ProVisions | Specialty Underwriting

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About Our Issue

About Our IssueRead More

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Working with Specialty Underwriting

Working with Specialty UnderwritingRead More

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Understanding Endorsements Commonly Required by Contract

Understanding Endorsements Commonly Required by ContractRead More

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Hospitals and Alternative Risks

Hospitals and Alternative RisksRead More

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Miscellaneous Medical

Miscellaneous MedicalRead More

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Senior Care

Senior CareRead More

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Get to Know the Specialty Underwriting Team!

Get to Know the Specialty Underwriting Team!Read More

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The Bind Order

The Bind OrderRead More

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News & Updates

News & UpdatesRead More

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Ties that Bind

Ties that Bind Read More

About Our Issue

Specialty Underwriting: Experience and Flexibility for Evolving Risks

Change remains the one enduring certainty—and in our business, that might be an understatement.

The healthcare landscape continues to evolve with ongoing consolidation of practices, increased private equity investment, and the growing role of allied health providers. At the same time, state legislation is fluid and sometimes contradictory—some states are experiencing the rollback of tort reform, while others are enacting new measures to curb unpredictable verdicts and awards. Technological advancements, particularly in artificial intelligence, promise to open fresh avenues as well as present new challenges.

ProAssurance Specialty Underwriting was formed to meet these shifting realities by offering comprehensive coverage options for the modern healthcare environment. Our broad appetite encompasses Physicians, Allied Providers, Hospitals, Senior Care, and a range of Miscellaneous Medical Facilities. We provide both primary and excess coverages and have the flexibility to support reinsurance for single-parent captives and offer a variety of alternative risk transfer solutions. While we offer both admitted and non-admitted policies, we anticipate the continued growth of the E&S market within medical professional liability, recognizing that adaptability and responsiveness are essential to navigating the evolving healthcare landscape.

Above all, our greatest strength is our people. The Specialty Underwriting team stands ready to discuss opportunities and share insights. Our Product Line leaders average more than 30 years of individual experience in MPL, ensuring you benefit from deep expertise and commitment to the healthcare and MPL space.

Even as efficiency and speed become ever more critical, we remain convinced that relationships and specialization are at the heart of our offerings.

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Working with Specialty Underwriting

Custom Physicians

Custom Physicians offers E&S and admitted solutions to large multi-state groups, locum tenens organizations, physician contract staffing, loss sensitive plans, and non-standard individual physicians.

Led by Chris Sweet. Route new business submissions to CustomPhysicians@ProAssurance.com.

Hospitals and Alternative Risks

Hospitals and Alternative Risks underwrites E&S and products with primary and excess solutions for hospitals and systems of any size. Admitted solutions are also available in select states. Alternative Risks offers reinsurance/ART risk-sharing programs, captive programs, loss portfolio transfers, and other innovative solutions for large healthcare operations.

Led by Heather Van Bibber. Route new business submissions to Hospitals@ProAssurance.com.

Miscellaneous Medical

Miscellaneous Medical offers E&S solutions to a wide array of medical facilities. Coverages offered include healthcare PL, shared limits for physicians, general liability, HNOA, EBL, and Sexual Misconduct/Physical Abuse coverage.

Led by Mike Iovine. Route new business submissions to MiscMedSubs@ProAssurance.com.

Senior Care

Senior Care provides E&S solutions for the full spectrum of senior care from independent living to skilled nursing.

Led by Mike Iovine. Route new business submissions to SeniorCare@ProAssurance.com.

Important Considerations

Route new business submissions to Submissions@ProAssurance.com when:

Gross primary premium is generally less than $4 million in no more than three states in a single Standard Underwriting region
Multi-state exposures will generally be underwritten by the Standard Underwriting region for the policy issue state

Route new business submissions to CustomPhysicians@ProAssurance.com when:

Gross primary premium is greater than $4 million
Large account with national footprint
Seeking E&S, retrospective rated, large deductible and SIR plans, or captive solutions

The Underwriting Rules and Rates manuals for all active issue companies in all states are available to appointed agents and located on the Portal.

Contract Complications:

Understanding Endorsements Commonly Required by Contract

Insurance brokers are frequently tasked with ensuring their clients meet complex contractual insurance requirements. These requirements might be found in contracts with the named insured’s clients, the named insured’s healthcare providers, or with third-party intermediaries. Four common and often misunderstood endorsements frequently required by the terms in certain contracts are “Additional Insured,” “Additional Insured - Primary and Non-Contributory,” “Waiver of Subrogation," and “Separation of Insureds.” Understanding these provisions is vital to protecting your clients and mitigating potential risks. Let's explore the insurance implications of each:

1. Additional Insured

This endorsement extends coverage to an individual or entity beyond the named insured. In the context of MPL, it often involves entities in a business relationship with the healthcare provider (named insured), such as hospitals, clinics, or staffing agencies.

