Compulsory liability insurance (patient insurance) for healthcare providers

An honest comparison

Claims-made vs. occurrence-based

Situation	MedMal — claims-made	Occurrence-based
What triggers cover	Submitting a claim.	The incident occurring.
Predictability of long-term risk	Up to 10 years of liability is arranged through the current policy and the extended reporting period. The risk is more predictable for the insurer, which helps keep the premium more reasonable and increases insurers’ willingness to offer cover.	Up to 10 years of liability rests with the policy that was in force when the incident occurred. The insurer must set aside more reserves for possible future claims, which can mean a higher premium or fewer providers to choose from.
Incidents before the contract start	Covers incidents that occurred before the contract start if a retroactive date has been agreed. If the retroactive date is the contract start date, incidents that occurred before the contract start are not covered.	Not covered.
Claims submitted after the contract ends	Covered if the incident the claim relates to occurred during the insurance period (including the retroactive period and after) and the one-time extended reporting period fee agreed in the contract has been paid.	Covered if the incident occurred during the insurance period.
Fee for the 10-year cover	Paid only when the business ceases operating or the claims-made contract is terminated at the request of the policyholder or the insurer.	Paid as part of the annual insurance premium.
Compensation limits if the law changes	Follows the limits in force on the day the claim is submitted.	Follows the limits in force in the year the incident occurred.
Meets the requirements set out in law (TOKVS)	Yes.	Yes.

The information in the table is a brief summary; all details relating to the claims-made contract are explained during the quotation and contract conclusion process.

The most common question

“Is claims-made insurance as safe as occurrence-based?”

Yes — claims-made insurance protects the same situations required by law, using different mechanisms.

Compliant with the law

Full compliance with TOKVS

The insurance contract complies with the Healthcare Provider Compulsory Liability Insurance Act and the Law of Obligations Act. The statutory insurance sums and limitation periods are guaranteed.

Covers the future

10-year extended reporting period

If the claims-made contract ends — either because the policyholder ceases operating or chooses to switch to an occurrence-based contract — a one-time extended reporting period fee applies, ensuring the statutory 10-year cover.

Covers the past

Retroactive cover

With a claims-made contract a retroactive date applies, meaning that each claims-made contract covers all incidents that occurred on or after the start date of the first claims-made contract.

Possible situations

What happens if…

“…I switch my occurrence-based contract to claims-made (MedMal)?”

Nothing happens: the occurrence-based contract covers incidents that occurred during its period, and the new claims-made contract covers claims submitted during its insurance period or extended reporting period, provided the incident occurred while the claims-made contract was in force.

“…a patient only submits a claim years later?”

The claim is covered if it is submitted during the insurance or extended reporting period (up to 10 years after the contract ends), provided the incident occurred while the claims-made contract was in force, including on and after the retroactive date (the start date of the first insurance period of the claims-made contract is the same as the retroactive date).

“…I cease operating or retire?”

If your business ceases operating and the claims-made contract is terminated, you pay a one-time extended reporting period fee to ensure the statutory 10-year cover. In the event of the death, retirement or permanent incapacity for work of a sole proprietor, the extended reporting period applies at no additional charge.

“…I want to renew the contract with a new insurer next year?”

If the new provider continues with a claims-made contract, cover carries over through the retroactive date. If the new provider uses an occurrence-based contract, you pay a one-time extended reporting period fee to ensure the statutory 10-year cover.

“…the law raises compensation limits in the future — how are past incidents compensated?”

With a claims-made contract, compensation follows the statutory limits in force on the day the claim is submitted. If the law has raised the limits in the meantime, even earlier incidents are compensated at the new, higher limits — to the patient’s benefit.

“…the insurer goes bankrupt?”

The Lloyd's insurance market has operated continuously for 337 years and has never left a confirmed insured claim unpaid. Policyholders are protected by the capital of the Lloyd's market syndicates and by Lloyd's central fund.

“…one of my several activity licences ends or is revoked?”

The insurance contract remains in force for the other activity licences. Incidents that occurred under the ended licence remain covered if the claim is submitted during the insurance or extended reporting period. Changes to activity licences must be reported to the broker; the change is recorded and, where relevant, reflected in the next period’s premium.

“…I renew the contract next year again as a claims-made contract?”

