Here's something most chiropractors don't think about until it happens: even if you do everything right, you can still get sued. Maybe a patient doesn't see the improvement they expected and blames your treatment. Maybe someone claims an adjustment made their condition worse. Or maybe it's something completely outside your control—a HIPAA violation from a staff member's honest mistake. That's where professional liability insurance comes in. It's not about admitting you'll make mistakes. It's about protecting your practice and your personal assets when the unexpected happens.
Professional liability insurance—often called malpractice insurance or errors and omissions (E&O) coverage—protects you against claims that you caused harm through your professional services. For chiropractors, this covers treatment-related injuries, negligence allegations, billing disputes, and even board investigations. The statistics are actually reassuring: only about 1 in 100 chiropractors faces a claim each year. But when it does happen, legal defense alone can cost tens of thousands of dollars, even if you're completely vindicated.
Claims-Made vs. Occurrence: The Decision That Affects Your Coverage for Years
The first big choice you'll face when shopping for professional liability insurance is between claims-made and occurrence policies. This isn't just insurance jargon—it fundamentally changes how and when you're protected.
A claims-made policy covers you only when two conditions are met: the incident occurred while your policy was active, and the claim was filed while your policy was still active. Here's why that matters: imagine you treat a patient in March 2025, but they don't file a lawsuit until January 2026. If you switched insurance carriers in December 2025 and didn't purchase something called "tail coverage," you're not covered. Claims-made policies start out cheaper—often 30-40% less expensive in year one—making them attractive for new chiropractors. But the premiums increase each year as your exposure grows, and if you ever let the policy lapse or switch carriers, you'll need to buy an extended reporting endorsement (that "tail coverage") to maintain protection for past treatments.
Occurrence policies work differently. They cover any incident that happens during the policy period, regardless of when the claim is filed. You could retire in 2030, and if someone sues you in 2035 for something that happened in 2029 when you had an occurrence policy, you're still covered. No tail coverage needed. The catch? Occurrence policies cost more upfront—sometimes 20-30% higher than first-year claims-made rates. However, the premiums stay more stable over time, and when you factor in the cost of tail coverage (which can run $15,000-$30,000 or more), occurrence often ends up cheaper in the long run.
The smart play if you're just starting out: go with claims-made to save money initially, but choose a carrier that offers free tail coverage upon retirement. Some major carriers, like those underwritten by MedPro Group, include this benefit automatically. That way you get the lower premiums now without worrying about a massive bill when you eventually hang up your practice.
Why Your Retroactive Date Is Critical
If you go with a claims-made policy, your retroactive date becomes one of the most important details in your coverage. This is the date that determines how far back in time your policy will cover incidents. Most chiropractors get their first policy with a retroactive date that matches when the policy starts. That's fine when you're brand new. But here's where people run into trouble: if you switch carriers five years into practice and your new policy has a retroactive date of today, you just lost coverage for the previous five years of patient treatments.
When shopping for new coverage, always ask whether they'll honor your prior acts coverage and maintain your original retroactive date. Most reputable carriers will, but you need to specifically request it. The goal is to maintain continuous coverage from the day you started practicing. This is sometimes called "nose coverage" because it extends back to the beginning of your career, while tail coverage protects you going forward after a policy ends.
Defense Costs: Inside or Outside Your Limits?
Most chiropractors carry $1 million per claim and $3 million aggregate coverage—written as $1M/$3M. In some states like Minnesota, these are actually the legal minimums. But here's a detail that dramatically affects the value of that coverage: whether defense costs count against your limits or sit outside them.
With defense costs "inside the limits," every dollar spent on lawyers, expert witnesses, court fees, and legal defense reduces your available coverage. If your attorney runs up $200,000 in defense costs, you now only have $800,000 left to pay a settlement or judgment. If you lose a case and owe $900,000, but you've already spent $200,000 on defense, you're personally on the hook for $100,000 because you've exceeded your $1 million limit.
Defense costs "outside the limits" (also called "defense costs in addition to limits") means the insurance company pays for your legal defense completely separately from your coverage limits. Your full $1 million remains available for settlements or judgments. This is clearly better protection, though policies with this feature may cost 10-15% more. When comparing quotes, always ask about this. A cheaper policy with defense costs inside limits might actually leave you more exposed than a slightly pricier policy with defense costs outside.
What Actually Gets Covered
Professional liability insurance for chiropractors covers more than just botched adjustments. The most common claims involve allegations that your treatment failed to meet the standard of care or caused injury—things like nerve damage claims after cervical manipulation, or allegations that you missed a diagnosis requiring medical referral. But your policy typically also covers billing and coding errors that lead to accusations of fraud, HIPAA violations from improper handling of patient records, sexual misconduct allegations (which often turn out to be unfounded but still require expensive legal defense), and even state board investigations or disciplinary proceedings.
What's not covered? Intentional acts, criminal conduct, and incidents that occurred before your retroactive date. If you knowingly falsify records or intentionally harm a patient, you're on your own. The policy also won't cover general business disputes unrelated to professional services—if you have a contract dispute with your landlord, that's not a professional liability claim.
What You'll Actually Pay
Professional liability insurance for chiropractors typically runs $1,000 to $2,000 per year for standard $1M/$3M coverage. Your specific premium depends on your location (some states have higher claim frequencies), your years in practice (newer docs often pay less with claims-made policies), whether you employ other practitioners (covering associate chiropractors increases your exposure), your claims history (even one claim can bump your rates significantly), and what additional services you offer (if you also do acupuncture or physical therapy, that may require separate coverage or endorsements).
Some carriers offer discounts for completing continuing education in risk management, being a member of certain professional associations, or bundling your professional liability with other coverage like general liability or commercial property insurance. New graduates can sometimes find policies starting around $50-75 per month through programs specifically designed for chiropractors just entering practice.
How to Choose the Right Coverage
Start by comparing at least three quotes from carriers that specialize in chiropractic coverage. General business insurers often don't understand the specific risks you face, which can lead to gaps in coverage or unnecessarily high premiums. Look for carriers that work extensively with chiropractors—they'll offer better policy terms because they actually understand your risk profile.
Ask about consent to settle clauses. Some policies let the insurance company settle a claim without your permission—even if you believe you did nothing wrong. A "consent to settle" clause means they need your approval before settling, giving you more control over how claims are resolved. Also verify what happens if you reduce your hours or take a leave of absence. Some policies offer part-time or inactive status at reduced premiums, which matters if you're planning to cut back before full retirement.
Finally, read the fine print about how claims should be reported. Most policies require you to report potential claims as soon as you become aware of them—even if no lawsuit has been filed yet. If a patient makes threatening comments or you have an outcome that concerns you, report it immediately. Failing to report in a timely manner can give the insurer grounds to deny coverage later.
Professional liability insurance isn't just a checkbox requirement for maintaining your license—it's fundamental protection for your career and your personal assets. The good news is that chiropractic is a relatively low-risk profession from an insurance perspective, which keeps premiums reasonable. Take the time to understand your policy options, especially the differences between claims-made and occurrence coverage and how defense costs are handled. The few hundred dollars extra you might spend annually for better terms could save you tens of thousands—or your entire practice—if you ever face a claim.