Generally, there are two types. One type requires that the additional insured be named in the endorsement specifically. The other is a blanket endorsement that includes those required by contract to be named as additional insureds.

Complications:
- Increased Liability Exposure: Adding an additional insured broadens the scope of potential claims the policy must cover, sometimes broadening it enough to cover the additional insured's own negligence. This may increase the likelihood of claims and could deplete policy limits faster, leaving the named insured potentially exposed to uncovered costs for future claims within the same policy period.
- Defense Costs: The insurer may be obligated to defend the additional insured, leading to potentially increased defense costs.
- Loss History Impact: Claims against the additional insured are typically recorded on the named insured's loss history, which can lead to higher premiums or difficulties in securing future coverage for the named insured. This remains true even if only defense costs are incurred and the matter is closed without indemnity payment.
Implications for Brokers:
- Coverage Scope: Additional insured coverage is typically limited to risks associated with the business relationship between the named insured and the additional insured. An incident must generally be related to the named insured's work or responsibilities for the additional insured to be covered. Be aware, the additional insured may only be covered for liability arising from the acts of the named insured or other insureds under the policy, and not for their own acts or omissions. Typically the additional insured will share the limits of liability of the named insured. No separate coverage limits are provided for the additional insured.
- Vicarious Liability: Adding an additional insured is often done to protect the additional insured from claims of vicarious liability, where they could be held responsible for the named insured's acts or omissions. For example, if a physician causes injury to a patient while working under contract in a hospital’s emergency department, and the hospital is named as an additional insured, the hospital’s vicarious liability for the physician’s acts may be covered by the physician's policy, while any direct allegations against the hospital may not be covered.
- Premium Responsibility: Additional insureds are typically not responsible for paying premiums.
- Ownership and Rights: The named insured is the policy owner and typically has full rights under the policy, while the additional insured's rights are usually more limited. Additional insureds generally cannot make changes to the policy, such as increasing coverage or adding other parties.
- Defense Costs: The additional insured generally benefits from defense cost coverage from the named insured's policy if they are named in a lawsuit related to the named insured's work.
- Reduced Financial Burden: This status helps the additional insured avoid directly bearing the financial burden of claims stemming from their relationship with the named insured.
- Proof of Coverage: Simply requiring additional insured status in a contract doesn't guarantee coverage. There must be an additional insured endorsement attached to the policy, and it is imperative to understand the terms. Obtaining a copy of the policy, including the declarations page and additional insured endorsement, is crucial. A certificate of insurance (COI) is important but may not be sufficient.
- Policy Exclusions and Limitations: Additional insured coverage may be subject to limitations and exclusions within the policy or the additional insured endorsement itself.
- As Required by Contract: It is not uncommon for a hospital to contract out its staffing procurement services to an intermediary (a vendor management system is an example), which will ultimately contract with the named insured (a physician, a medical group, or a locum tenens organization). This can break the link between the named insured and the client for their services when it comes to the Additional Insured as Required by Contract since the named insured is not directly contracting with the client. Additionally, an indemnification requirement or a requirement that the named insured procure insurance is not sufficient. The contract must specifically require the named insured to add them as an additional insured.

2. Additional Insured - Primary and Non-Contributory This endorsement, often abbreviated as AI-PNC, significantly shifts how coverage responds in a claim scenario where multiple parties are involved.

Primary Coverage: The named insured's policy is designated as the first to respond to a claim, regardless of other insurance policies covering the additional insured. This means the additional insured's own coverage would only be triggered after the named insured's policy limits are exhausted.
Non-Contributory: This specifies that the named insured's policy will not seek contribution from the additional insured's policies for a claim unless the named insured’s policy's limits are exhausted.
Complications:
- Sole Responsibility: Absent additional exclusionary wording or other limitations, the insurer takes on the full financial burden for claims against the additional insured, even if the additional insured is partially or solely at fault.
- Higher Claim Costs: If a claim exceeds the named insured’s policy's limits, the named insured or their umbrella policy (if they have one) may be responsible for the remainder, but the insurer bears the full brunt up to the policy limit, effectively reducing the overall coverage for the named insured.
- Reduced Negotiation Power: The insurer's ability to negotiate a shared settlement with other potentially responsible insurers is significantly curtailed.
- Disputes Over Interpretation: While intended to provide clarity, ambiguity in the endorsement's wording can still lead to disputes regarding the order of contribution, potentially requiring judicial intervention.
Implications for Brokers:
- Risk Transfer: This arrangement provides increased contractual protection to the additional insured (e.g., a hospital or a vendor management system) by ensuring the named insured's policy (such as a medical group or a locum tenens organization) bears the initial and primary responsibility for covered losses. For the named insured, this means their policy is likely to be impacted first and potentially bear the full burden of a covered loss up to the limits of the policy, even if the additional insured is also partially at fault. This can affect the named insured’s loss history and future premiums.
- Negotiation: Brokers should guide their clients to carefully review contracts and negotiate the terms of these endorsements to ensure they are fair and manageable.

