renewal applications, hospital reappointment forms, payer credentialing and future employment applications. Keep a short, factual summary of each claim and its outcome so your answers are consistent. Use the experience to review consent, communication and follow-up practices; our guides on informed consent and patient communication are good places to start.
When to call a broker
Call us when you receive a records request or demand you are unsure how to handle, before changing employers or carriers, when negotiating tail coverage in a contract, and before renewal if you have open claims. As a broker, we compare medical liability options across the market, review retroactive dates and consent terms, and help present your claims history to underwriters accurately.
This article is general information, not legal advice. Rely on your defense counsel for advice on any specific claim.
Sources
- American Medical Association — For 7th straight year, medical liability insurance premiums climb (May 2026)
- American Medical Association — AMA research details toll of broken medical liability system
- National Practitioner Data Bank — Reporting medical malpractice payments
- Washington State Legislature — RCW 4.16.350
- Claims Journal — Washington Supreme Court overturns 8-year deadline for medical malpractice suits (Dec. 2023)