Medical Malpractice Insurance in Israel
- Rivka Lebrett
- Mar 9
- 7 min read
Updated: Mar 10
With thanks to Avner Goldfus of Goldfus Insurance for his valuable input.
This topic can be really confusing, especially when a doctor is working in various workplaces. Being covered is essential, and therefore it's really important that you have clarity about what coverage your workplace provides and if it extends to cover any private work you may be doing on the side.
Terminology:
בִּיטּוּחַ אַחֲרָיוּת מִקְצוֹעִית
Pronunciation: Bituach Achrayut Miktzo’it
Meaning: Professional liability insurance / malpractice insurance
רַשְׁלָנוּת רְפוּאִית
Pronunciation: Rashlanut Refuit
Meaning: Medical malpractice
פּוֹלִיסָה
Pronunciation: Polisa
Meaning: Insurance policy
Why it matters:
Medical malpractice (professional liability) insurance protects healthcare professionals against legal claims arising from negligent medical care that causes patient injury or harm. The policy typically covers legal defense costs, settlement payments or court-ordered damages, and legal representation during proceedings.
Coverage for Public Sector Employees:
Definition: Public Sector Employee (שָׂכִיר / Sachir) — Employed by a public hospital or Kupah under a standard employment contract, receiving employee benefits and paid through the monthly payroll.
The collective agreement (הֶסְכֵּם קִיבּוּצִי) between the Israeli Medical Association and the government sets employment conditions across the public healthcare system. These agreements include arrangements for professional liability (malpractice) insurance as part of collective employment benefits.
Doctors working in hospitals, kupot/HMOs or public health institutions are generally covered under group professional liability insurance policies organized at the institutional level. Under these agreements, malpractice insurance is arranged collectively for doctors in the public system, and the cost of the premium is shared among physicians.
Payroll deductions
Because the insurance is collectively funded, doctors contribute to the premium through payroll deductions.
Doctors working above a minimum employment threshold are included in these collective deductions. The exact threshold may vary between employers and agreements and is not a universal statutory rule.
The insurance premium is typically billed annually, but employers often collect it through payroll in installments. In many hospitals this appears as four deductions per year (approximately 1,000–1,500 NIS each quarter). In Kupot Holim, it may appear as a monthly deduction (around 100 NIS).
On pay slips, the deduction may appear as "ביטוח מקצועי" or a similar description.
Coverage for Independent Contractors within the Public Sector:
Definition: Independent Contractor (עַצְמָאִי / Atzmai) — Self-employed within the Kupah or Hospital; payment is made against invoices (calculated quarterly), with no employment benefits. The individual is responsible for their own taxes, pension contributions, and other obligations.
Although independent doctors are theoretically responsible for arranging their own professional liability insurance, in practice the situation varies considerably. For example, Maccabi, the Kupah with the highest proportion of independent contractors, provides malpractice insurance for doctors who work more than four hours per week within the system.
In reality, each doctor negotiates their own working arrangement with the Kupah, and malpractice insurance terms may differ accordingly. In some cases, the doctor will arrange and fund their own insurance; in others, the Kupah may arrange the coverage and deduct the contributions from the doctor’s payments. Coverage may also depend on factors such as the number of hours worked within that Kupah, and whether the doctor also works in other Kupot or in private practice.
Sharap (שָׁרָ״פ – שֵׁרוּת רְפוּאָה פְּרָטִי) (private medical services) is the framework through which self-employed physicians can work within Shaare Zedek and Hadassah Ein Kerem hospitals. In many cases, doctors working in Sharap are covered by the hospital’s malpractice insurance, often because their work will also include public-sector activity within the same hospital.
Coverage for Private Practice:
If you already practice in the public sector and plan to add a private practice, the first step is to understand whether your current malpractice insurance covers that activity.
Employer-provided malpractice insurance covers work performed within the scope of your employment, but it does not automatically cover private practice.
Coverage depends on several factors, including which hospital or Kupah you work for, your work hours and your employment structure (salaried with monthly pay slip/ self-employed with quarterly earnings).For example, Clalit employees will be covered for private practice if they work at least 30% of their position within the Kupah. (This percentage can vary between individuals)
In many cases, public-sector malpractice insurance does extend to private practice, but this is not always guaranteed. Because this coverage is SO important, it is essential not to rely on assumptions or informal advice (like this blog). Always verify the details of your specific policy.
Coverage may also depend on factors such as:
The type of procedures or services you provide
The setting in which you practice
Whether you employ staff, like a secretary
The small print matters, so you should review the policy directly and confirm your coverage in writing.
How to check your coverage
There are two simple ways to verify your malpractice coverage:
1. Contact HR
Email your employer’s Human Resources department and ask whether your policy covers the specific private work you intend to perform.
2. Request your policy from Madanes
Madanes is the primary agency arranging malpractice insurance for the kupot and hospitals. You can request a summary of your malpractice insurance policy through the Madanes WhatsApp bot (052-825-9424).
Enter your details according to the bot’s questions, and it will send you the information you need.
Who needs to arrange their own malpractice insurance?
You will need to arrange your own malpractice insurance if:
Your public-sector coverage does not extend to the private work you plan to do.
You are working as a self-employed doctor within the public healthcare system and your contract does not include malpractice insurance.
You are working exclusively in private practice.
Understanding Insurance Structures:
It is really important to understand the different structures of malpractice insurance and the significance of each set-up.