3. Waiver of Subrogation A waiver of subrogation is an endorsement that prevents an insurance company from pursuing a third party for reimbursement after paying out a claim on behalf of their insured. Subrogation is the insurer's right to recover costs from a responsible third party after paying a claim on behalf of its insured.

How It Works: Normally, an insurance company would pay a claim on behalf of their insured and then seek to recover those funds from the party responsible for the loss. With a waiver of subrogation, the insurer relinquishes this right, meaning they cannot sue the at-fault party to recoup their losses.
Common Applications: This is often seen in construction contracts (subcontractors waiving subrogation against general contractors), leases (landlords and tenants waiving subrogation against each other), healthcare provider staffing contracts, and other contractual relationships where parties want to minimize the risk of litigation between them.
Complications:
- Sole Responsibility: The insurer may take on the full financial burden for claims against the additional insured, even if the additional insured is partially or solely at fault.
- Loss of Recovery Rights: The insurer relinquishes its right to seek reimbursement from a potentially at-fault third party, directly impacting its ability to mitigate the named insured’s losses.
- Reduced Negotiation Power and Higher Claim Costs: The insurer's ability to negotiate a shared settlement with other potentially responsible insurers is significantly curtailed, which can result in higher claim costs and lead to reduced overall coverage for the named insured, impacting loss experience and profitability.
- Potential for Abuse: In some situations, this endorsement could encourage less careful behavior from the additional insured, as they face reduced financial consequences for their actions.
Implications for Brokers:
- Loss of Recovery Rights: For the named insured's insurer, a waiver of subrogation means they lose the ability to recover funds from a third party who caused a loss, potentially increasing their financial burden.
- Premium Impact: Insurance companies may charge an additional premium for a waiver of subrogation endorsement to account for the increased risk they are assuming. Additionally, any losses paid, where subrogation is not possible due to this endorsement, count against the named insured when evaluating their renewal premium.
- Relationship Management: Waivers of subrogation can foster stronger relationships between parties by minimizing the potential for lawsuits between them.
- Risk Assessment: Brokers should help their clients weigh the benefits of a waiver of subrogation (potentially avoiding lawsuits, satisfying client requirements) against the potential costs (higher premiums, reduced recovery rights).

4. Separation of Insureds The separation of insureds clause clarifies how the policy's coverage applies when multiple insureds are involved in a claim.

Separate Coverage: This clause dictates that the policy's coverage applies "separately" to each insured against whom a claim is made, as if that insured was the only insured under the policy. This means that the actions of one insured typically will not prevent coverage for another insured under the same policy.
"The Insured" vs. "Any Insured": Policy wording is critical. A policy’s use of the terms "the insured" or “any insured” in conjunction with Separation of Insureds may cause significant complications with policy interpretation.
Complications:
1. Broadening Coverage: Depending on the specific policy language, this clause can inadvertently broaden coverage.
2. Potential Contradictions: Separation of insureds clauses can clash with certain exclusions and conditions that refer to "any insured," creating ambiguity and potential for disputes and litigation.
3. Impact on Exclusions: The effectiveness of exclusions (e.g., related to intentional acts or actions by certain individuals) can be diminished as they might only apply to the specific insured whose conduct triggered the exclusion, allowing other insureds to retain coverage.
4. Coverage for Named vs. “Other” Insureds: There might be subtle distinctions in how coverage applies to named insureds versus other insureds under this clause, further complicating interpretation.

Implications for Brokers:
- Protecting Additional Insureds: This clause helps protect additional insureds from the actions or omissions of the named insured that might otherwise preclude coverage.
- Navigating Exclusions: Brokers must meticulously review policy language, especially exclusions, to determine how they interact with the separation of insureds clause and ensure proper coverage for all insured parties.
- Cross-Suits: The separation of insureds provision may also eliminate the cross-suits exclusion traditionally found in MPL policies, allowing one insured to sue another insured under the same policy.
- Policy Conditions: Additional insureds may request this in an effort to protect themselves from situations where the named insured has failed to comply with a policy condition. An example would be a condition that requires a claim to be reported in a timely manner.

In conclusion, contractually required endorsements like Additional Insured, Additional Insured - Primary and Non-Contributory, Waiver of Subrogation, and Separation of Insureds significantly impact liability and risk allocation. Insurance brokers play a crucial role in understanding these nuances, advising clients on the implications, and ensuring their clients meet contractual obligations while adequately protecting their interests. Detailed review of contracts, negotiation of endorsements, and clear communication with clients and insurers are essential for successful risk management in these complex scenarios. Policy language may vary, and it is imperative that the policy and the named insured’s contracts be carefully reviewed by a competent professional.

