Indemnity insurance: how much is enough?

Professional indemnity for doctors in India is a small, technical, deeply important field that most general insurance brokers handle as an afterthought. The doctor, evaluating it through a generalist channel, ends up with a policy that is correctly paid but probably not correctly sized.

The size question — how much indemnity cover is enough — depends on three things: the specialty, the volume of practice, and the legal environment in which the practice operates.

How the legal environment is shifting

Indian medical malpractice claims, for most of the last forty years, were handled through consumer courts and resulted in awards that were modest by international standards. The picture has been shifting steadily over the last fifteen years. Awards have grown in size, particularly for specific kinds of negligence claims (delayed diagnosis, surgical errors with permanent consequence, perinatal care). Recent landmark judgments have settled in the multi-crore range. The trajectory is upward, and not slow.

A doctor whose indemnity cover was set at ₹50 lakh or ₹1 crore a decade ago — a level that was reasonable then — may today be carrying a fraction of what an adverse judgment could realistically reach.

Specialty-specific exposure

Different specialties carry different malpractice profiles. The factors that drive higher exposure include:

• Specialties where outcomes are heavily binary (surgery, anaesthesia, obstetrics) carry higher claim probability and severity than specialties with more graduated outcomes (internal medicine, dermatology).
• Specialties involving children and pregnancy — paediatrics, obstetrics, neonatology — carry above-average exposure because of the long-tail nature of claims (a brain-injured child has a 60-year horizon of expected medical and life costs, and judgments reflect this).
• Specialties with high-volume procedural work — IVF, cosmetic surgery, ophthalmology, dentistry — carry higher exposure simply because the absolute number of procedures (and thus the number of potential claim events) is high.
• Specialties involving end-of-life or major life-altering decisions carry more potential for emotionally-loaded litigation.

Reasonable cover sizing, today

In our practice, the rough indicative ranges for adequate professional indemnity cover in 2026 are:

• General physicians, dermatologists, psychiatrists: ₹2-3 crore minimum.
• Internists, paediatricians (non-NICU), radiologists: ₹3-5 crore.
• Surgeons (general, orthopaedic, ENT): ₹5-10 crore.
• Obstetricians and gynaecologists: ₹8-15 crore (the OB exposure is structurally high).
• Neonatologists, anaesthesiologists, cardiac/neurosurgeons: ₹10-20 crore.
• High-volume procedural specialties (IVF, cosmetic, ophthalmic surgeons): ₹8-15 crore depending on volume.

These are minimum reasonable numbers, not aggressive ones. Many doctors are carrying half or less.

Premiums for properly-sized cover are not trivial — typically ranging from ₹40,000 a year for a generalist to ₹3-5 lakh a year for a high-exposure surgical practice. They are, however, small compared to the cost of a successful claim above the cover ceiling.

What a good policy includes

Beyond the cover amount, the structural quality of the policy matters significantly. Items to look for:

• Occurrence-based vs. claims-made coverage. Indian indemnity policies are typically claims-made — meaning, the policy in force at the time the claim is filed (not the time the incident occurred) is what responds. This has implications for retirement, career changes, and policy renewals.
• Retroactive cover. A policy bought in year 10 of practice can typically include retroactive cover for incidents that occurred earlier — this is critical and often missed.
• Defence costs separate from cover ceiling. Some policies include defence costs within the cover limit; others provide them in addition. The latter is materially better.
• Run-off cover at retirement. When the doctor retires, claims can still arise for incidents during practice. Run-off cover (sometimes called "tail cover") protects against this. Without it, the retired doctor is exposed personally.
• Specialty-appropriate language. A policy that is generic medical indemnity may have exclusions that materially affect a specific specialty. Reading the exclusions matters.

The structural question of clinic vs. doctor cover

A doctor running their own clinic should consider both individual indemnity (covering them personally) and clinic indemnity (covering the clinic as an entity, including for support staff and the institution's potential liability). The two are not always aligned, and clinic-only or individual-only cover leaves gaps.

For doctors who operate at multiple hospitals or clinics, it is worth verifying which indemnity arrangements cover which work. Some hospital appointments include institution-provided cover; others assume the doctor carries personal cover. The doctor should know, for every place they practice, which insurance responds in the event of a claim.

A practical review

We typically conduct an indemnity review for doctor clients on a 3-year cycle. The review covers:

• Current cover, current premium, current carrier.
• Realistic exposure given specialty, volume, and current legal environment.
• Policy structural quality (claims-made details, retroactive cover, run-off, exclusions).
• Comparable quotes from at least two specialised brokers.
• Coordination with the doctor's other policies (life, disability, health).

Done every three years, this keeps the cover roughly in step with both the doctor's exposure and the legal environment. The doctor whose cover was set at the start of practice and never re-examined is, in 2026, almost certainly significantly under-covered.

The plain version

Indemnity is not where to economise. The premium for correctly sized cover is, in absolute terms, small. The cost of being under-covered, in the rare event a claim does arise, is typically catastrophic — both financially and professionally. Of all the insurance reviews we conduct for doctor clients, indemnity is the one that most often reveals real gaps. It is also the one most worth fixing first.