Starting a chiropractic practice in New York comes with unique challenges, and understanding your insurance requirements is one of the most important steps. Unlike some states where insurance is optional or loosely regulated, New York takes a firm stance: if you want to practice, you need proper coverage. The good news? Once you understand what's actually required versus what's just recommended, you can make informed decisions that protect both your practice and your patients.
Here's what surprises most new chiropractors: the insurance requirements aren't just about protecting you from lawsuits. They're woven into everything from your state license to your ability to treat workers' comp patients to simply signing a lease for office space. Let's break down exactly what you need, what it costs, and why it matters.
Professional Liability Insurance: Your Non-Negotiable Requirement
Professional liability insurance—also called malpractice insurance—is the cornerstone of your insurance portfolio, and in New York, it's not optional. The New York State Education Department's Office of the Professions requires every licensed chiropractor to carry a minimum of $1 million per occurrence and $3 million aggregate coverage. This isn't just a suggestion buried in fine print; it's a licensing requirement. If you let your coverage lapse, you risk disciplinary action including suspension or outright revocation of your license.
What does this coverage actually do? It protects you when a patient claims your treatment caused them harm. Maybe they say an adjustment worsened their condition, or they develop complications they believe are tied to your care. Without malpractice insurance, you'd be paying legal defense costs and potential settlements out of pocket—and those numbers can easily reach six or seven figures. With proper coverage, your insurance company handles the defense and pays covered claims up to your policy limits.
The $1 million/$3 million minimum is also what you'll need to participate with most insurance networks. Many insurance companies won't credential you as an in-network provider without proof of this coverage. If you're planning to accept insurance—and most practices do—consider this your entry ticket.
Workers' Compensation Insurance: When You Hire Your First Employee
New York's workers' compensation law is straightforward: if you have even one employee, you must carry workers' comp insurance. It doesn't matter if they're part-time, full-time, or a family member. The moment you have someone on payroll—whether it's a receptionist, a chiropractic assistant, or a billing specialist—you're required to have coverage in place.
This insurance covers medical bills and lost wages if an employee gets hurt on the job. A chiropractic assistant strains their back moving equipment. Your receptionist slips on a wet floor. These workplace injuries are covered by workers' comp, which means your employee gets care without suing you, and you're protected from those lawsuits. New York takes compliance seriously—operating without required workers' comp coverage can result in hefty fines and even criminal penalties.
If you're a solo practitioner with no employees, you're not required to carry workers' comp for yourself. But many chiropractors choose to add themselves to a policy anyway because it provides income protection if they're injured and unable to work. It's an optional coverage worth considering, especially in the early years when you're building your practice and an injury could mean lost revenue with no safety net.
General Liability Insurance: Not Required, But Practically Essential
General liability insurance isn't mandated by the state, but here's the reality: you'll almost certainly need it anyway. This coverage protects you from third-party claims for bodily injury or property damage that occur on your premises. A patient trips over a loose rug in your waiting room and breaks their wrist. A visitor's child knocks over expensive equipment. These situations aren't covered by your malpractice policy—they're general liability claims.
Most commercial landlords require proof of general liability before you can sign a lease. The typical minimum they'll ask for is $1 million in coverage, often with the landlord listed as an additional insured on your policy. Without it, you won't get office space. Beyond lease requirements, general liability is simply smart risk management for any business that welcomes the public into a physical location.
Many insurers bundle general liability with professional liability in a Business Owner's Policy (BOP) designed specifically for healthcare practices. This package approach often saves money compared to buying policies separately and ensures you have comprehensive coverage without gaps.
Special Considerations for Workers' Compensation Treatment
If you plan to treat patients injured on the job, New York has specific requirements beyond your general license. You must be authorized by the Workers' Compensation Board to treat workers' comp patients, and you'll need to follow strict guidelines for billing and treatment duration. All bills must be submitted within 120 calendar days from the date you provide treatment, and as of August 2025, New York requires electronic billing for all workers' comp claims.
The state's Medical Treatment Guidelines limit chiropractic treatment to a maximum of three months for acute conditions, and treatment must show objective measures of improvement to continue. These guidelines exist to prevent overtreatment and ensure injured workers receive appropriate care. If you're building a practice around workers' comp cases, familiarize yourself with these rules early—missing billing deadlines or violating treatment protocols can result in denied claims and lost revenue.
Licensing Requirements That Connect to Insurance
To practice chiropractic in New York, you need a license from the State Education Department. That means completing a Doctor of Chiropractic degree from a Council on Chiropractic Education (CCE) accredited program—that's typically two years of pre-chiropractic college coursework followed by four years of professional study. You'll also need to pass national written and practical examinations. The license fee is $294, and you'll need proof of your professional liability insurance when you apply.
Once you're licensed, you'll register every three years and complete 36 hours of continuing education during each registration period. At least 12 of those hours must cover patient communications, recordkeeping, or legal and ethical matters. New practitioners are exempt from continuing education requirements for their first three years, giving you time to establish your practice before adding that obligation.
How Much Does This Insurance Actually Cost?
Insurance costs vary based on your location, claims history, and practice specifics, but here's a rough estimate. Professional liability insurance for chiropractors typically runs between $1,500 and $3,500 annually for the required $1 million/$3 million coverage. General liability might add another $500 to $1,200 per year. Workers' compensation costs depend on your payroll and employee roles, but for a small practice with one or two employees, expect $1,000 to $3,000 annually.
Many insurance carriers offer discounts for bundling policies or for completing risk management training. Shopping around pays off—rates can vary significantly between carriers, and you might find specialized insurers who focus on healthcare practices and understand your unique needs better than general commercial insurers.
Getting Started: Your Action Plan
Before you see your first patient, make sure you have your professional liability insurance in place—it's required for your license application. If you're leasing office space, secure general liability coverage before signing your lease. And the moment you hire your first employee, get workers' comp insurance set up.
Work with an insurance broker who specializes in healthcare practices. They'll understand the specific requirements for chiropractors in New York and can help you find coverage that meets state mandates without paying for unnecessary extras. Get quotes from multiple carriers, compare not just price but also coverage details and claims support, and read your policies carefully before you sign.
Finally, build insurance costs into your business plan from day one. These aren't optional expenses you can defer—they're fundamental requirements for operating legally and protecting the practice you're working so hard to build. With the right coverage in place, you can focus on what matters most: helping your patients and growing your practice with confidence.