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Hospitals and Alternative Risks: It’s Been a Very Good Year

Undoubtedly, 2025 is proving to be a very successful year for Hospitals and Alternative Risks. This success is driven by various factors. Foremost is the value ProAssurance has to offer policyholders through our servicing, claims handling, and risk management services. We have also found opportunities to quote on hospital programs due to ongoing market conditions affecting the industry. Some of these factors include coverage terms changes and decreases in limit capacity offered by other carriers due to ongoing claims severity, as well as overall shifts in underwriting appetite.

Our General Approach to Specialty Underwriting

At ProAssurance every account is underwritten and rated based on its own merit. We consider the coverage terms requested, attachment point, services offered, and venue. We also work collaboratively with other internal departments like Actuarial, Claims, and Risk Management to make sure we take all aspects into account within our underwriting analysis and pricing.

Important Recent Wins

We view all new business as important wins. While some accounts are larger than others, they each elected ProAssurance as their Carrier of Choice.

Here is just one example of how we took advantage of a market opportunity to gain a new account:

Earlier this year, my team had the opportunity to review a lead excess opportunity on a large hospital system that had been with its incumbent carrier for nearly 20 years. Prior to renewal, the incumbent carrier communicated changes to their underwriting appetite. While there were several other carriers on the current excess tower that wanted to write the lead layer, our underwriting responsiveness in working with the broker and our ability to offer competitive terms proved to be key factors in our success. Ultimately we received the request to bind on the lead excess layer for the hospital’s insurance program and look forward to our ongoing partnership.

Types of Business We’re Seeing Recently

We continue to welcome partnerships with community hospitals, integrated healthcare systems, and specialty hospitals such as orthopedic, rehabilitation, sub-acute and long-term care. We also see a lot of excess opportunities, whether it be over a hospital system’s self-insured retention (SIR) or a captive policy that would fall under our Assumed Reinsurance portfolio. On these types of excess placements, our appetite typically falls within the lead or second layer of the program.

Available ProAssurance Coverages and Limits:

Primary and excess professional and general liability coverage
Primary limits up to $1M each claim/$3M each aggregate
Total excess limit capacity on hospital business up to $10 million, based on services offered, attachment point, and venue
Customized solutions for non-admitted, E&S paper
Admitted coverage on a limited basis in select fund states

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Miscellaneous Medical

Providing excess & surplus products for small- to mid-sized operations not handled by the Hospitals & Healthcare Systems team.

The ProAssurance Miscellaneous Medical team has decades of underwriting and claims experience specific to the miscellaneous medical market.

Policies are written on an excess & surplus basis to ensure fit and reliable coverage. Claims are handled by experienced medical professional defense teams. Risk management resources are available online at no additional cost.

Basic Policy Form Features

Professional liability written on a claims-made form
General liability written on either a claim-made form or occurrence form
Primary limits up to $2M per occurrence and $4M aggregate
Prior acts available
Extended reporting period available up to 36 months
Limits up to $1M/$1M hired and non-owned auto liability available
Legal defense coverage available
Additional insured coverage available
Eligible physicians may share in the limits of liability

$0 deductible available
Minimum premiums at $1M/$3M limits:
- Individuals: $1,500
- Facilities/entities: $3,500
Sub-limited sexual abuse
Employee benefits
Defense outside the limits
Incident claim trigger
Hired/non-owned auto

We are also able to provide blanket additional insureds, primary wording for additional insureds, and waiver of subrogation.

Preferred Business

Advanced Practice Clinicians
Allied Medical and Nursing Schools
Therapy Services (Physical, Occupational, Speech, and Behavioral)
Home Health
Hospice
Laboratories
Medical Clinics

Medical Director
Non-Physician Healthcare Staffing
Specialty Pharmacies
Dialysis Centers
Imaging Centers
Surgery Centers

Senior Care

Offering stock and custom insurance solutions across the full spectrum of senior care from independent living to skilled nursing.

The ProAssurance Senior Care team works to tailor solutions that meet the specific risk tolerance and objectives of policyholders. Our aim is to provide sustainable solutions over the long term. We offer quick turnarounds and a creative underwriting team that listens to policyholder needs. Our appetite is flexible, and each account is underwritten based on its own merits.

We know every aspect of medical and facility liability from underwriting to risk management to claims. Our tailor-made coverage and knowledge of risk help bring stability to this long-tail severity insurance market.

Overview

We offer primary and excess professional and general liability insurance on a claims-made basis through surplus lines nationwide.

Primary and excess coverage available
- Professional liability
- General liability
- Employee benefits liability
- Medical payments
Broad range of limit structures and deductibles available
In-person and online risk management solutions
Dedicated Senior Care claims handling team

Coverage Enhancements

Low deductibles
Competitive premiums
Prior acts coverage
Sexual misconduct coverage
Evacuation expense reimbursement
Medical director coverage
Legal expense coverage
Additional insured coverage
Non-owned and hired auto

Dedicated Senior Care Claims Team

ProAssurance Senor Care claims are managed through a carefully established Senior Care Claims team. This team is composed of Senior Care liability professionals working with national counsel to offer insight and strategies learned from managing Senior Care claims of all types and sizes.

