George Maughan, THEMIS’ director of insurance services, reveals why medical indemnity cover is not one size fits all.

There is a phrase I am hearing with increasing frequency from clinicians reviewing their indemnity arrangements:

“I’ve been told the policies are essentially like for like.”

On the surface, it sounds reassuring. Efficient. Convenient.

In reality, it is often an oversimplification, and in some cases, a dangerously misleading one.

Medical indemnity is not a commodity. It is not broadband. It is not car insurance. And reducing complex contractual protections to “like for like” does a disservice to clinicians making decisions that could define their professional future.

This is not about criticising competition. A healthy market is important. But clarity matters. And language matters.

Indemnity is structural — Not cosmetic

Two policies can appear similar at a headline level:

  • The same indemnity limit
  • A comparable premium
  • The same specialty declared

But the real protection lies beneath the surface.

When comparing indemnity arrangements, meaningful differences can exist in:

  • Claims conditions
  • Notification requirements
  • Consent provisions
  • Retroactive dates
  • Run-off structures
  • Aggregation wording
  • Exclusions relating to cosmetic or evolving procedures
  • The contractual versus discretionary nature of the promise to indemnify
  • Additional protections outside of normal cover
  • The credibility and experience of the legal team that will support you

These are not minor technicalities. They form the framework that determines how a claim is handled, and whether a clinician is protected in the way they expect.

To suggest these nuances are “essentially the same” without careful analysis is, at best, incomplete and at worst, wilfully lazy. 

Beyond the core policy: The additional protections that matter

Another area frequently overlooked in “like for like” comparisons is the additional protections wrapped around the core indemnity.

Many products provide extensions or ancillary protections that sit above and beyond standard civil negligence cover. These may include, for example:

  • Regulatory and disciplinary defence
  • Coroner’s inquests
  • Criminal defence costs arising from clinical practice
  • Media or reputational support
  • Good Samaritan acts
  • Public liability or entity extensions
  • Breach of confidentiality or data-related liabilities
  • Employment support

The breadth, limits, triggers, and conditions attached to these protections can vary significantly between providers.

Two policies might both offer £10 million indemnity for clinical negligence but differ materially in how they respond to a GMC investigation, a coroner’s inquest, or allegations outside the strict confines of a negligence claim.

These differences are rarely visible in a simple premium comparison. Yet they can be pivotal in moments of professional stress.

Claims-made is not claims-made is not claims-made

Take claims-made policies as an example. Two providers may both offer a claims-made structure. That does not mean they operate identically.

Key questions include:

  • What triggers notification?
  • How is prior knowledge defined?
  • What happens if practice changes?
  • What are the conditions attached to run-off?
  • How are defence costs treated within the limit?

Similarly, an occurrence-based policy may appear straightforward – until exclusions, territorial restrictions, or sub-limits are examined.

Structure matters. Wording matters. Conditions matter.

The myth of interchangeability

One of the underlying problems is the assumption that medical malpractice policies are interchangeable. They are not.

Indemnity providers operate with different risk appetites, different pool compositions, different capital structures, and different long-term strategies. These factors influence not only pricing, but claims philosophy and sustainability.

When a clinician is told a policy is “like for like,” an important question follows:

On what basis?

  • Was the comparison limited to limit and price?
  • Was the wording reviewed line-by-line?
  • Were exclusions mapped?
  • Were additional protections compared?
  • Was the claims handling philosophy considered?
  • Was the long-term resilience of the indemnity pool assessed?

Without that depth, “like for like” becomes shorthand for “superficially similar.”

Risk has become more complex

The claims environment is evolving. Severity is increasing. Legal costs are rising. Cosmetic and elective work carry distinct litigation patterns. Patient expectations continue to shift.

At the same time, clinicians’ practices are more diverse than ever:

  • Mixed NHS and private work
  • Entity and individual exposure
  • Cosmetic alongside reconstructive
  • Advisory, medico-legal, or digital health activity

In such an environment, the idea that policies can be casually categorised as interchangeable should give us pause.

Brokers and responsibility

Most brokers work hard for their clients. Many provide thoughtful guidance. But simplification can creep in, particularly when market competition intensifies.

Reducing indemnity to a price comparison risks turning a professional safeguard into a procurement exercise.

As clinicians, you would not accept a colleague describing two surgical approaches as “essentially like for like” without understanding anatomy, technique, and outcome data.

Indemnity deserves the same intellectual discipline.

The real question to ask

If you are reviewing your cover and hear the phrase “like for like,” consider asking:

  • Can you walk me through the key structural differences?
  • How do notification and prior knowledge provisions compare?
  • Are there differences in retroactive protection?
  • What are the conditions for run-off?
  • What additional protections are included; and how do their limits differ?
  • How does each provider construct and protect its indemnity pool?

If those questions cannot be answered clearly, the comparison may not be complete.

This is not about fear – It is about understanding

This is not an argument that one model is universally better than another. It is not an attempt to create alarm. It is a call for precision.

Medical indemnity is there for the worst day of your career. It is activated in moments of stress, scrutiny, and uncertainty. At that point, nuance becomes everything.

The time to understand difference is before a claim arises; not after.

A consultative approach

At THEMIS, we believe indemnity conversations should be consultative, not transactional.

That means:

  • Understanding the detail of a clinician’s work
  • Discussing how practice evolves over time
  • Explaining policy structure clearly
  • Being transparent about what is and is not covered
  • Ensuring clinicians understand their obligations under the policy

Comparison is entirely appropriate. Switching providers can be appropriate. Markets should compete.

But comparison should be rigorous, not reductive.

Because when it comes to professional protection, “essentially like for like” may be the most expensive assumption a clinician ever makes.