Lloyds' of London is the best known exchange. During the medical malpractice crisis of the 1970's, many stock insurance companies and mutual insurers sought to discontinue writing malpractice liability policies or to raise premiums to almost unpayable levels because of fears of potential losses. This led to action by state insurance commissioners and to the development of numerous physician-sponsored insurance exchanges. In addition, a number of large medical organizations established sponsored programs for their members underwritten by commercial underwriters and administered by professional insurance services under contract. Insurance companies in the U.S. and Canada categorize physicians into risk categories, with as few as three and as many as nine classes.
Occupational physicians tend to be treated very differently by different companies.
Seven insurance companies writing malpractice coverage in Southern California were queried in 1984. One indicated that company policy was to examine the practice patterns of each physician individually. This latter approach makes a great deal of sense in occupational medicine. Occupational physicians, almost uniquely, fall into either the highest or the lowest risk categories depending on their particular situation and the degree of formal preparation they have completed. The factors most often cited in determining whether an occupational physician would be considered low-risk are board certification in occupational medicine, whether one's activities are primarily administrative duties, the emphasis on preventive medicine in the practice, and presence within a large organization.