Senior Care Risk Management

Senior Care insureds receive risk management support at no additional charge, including access to:

Risk consultants available for consultation via phone and email
Risk publications covering exposure trends, articles, data, and Senior Care claim studies
Onsite or virtual risk management assessments available upon request

Preferred Business

Continuing care retirement communities
Skilled nursing and rehabilitation facilities
Assisted living and memory care
Independent living and senior apartments

Preferred Characteristics

Established operators with stable ownership, exposure, and claims history
Run by non-profit operators
Operating in favorable legal jurisdictions

Non-Preferred

Pediatric skilled nursing
Startup or rapidly expanding operations

Chris Sweet, MBA, CPCU Vice President, Underwriting

Heather Van Bibber, MSRI Vice President, Hospitals and Alternative Risks

Jason Allen, RPLU Specialty Underwriting Supervisor, Custom Physicians Division

Charity Nelson Underwriter, Specialty, Miscellaneous Medical

Patricia Manzi Associate Underwriter

Ana Nolasco Senior Underwriting Technician, Miscellaneous Medical

HOW LONG HAVE YOU BEEN WITH PROASSURANCE & WHAT DO YOU DO ON A REGULAR BASIS?

Six years. I lead the Custom Physicians team in Specialty Underwriting. I also serve as a member of the Southeast and Southwest Regional Executive Teams.

Chris Sweet

I have been with ProAssurance for almost three-and-a-half years. I am a supervisor on the Custom Physicians team, and on a regular basis I manage my book of business, work on new business opportunities with our brokerage partners, and provide support to my team.

Jason Allen

Fifty-two months! I underwrite allied health accounts, which include solo practitioners, medical professional liability for mid-level practitioners, and PL/GL (general liability) including sex abuse, if needed for most other accounts. These are primarily claims-made policies.

I quote tail coverage if desired, and quote and bind both new and renewal policies. I manage the ProAssurance American Mutual RRG for the special agent and provide limited back-up for Charlott Ameperosa, our Account Executive. I also respond to questions regarding claims and offer quotes to the special agent when the risk is outside of their authority.

Patricia Manzi

While I’ve been in the insurance industry more than 25 years, I’ve been with ProAssurance three years this August! As the Vice President of Hospitals and Alternative Risks, I work with my Underwriting team to analyze risks, price accounts, and evaluate policy language and coverage terms.

Heather Van Bibber

I have been with ProAssurance since 2022. I assist the Miscellaneous Medical Facilities team as an Underwriting Assistant. My administrative duties include binding new and renewal business, process endorsements, and policy issuance. I keep close contact with our agents when following up for payments and other subjectivities required for our files.

Ana Nolasco

I have been with ProAssurance for nine years. I’ll be celebrating my 10-year anniversary in October 2025. I underwrite Ambulatory Surgery Centers and some Community Clinics.

Charity Nelson

WHAT IS YOUR FAVORITE PART OF THE WORK YOU DO?

Coaching and mentoring team members.

Chris Sweet

My favorite parts of the work I do are building new and existing relationships with our broker/agent partners, successfully writing and retaining new business accounts, as well as working with my Custom Physicians teammates.

Jason Allen

Binding new business.

Patricia Manzi

One of the favorite parts of my job is getting the opportunity to collaborate with my peers and build upon relationships (both internally and externally). I’ve found the staff at ProAssurance to be extremely talented and always willing to share ideas to come up with the most effective solutions for our policyholders.

Heather Van Bibber

My favorite part of the job is assisting my team with their workloads. Also I make our agents a priority with their concerns.

Ana Nolasco

My favorite part is working with my internal and external partners as I am able to build relationships while achieving high-quality results and meeting goals (sounds cliché but true).

Charity Nelson

WHAT IS ONE MISCONCEPTION ABOUT YOUR JOB/DEPARTMENT THAT PEOPLE OFTEN MAKE?

Within Custom Physicians, given the unique risks we encounter, most decisions are based on the specific details of the risk rather than applying a general rule to each circumstance. We look at risks holistically and all the variable exposures that make up a specific risk. As a result of this approach, a specific exposure we are willing to write for one risk may not be the case for another.

Jason Allen

That we sell health insurance.

Chris Sweet

That we write physicians.

Patricia Manzi

One misconception about my department is that submission reviews are straightforward. As every account is underwritten and priced on its own merit, there are several variables my team takes into consideration when reviewing an opportunity, including services provided, loss experience, exposure trends, and venue.

Heather Van Bibber

Sometimes some people think that I’m only one button away from making things happen. It’s a little more complicated.

