While the annual premium is a key issue in insurance, you want to balance it against what the insurance will do for you. Particularly, look for holes you may painfully fall though later.

Here are some questions about your insurance you may not normally consider that can make a big difference in what happens to you in a malpractice case.

• Do you still have defense monies if the aggregate is breached by a malpractice award? Some companies put in a clause restricting this. It has a huge impact because you would have to pay all legal fees for any further defense or negotiations. For example, if you were unlucky enough to have two malpractice cases in the same year, and the first breached the total aggregate, you would be without defense money for the second case. This could be true even if the first case is negotiated down.
   
• If you have a claims made policy, what is the cost of a tail? What are the conditions of chosing it, and the timelines. This is often a serious problem that a physician does not plan for, and the cost can be substantial. Understand it well and if possible negotiate it in advance.
   
• Does the policy contain monies for state licensing board issues? More insurance companies do include this at a relatively low rate, e.g. $25, 000. This is enough for simple inquiries that end well. However if you have to go to a hearing process, it is unlikely to cover the expenses by a wide margin. Such problems can cost hundreds of thousands of dollars, from your pocket. Should the company offer this benefit, check the fine print. Is is per year of coverage, or a lump sum for all years? Is it based on the year of the case incident, or of the licensing board investigation intiation when you learn of the case? These issues make a large difference in your coverage, and may be left vague.
   
• Under what conditions do you settle? Is your permission required for settlement? Or can the insurance company settle without your permission?
   
• Can you chose your own defense attorney, and who is on the list?
   
• If possible, as a physician who has worked with the company in a lawsuit what the case worker was like. They have a large influence in dealing with you, and may well determine the terms of a settlement.