The retroactive date applies — the start date of the first insurance period of your claims-made contract. All earlier incidents from the retroactive date onward remain covered under the new contract too. When renewing as a claims-made contract, cover stays uninterrupted and no extended reporting period fee applies, because claims-made cover continues.

Cover

Compulsory cover + additional extra cover

The statutory minimum is always guaranteed. In addition, the contract includes extra cover.

Required by law

Compulsory cover

Insurance sums set out in law (TOKVS):

Per entitled person100 000 €

Per insured event300 000 €

Non-pecuniary damage per entitled person30 000 €

Non-pecuniary damage per insured event100 000 €

Per insurance period (year)3 000 000 €

Included in the contract

Additional cover

Additional insurance sums, including legal costs:

Good Samaritan act100 000 €

Loss of documents25 000 €

Defamation25 000 €

Breach of confidentiality25 000 €

Claims support in Estonia

In Estonian, by Estonians

The claims handler authorised by the insurer is Crawford, an internationally experienced firm operating in more than 70 countries. For submitting claims in Estonian on volitatud Denis Europe OÜ.

In Estonian

Claims intake and communication in Estonian throughout the entire claims process.

Local experts

Where needed, local medical experts are involved in assessing the claim.

International panel

Crawford’s international panel of experts for complex cases.

Submit a claim

They trust us

Over 100 Estonian healthcare providers

Hambaarstid

Logopeedid

Õendusabi osutajad

Kiirabid

Väikehaiglad

Erakliinikud

Perearstid

Taastusraviarstid

Füsioterapeudid

“On behalf of our whole team, we are very grateful to you for bringing an alternative insurance provider to the market!”

— A policyholder who requested confidentiality

A look at history

Medical liability insurance has a long history

~1750 eKr

Code of Hammurabi

A physician’s liability is written into law for the first time — serious errors bring harsh penalties.

~400 eKr

The Hippocratic Oath

“Do no harm” — responsibility takes on a moral dimension.

1374

First court case · England

Stratton v. Swanlond confirms: a physician can be liable for negligence.

1794

First court case · USA

A failed procedure goes to court — the American era of malpractice claims begins.

1800–1900

The first liability insurance policies

Advances in medicine and a rise in lawsuits create the need for insurance.

1970ndad

Crisis and the claims-made model

Payouts explode in the USA; the claims-made model is born to keep the system controllable and sustainable.

1980–2000

European special models

The Nordics: no-fault compensation without establishing fault; elsewhere, voluntary liability insurance predominates.

2024

Estonia’s new chapter

The compulsory liability insurance act enters into force — every healthcare provider must be protected, and every patient knows that protection exists.

Frequently asked questions

Clarity before you decide

What is patient insurance?

Patient insurance is the healthcare provider’s compulsory liability insurance (TOKVS), required in Estonia since 2024. It covers harm caused to a patient during care for which the provider is liable by law, and ensures that potential claims do not threaten the provider’s financial position.

Who is the insurer that enters into the insurance contract with me?

The insurer is Lloyd's Insurance Company S.A. PAT5404 (syndicate MCI), which is authorised to conduct cross-border insurance under the cross-border licence granted to Lloyd's Insurance Company S.A. Lloyd's Insurance Company S.A. is entered in the Estonian Financial Supervision Authority’s register of cross-border non-life insurance providers. You can verify this here.

Are the insurance contract materials in Estonian?

Yes, all insurance contract materials – the quote, the insurance terms and conditions and other important documents – are issued in Estonian through the Northern1 insurance broker.

Does the insurer provide materials for informing patients?

Yes, an information document for patients is sent to you together with the policy.

What do I need to do to get a quote?

Download the application form here, fill it in and send it to info@medmal.ee. The Northern1 insurance broker forwards the application to the insurer for a quote and passes it on to you as soon as it arrives.

How quickly will I get a quote?

Within 1–5 business days after the application form has been completed. For more complex risks, clarifying the details may take longer.

Where is MedMal’s contact point?

Meetings take place by prior appointment at Hobujaama 4, Tallinn. If the claimant is located outside Tallinn and submitting a claim online is not possible, the claims handler can, by agreement, travel to the claimant.

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Insurance cover at a sensible price