Ana Nolasco

Oftentimes we are viewed as the “catch-all tray” and will cover anything that is submitted for new business. We do have an appetite for new business, and it can be found at ProAssurance.com/Miscellaneous-Medical.

Charity Nelson

DO YOU HAVE A HOBBY OUTSIDE OF WORK THAT OFFERS YOU A POSITIVE WORK-LIFE BALANCE?

One of my favorite hobbies outside of work is involving myself with any sort of motorized vehicle, specifically cars, motorcycles, and boats, to name a few.

Jason Allen

Watching documentary shows, sewing, playing with my two pups, listening to music, reading, and painting.

Patricia Manzi

Outside of work, I like to decorate, read, and spend time with my pets—typically going out for long walks. I’ve also spent a lot of time swimming this summer.

Heather Van Bibber

My hobby is competitive pistol shooting.

Chris Sweet

Rest. This helps me balance my body and mind.

Ana Nolasco

Gardening, reading, board games, spending time with family and friends, exercise, and of course, social media.

Charity Nelson

MISCELLANEOUS MEDICAL FACILITIES

MEDICAL STAFFING

Texas Limits: 1M/3M E&S
Premium: $69,000

HOME HEALTH

Virginia Limits: 1M/3M E&S
Premium: $19,500

AMBULATORY SURGERY CENTER

Delaware Limits: 2M/4M E&S
Premium: $9,400

AMBULATORY SURGERY CENTER

Colorado Limits: 1M/3M E&S
Premium: $21,000

AMBULATORY SURGERY CENTER

Pennsylvania Limits: 1M/3M E&S
Premium: $47,000

IMAGING CENTER

Tennessee Limits: 1M/3M E&S
Premium: $14,500

IMAGING CENTER

Pennsylvania Limits: 1M/3M E&S
Premium: $10,800

MEDICAL CLINIC

Michigan Limits: 1M/3M E&S
Premium: $40,000

MEDICAL GROUPS

RADIOLOGY

Indiana Limits: 500k/1.5M
Admitted Premium: $274,000

INTERNAL MEDICINE

New York Limits: 1M/3M
E&S Premium: $111,900

PEDIATRICS

Ohio Limits: 1M/3M
Admitted Premium: $113,300

PULMONARY

Ohio Limits: 1M/3M E&S
Premium: $12,000

NEUROLOGY

Florida Limits: 1M/3M
Admitted Premium: $45,200

FAMILY MEDICINE

California Limits: 1M/3M
Admitted Premium: $35,900

CONCIERGE MEDICINE

Illinois Limits: 1M/3M
Admitted Premium: $18,000

SOLO PHYSICIANS

ANESTHESIOLOGY

California Limits: 2M/4M E&S
Premium: $6,100

CONCIERGE MEDICINE

Virginia Limits: 2.7M/8.1M
Admitted Premium: $1,700

INTERNAL MEDICINE

New York Limits: 1.3M/3.9M
Admitted Premium: $5,500

VASCULAR

Alabama Limits: 1M/3M
Admitted Premium: $14,200

NEPHROLOGY

Pennsylvania Limits: 500k/1.5M
Admitted Premium: $11,700

GYNECOLOGY

Texas Limits: 200k/600k
Admitted Premium: $13,600

ALLERGY & IMMUNOLOGY

California Limits: 1M/3M
Admitted Premium: $800

GENERAL SURGERY

Nevada Limits: 1M/3M
Admitted Premium: $16,300

INTERNAL MEDICINE

Florida Limits: 250k/750k
Admitted Premium: $13,300

UROLOGY

California Limits: 1M/3M
Admitted Premium: $2,900

ANESTHESIOLOGY

Maryland Limits: 1M/3M
Admitted Premium: $9,800

FAMILY MEDICINE

South Carolina Limits: 1M/3M
Admitted Premium: $3,000

ENDOCRINOLOGY

Illinois Limits: 1M/3M
Admitted Premium: $15,300

GYNECOLOGY

Texas Limits: 200k/600k
Admitted Premium: $10,400

CONCIERGE MEDICINE

Rhode Island Limits: 1M/3M
Admitted Premium: $2,200

PEDIATRICS

Texas Limits: 500k/1.5M
Admitted Premium: $1,800

PSYCHIATRY

Nevada Limits: 1M/3M
Admitted Premium: $1,600

INTERNAL MEDICINE

Illinois Limits: 1M/3M
Admitted Premium: $16,200

SENIOR CARE FACILITIES

SKILLED NURSING

North Carolina Limits: 1M/3M E&S
Premium: $89,000

ASSISTED LIVING

California Limits: 1M/3M E&S
Premium: $85,000

ASSISTED LIVING

Missouri Limits: 1M/3M E&S
Premium: $38,300

New Business Submissions

Our standard business intake address for submissions is Submissions@ProAssurance.com. For specialty lines of business, please use one of the following: CustomPhysicians@ProAssurance.com, Hospitals@ProAssurance.com, MiscMedSubs@ProAssurance.com, and SeniorCare@ProAssurance.com. Visit our Producer Guide for additional information on our specialty lines of business.