Occurrence-Based Coverage
With occurrence-based coverage, the key factor is when the medical event occurred.
If the treatment took place while the policy was active, the doctor remains covered even if the claim is filed many years later, after the policy has ended.
Because medical malpractice claims can arise long after the treatment occurred, occurrence-based policies are often considered more secure.
Claims-Made Coverage
With claims-made coverage, the key factor is when the claim is filed.
The policy must be active at the time the claim is made in order for coverage to apply - even if the medical incident occurred years earlier.
This means that if a doctor changes insurers, retires, or cancels the policy, they may lose coverage for past work unless additional protection is arranged.
Tail Coverage
Tail coverage (זְנַב בִּיטּוּחִי) protects doctors after they leave a claims-made policy.
It allows claims to be filed years later for treatments that occurred while the policy was active.
For this reason, many claims-made malpractice policies either:
include tail coverage, or
offer the option to purchase tail coverage when leaving the policy.
Retroactivity
In claims-made malpractice insurance policies, it is important to check the retroactive date. Retroactive coverage ensures that when you switch from one insurer to another, your new policy will still cover claims related to medical work performed in the past, as long as it occurred after the retroactive date. This is different from run-off (tail) coverage, which protects you after you leave a policy. Retroactivity ensures continuity of coverage when changing insurers, preventing gaps in protection for earlier treatments.
With any insurance you take you, you must confirm:
Is the policy occurrence-based or claims-made?
If claims-made, is retroactivity and tail coverage included?
If leaving the insurer, is extended coverage available?
Insurance Brokers
Madanes
Madanes Insurance Agency is the dominant provider in the Israeli medical malpractice insurance market. Founded in 1972, it became the main malpractice insurance provider in Israel in 1979 and has historically managed around 80% of malpractice coverage for Israeli physicians.
Most Israeli doctors working in institutional settings are insured through large group policies arranged via hospitals, Kupot Holim, or professional organizations, which is why the majority of physicians encounter malpractice insurance through Madanes.
Importantly, Madanes is an insurance broker/agency, not the insurer itself.
This means Madanes arranges and manages the policies and the actual insurance risk is underwritten by a separate insurance company.
Historically, these policies were exclusively underwritten by Harel, but this exclusivity was legally challenged and no longer applies.
Lloyd’s of London
Although local arrangements dominate the Israeli market, international insurers offer competitive prices and increasingly participate. One of the most prominent is Lloyd’s of London.
Unlike a traditional insurance company, Lloyd’s is an insurance marketplace where multiple underwriting syndicates provide coverage. When a doctor purchases “Lloyd’s insurance,” the policy is actually issued by one of the insurers operating within the Lloyd’s market.
Doctors cannot purchase insurance directly from Lloyd’s. Instead, policies must be arranged through a licensed insurance broker or agency. A Lloyds broker allowed to provide insurance in Israel has to be approved by the comptroller of insurance of the State of Israel.
The broker typically:
Identifies the appropriate Lloyd’s insurer
Arranges the policy
Assists with claims if they arise
Some doctors choose Lloyd’s policies because premiums can often be lower, policies can be customized for private practice and coverage can be arranged independently from hospital insurance
Many Lloyd’s malpractice policies operate on a claims-made basis (explained later).
Here are some insurance brokers which ADII members have used and recommend, this is not a comprehensive list;
Cooper-Ninve Insurance Broker
Doctors who choose Lloyd’s coverage typically work through specialized insurance brokers.
One example is Cooper-Ninve, one of the oldest and leading insurance agencies in Israel in the general insurance sector, which acts as a Lloyd’s Coverholder in Israel.
Goldfus Insurance & Finance
Goldfus provides full insurance brokerage services in English.
Founded in 1971, Goldfus is part of Oren Mizrach, one of the largest insurance brokerages in Israel. This affiliation enables the agency to provide competitive and comprehensive solutions across insurance and pension services.
Egert & Cohen
Egert & Cohen is a family insurance brokerage with over 35 years of experience serving the Anglo community in Israel, with offices in Jerusalem, Efrat, and Ramat Beit Shemesh and clients across Israel and internationally.
0 2-622-7999
Gold Insurance
Yirmi Gold has been working in insurance for over a decade. He is determined to help clients understand how insurance and savings plans can pave the way to financial security and peace of mind.
Important to note:
Tax refund: If you file an annual tax return, you may be eligible for a partial income tax deduction for malpractice insurance premiums. To claim this, request confirmation from HR showing that the deduction was made.
Policy comparison: The Israeli Medical Association (IMA) can help doctors compare malpractice insurance policies.
Artzi members: Members of Artzi (אַרְצ״י – ארגון הרופאים העצמאיים בישראל, the Association of Independent Physicians in Israel) may also receive discounted professional liability insurance through their organization.
Review annually: Coverage for private work can change between policies and from year to year, so it is important to check your coverage at least annually.
Reduced practice: Retired or retirement aged doctors that have reduced activity will normally get a reduction in premium.
Summary
Malpractice insurance is an essential part of practicing medicine, even though we all hope we will never need it. It can feel daunting to understand where you stand, but in practice it comes down to three things: understanding how coverage works in Israel, clarifying what your current policy covers, and knowing who to turn to if you need additional protection to cover all areas of your practice.
We hope this blog helps give you some clarity and points you in the right direction.
Have any comments? Suggestions?
Talk to us.
