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Massage Today
September, 2008, Vol. 08, Issue 09

Insuring Your Success

By Dixie Wall, Contributing Editor

When embarking on an alternative health career as a massage and bodywork practitioner, being sued for professional malpractice is not something we usually consider. While a lawsuit against you or your practice might be unimaginable, it still happens.

A claim is more likely than we would like to think, especially when we live in such a suit-happy and sometimes greedy society. Even the most careful massage therapist may have something go wrong unintentionally. What are the common claims against therapists, and how can we avoid them? What steps can we take to keep our careers from being jeopardized by nuisance claims?

The essential element in protecting yourself is obtaining and maintaining professional liability insurance. Malpractice and liability insurance protects the therapist from lawsuits filed by a client due to injury or loss. Liability insurance is mandatory to satisfy licensing requirements in states such as Massachusetts, Missouri, South Dakota and Wisconsin, and even in some local, permitting regulatory agencies of California. Spas, clinics and other places of employment typically will require therapists or employees to carry insurance in order to protect themselves and their customers.

Standardized policies offer this additional coverage for places of employment through an additional insured option on the therapists' individual policy. This usually is anywhere from $10 to $50 extra a year (depending on how many places you need listed on your policy) and will cover the named business in case they also are named on a suit. If you're not an employee, liability protection can be expanded by adding your business to the policy whether you're a corporation or a sole proprietor.

Terms and amount of coverage generally is standardized or varies a little, but prices definitely vary. In general, malpractice insurance companies and massage and bodywork associations recommend you have all new clients sign some form of a "release of liability" statement along with the initial intake form. Insurance companies also suggest a claim should be reported as soon as possible. A claim must be reported within 48 hours to most providers.

Claims generally can be categorized into intentional acts or unintentional acts; unintentional acts are more commonly known as negligence. In this article, we will discuss unintentional acts or negligence claims, which can be further defined as failure to perform a degree of learned skills ordinarily possessed by a reputable health care professional.

Be aware malpractice insurance does not cover you when you perform intentional illegal acts or partake in activities not included in your policy. These acts include engaging in sexual misconduct with a client or using modalities beyond your scope of practice. When sexual impropriety takes place, the issue is no longer in the malpractice realm but now becomes a criminal issue. This subject will be discussed in a future issue.

I was able to contact a professional liability insurance provider in order to see what common claims have been occurring recently. After talking with Phil Stump, the president of the American Massage Council, I was able to get the most recent claims data. According to their data, the most popular claim was an unintentional or negligence suit involving physical injury to the client. A majority of these injuries were due to burns from heating pads and hot stones. The other common injuries involved the spine and ribs, and usually resulted from an excessive amount of pressure or disregard for a contraindication of the client.

Here are some examples of recent claims and tips to help you avoid this in your practice:

1. A client who is injured, causing pain including disk herniation, burns and bruised ribs.

  • Always use a professional intake form that asks about contraindications and medical history. Get a doctor's approval when indicated. Pay attention to medications such as blood thinners that could lead to bruising, past surgeries or accidents.
  • Use clear and effective communication with client about your office policies and treatment procedures.
  • Always check in regularly with the client about their temperature sensation, especially when the client might have chronic circulatory issues such as diabetes or heart problems. Several medications might affect circulation and create false perception of heat sensation that could lead to burning of the skin.
  • Respect the limits of different clients. Some clients can enjoy deep pressure and stretching, while others can be more sensitive.

2. Claims involving colleagues or friends.

  • Treat friends, family and colleagues with the same professional manner and office policies as you would a regular client.

3. Claims due to poor office maintenance such as table collapse or allergy attack.

  • Routinely check table for weak points and loose screws.
  • Keep office clean and sterile, and avoid using aromatherapy without checking the client's history.

4. Other tips to avoid claims.

  • Respect the limits, outcomes and privacy of your clients.
  • Make sure you purchase malpractice insurance before you start practicing. Pay your dues on time and report all claims in writing immediately to your insurance provider.

5. Claims due to poor policy procedures.

  • Use clear and effective communication with client about your office policies and treatment procedures.
  • Always tell clients what you're doing and why, especially when they are rolling over to face up.
  • If the client is large, weak or elderly, try having them roll towards you.

6. Claims due to using techniques beyond your scope of practice or education.

  • Never use chiropractic manipulation, such as spinal adjustment or traction.
  • Trust your intuition. If you see red flags at the initial interview with a client, refer them out. You cannot help absolutely everyone. There are different types of therapists to meet different types of client needs.

7. Read and develop your own ethical guidelines. (Visit to read the 2007 series, "Professional Ethics for the Massage Practitioner.")

Ultimately, we are the creators of our own destinies by establishing and following our own professional standards. It is these principles in which we conduct ourselves that the solid foundation of a lasting career can be set.


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