The types of business and premium amounts are illustrative of where we have written new business and not intended to reflect actual pricing or specific appetites.

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No Let Up in Sight. Medical Cost Trend Set to Grow at 8.5%

Medical cost trend is once again hovering at rates reminiscent of 15 years ago. The U.S. healthcare system is heading into another year of powerful inflationary forces exerting pressure with few deflationary forces in sight. Commercial payers in 2026 will be asked to continue paying the ballooning bill for medical services and prescription drugs. Meanwhile, federal health policy and legislation likely will reduce federal spending on healthcare over the next 10 years, with an expected but unknown impact on medical cost trend in the future. (PWC)

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PA Court Upholds Venue-Selection Clauses: Why It Matters

The Pennsylvania Superior Court recently issued a significant decision in Somerlot v. Jung, which strengthens the ability of healthcare providers in Pennsylvania to control the venue where medical malpractice lawsuits are filed. Prior to this recent ruling, under Rule 1006 that went into effect January 1, 2023, plaintiffs could file medical malpractice suits in any county where any named defendant regularly conducted business, even if the malpractice occurred elsewhere. This practice of forum shopping led to medical malpractice cases being filed in Philadelphia and Allegheny Counties as they were viewed as venues more favorable to plaintiffs.

In Somerlott v. Jung, a patient attempted to sue a Bucks County provider in Philadelphia County. However, before the provider rendered treatment, the patient signed a consent-to-treatment agreement containing a venue-selection clause, which is a common contract provision that allows parties to agree in advance to a specific venue where any future disputes must be filed and resolved. The agreement at issue required that all legal claims, including medical malpractice claims, be filed in Bucks County. On July 30, 2025, the Superior Court enforced the venue-selection clause and rejected the plaintiff’s arguments that Pennsylvania’s procedural rules or claims of unfairness should override it. The Superior Court upheld the transfer of Somerlott v. Jung to Bucks County.

Why This Matters for Healthcare Providers

Reduces venue shopping: Providers can contractually require litigation to take place in the county where the alleged malpractice occurred, rather than in venues known for large plaintiff verdicts. This ruling follows recent developments that have expanded plaintiffs’ venue options in Pennsylvania, fueling concerns about an increase in medical liability suits in plaintiff-friendly jurisdictions. This decision helps restore balance by reaffirming the ability to contract for a fair venue.
Enforceable protection: The Court held that such provisions are not automatically unconscionable, even when signed just before treatment, if patients have a meaningful choice. In this case, the Court noted that the patient could have “crossed out” the venue-selection clause and presented the modified agreement as a counteroffer to the provider.

Practical Takeaways:

Sample Language to Consider: Pennsylvania healthcare providers should review their patient agreements and contracts and consider including clear, enforceable venue-selection provisions where a patient signs and dates in agreement, such as in a consent to treat form. Doing so can provide a valuable safeguard against venue shopping and help manage future litigation risk.

Sample Venue-Selection Language:

NOTICE: Any legal claims or civil actions, including, but not limited to, a claim for medical malpractice in any way related to this admission/procedure, and medical services provided by ____________________or its employees, shall be brought solely in the Courts of ____________ County, in the Commonwealth of Pennsylvania.

Future Developments: While it is likely that the Pennsylvania Supreme Court will be asked to review this decision, the Jung opinion is now controlling law. This matter may have further developments, and ProAssurance commits to keeping Pennsylvania insureds up to date on changes.

Please note this information does not constitute a legal opinion, nor is it a substitute for legal advice. Legal inquiries about this topic should be directed to an attorney.

What Medical Reps See that Underwriters Should Know

Aug25TTB

I teach something called The Value Algorithm during my medical sales workshops. It’s a simple framework that looks at healthcare products and services through six lenses of value. The one that consistently gets the most attention from healthcare professionals?

Risk.

More specifically—risk reduction.

Physicians wear many hats, including that of a risk manager. Every diagnosis and treatment decision is a calculation of risk vs. reward (including the risk of doing nothing at all). Medical sales professionals who survive more than a few annual sales reviews tend to recognize this. The best ones lean into it.

One of the first medical devices I sold was a tourniquet system—pneumatic cuffs wrapped around arms and legs to reduce blood flow during procedures. To the average healthcare professional, a tourniquet is about as exciting as a screwdriver is to a carpenter. Until, of course, something goes wrong.

Here’s a quick example: In extremity surgery, there’s a form of anesthesia called a Bier block (regional anesthesia). A tourniquet cuff is inflated to isolate the limb, and then a local anesthetic is injected intravenously to numb everything downstream of the cuff. Because the patient is awake, the part of the limb under the tourniquet cuff is not anesthetized, and tourniquets are painful, a second cuff is applied below the first, inflated over anesthetized tissue, and then the original cuff is deflated to relieve the pain. But here’s the risk—if the first tourniquet deflates before the second inflates completely, that local anesthetic enters systemic circulation and could cause seizures, cardiac issues, and even death.

When I first began selling the device, I led with all the sexy features: digital pressure displays, high-tech alarms, programmable settings. The indifference was palpable. Then I tried a different approach: “Doctor, can I show you how some of your colleagues are avoiding the risk of anesthesia complications during Bier blocks so it’s never a concern?”

Suddenly, I had their attention.

Why? Because I was no longer selling a device. I was selling risk mitigation.

Why would this matter to you as an MPL agent?

Medical sales reps are in clinics and ORs every day. They see what’s added, changed, and evolving in medical practices—often before MPL agents ever know. Practices and their owners add new revenue streams that stretch beyond the primary scope of the specialty. Botox injections in family medicine. Weight loss programs in Ob-Gyn. Supplements, IV hydration, hormone pellets, even in-house pharmacies. All offering new value to the practice—and new exposure for you.

I sometimes wonder if doctors ask themselves: “Is my MPL coverage up to date for this?” Because if they’re not asking, you should be.

Sales representatives often discover these changes even before a practice manager is aware. They spot new equipment. They know when a PA is hired or when a nurse is trained on something outside their scope. They know which docs are trying new things (and which ones probably shouldn’t be).

Want to underwrite better?

Think like a medical sales rep. If you were trying to boost a practice’s revenue, what products and services would you add? Then ask: What new risk does that introduce? More procedures? More staff? More devices that can be misused?

Doctors don’t automatically call you when they introduce a new risk into the practice. They may not even consider something new to be risky, even when it is.

Risk doesn’t always come with an announcement. Sometimes it slips in unnoticed—delivered by a sales rep, embraced by a physician, and ignored until it becomes your problem to underwrite.

Written by Mace Horoff of Medical Sales Performance.

Mace Horoff is a representative of Sales Pilot. He helps sales teams and individual representatives who sell medical devices, pharmaceuticals, biotechnology, healthcare services, and other healthcare-related products to sell more and earn more by employing a specialized healthcare system.

Have a topic you’d like to see covered? Email your suggestions to AskMarketing@ProAssurance.com.

Risk Management August Releases

Healing the Healers: Litigation Stress Support for Physicians

Join Dr. Gita Pensa, a renowned stress coach with deep insights into the healthcare litigation process, as she shares her personal experiences and expert guidance in managing the emotional toll of litigation on physicians and other healthcare professionals. This course, rooted in an enlightening interview with Dr. Pensa, explores the significant stressors faced during litigation and their effects on a physician’s well-being. Gain valuable knowledge and practical tools to help you navigate these challenging times with resilience, leveraging Dr. Pensa’s proven coaching techniques. 1 hour of CME.

Insureds can sign in at ProAssurance.com to take this seminar.

Watch a preview.

TOUCH

Rapid Risk Review Mobilizing Medicine: Why Physician Advocacy Matters

Rapid Risk ReviewMobilizing Medicine: Why Physician Advocacy Matters

In this episode, host Lesley Lopez Viner discusses key legislative issues impacting healthcare with Clayton Stewart, Chief Lobbyist for the Texas Medical Association, the largest state medical association in the country. They explore federal advocacy issues, pressing challenges in medicine, recent legislative successes in Texas, and the importance of physician involvement in advocacy efforts nationwide.

Listen here

TOUCH

Malpractice Case Study – Pediatrics Beyond the Legal Outcome: Vital lessons in detection and treatment of infection in premature infants

Malpractice Case Study – PediatricsBeyond the Legal Outcome: Vital lessons in detection and treatment of infection in premature infants

Allegation

Alleged failure to diagnose and treat bacterial infection in 2-month-old infant resulting in death.

Read the issue

TOUCH

Two Minutes: What’s the Risk? Workplace Violence

Two Minutes: What’s the Risk?Workplace Violence

If you are involved in patient care, you likely have experienced workplace violence or you know someone who has. In this video we present some ideas on how to effectively handle workplace violence in a healthcare setting.

Watch here

Leadership Elite 2025

Leadership Elite is ProAssurance’s premier annual gathering designed to honor, engage, and inspire our top-performing agents and brokers. Set in a dynamic and memorable destination each year, the event blends professional development, strategic insight, and meaningful connection in a setting that fosters both celebration and collaboration.

Leadership Elite is more than just a meeting—it’s a strategic investment in relationships, reflection, and future growth. Each year builds on the last, creating a legacy of excellence and a shared vision for what’s next.

We are looking forward to seeing our invited guests in San Jose del Cabo, Mexico, September 22-25.