What Insurance Do You Need to Start a Private Physio Practice?

Your CSP membership insurance may already cover you, but it stops covering your limited company once annual turnover passes £200,000. That threshold is the single most important number in physiotherapy insurance and almost nobody publishes it.

Most articles on this topic are written by brokers. They tell you that you need professional indemnity and public liability, which is true, and then they invite you to get a quote. What they do not tell you is where your existing cover runs out, because that is the moment they would rather you discovered while buying a policy from them.

What cover do you actually need?

Three types, and they do different jobs.

Professional indemnity, sometimes called medical malpractice, covers claims arising from your clinical work: a treatment that caused harm, a missed red flag, advice that turned out to be wrong. This is the one that matters most and the one your registration assumes you have.

Public liability covers injury or damage that has nothing to do with your clinical judgement. A patient trips on a trailing cable. A plinth collapses. Somebody's coat gets ruined.

Employers' liability is legally required the moment you employ anyone, including part-time reception staff. It is not optional and the penalties for going without it are significant.

Indemnity is also a condition of HCPC registration. You declare that you have appropriate cover when you register and at every renewal. The HCPC does not set a minimum sum, deliberately: "appropriate" means appropriate to the risks of your own practice, and judging that is your responsibility.

Does CSP membership already cover me?

For most physiotherapists starting out, yes. CSP membership includes a professional liability insurance scheme, and its headline limits are substantial: £7.5 million per claim and £10 million in the aggregate, with an option to increase the per-claim limit to £10 million.

For a sole practitioner seeing patients under their own name, that is normally the whole answer, and paying a broker for a duplicate policy is money wasted.

The complications start when you stop being just yourself.

The £200,000 cliff

Here is the clause that matters. The CSP scheme extends to limited companies and partnerships owned entirely by CSP members, but only provided annual turnover does not exceed £200,000.

Cross that line and the business is no longer covered by the membership scheme. You personally remain covered as a member. The company through which you trade does not.

This catches people in a specific and predictable way. A physiotherapist incorporates, the practice grows, turnover creeps past £200,000 across a busy year, and nothing visibly changes. There is no letter, no alarm. The gap only becomes apparent when there is a claim, which is the worst possible moment to discover it.

If you are approaching that number, or already past it, you need commercial cover for the entity as well as your membership cover for yourself. Our guide to sole trader versus limited company covers the structure question that usually arrives at the same time.

The second threshold: what insurers require

If you take insurer-funded work, the requirement is contractual rather than professional, and it is higher.

Bupa's published physiotherapy contract requires medical malpractice cover of at least £5 million for any one claim and £5 million in total for any 12 month period, and states that where annual turnover or sales by audited accounts exceeds £500,000, that requirement rises to £10 million. It also requires employers' liability of £5 million per claim and public liability of £5 million per occurrence.

And it requires all of it to be maintained during the contract and for a period of six years following termination. That is mandatory run-off cover, and it is a real cost that continues after you stop doing the work.

Threshold	What changes
£200,000 turnover	CSP scheme stops covering your limited company
£500,000 turnover	Bupa's required malpractice cover doubles to £10m
Contract ends	Six years of run-off cover still required

Our guide to getting recognised by Bupa, AXA and Vitality covers the rest of that contract, which has several other terms worth reading before you sign.

What is not covered?

This is the section brokers skip and the one that actually prevents claims being refused.

The CSP scheme carries a published exclusions list. Among the items worth knowing:

Treatment of top-league male professional footballers
Spinal and epidural injections
Thoracic acupuncture, excluded since 1 July 2024
Platelet-rich plasma treatment
Treatment of animals without ACPAT membership
Complementary therapies without an adequate evidence base
Allegations of sexual misconduct

If any of those describe part of your practice, you need cover for that part specifically. The thoracic acupuncture exclusion is recent enough that practitioners who checked their position a few years ago may be working on an out-of-date understanding.

What about online consultations?

Covered, with geography attached.

The CSP position is that telemedicine cover applies to members based in the UK treating patients in the UK, and patients based overseas except in Australia, the USA and Canada. It also does not extend to any country where telemedicine is subject to local regulation.

The practical consequence is specific: video-treating your own patient while they are on holiday in Florida is not covered. Neither is a patient who has moved to Sydney and would like to continue with you. This is worth a line in your booking terms rather than a discovery afterwards.

Insurer contracts add their own layer. Bupa's remote physiotherapy standards require a peer-to-peer connection rather than a third-party hosted session, no retention of stream data, and both parties physically located in the UK, which rules out default configurations of the most common video tools.

What about group classes?

A pleasant surprise, and the opposite of what you will be told.

CSP professional liability already covers antenatal and postnatal Pilates and yoga classes delivered as part of physiotherapy practice. No extension needed. The CSP even pre-empts the upsell, noting that a course provider may tell you that you need insurance to practise, but that as a CSP member you already have it.

The cliff edge is not class size. It is how you present yourself. The CSP position is that if you are working solely as a Pilates or yoga instructor, and you clearly present yourself as such, you are not practising as a physiotherapist, and the cover falls away.

So the deciding factor is your own marketing. A physiotherapist running a postnatal class as part of their clinical practice is covered. The same person running the same class under a separate fitness brand, with no reference to their registration, may not be.

Note also that the corporate-entity threshold applies here too, so a growing classes business runs into the same £200,000 question.

A practical checklist

Confirm what your CSP membership covers for your current structure, and check it again whenever the structure changes
Know your turnover against £200,000, and get commercial cover for the entity before you cross it rather than after
Check the exclusions list against what you actually do, particularly acupuncture, injections and any complementary modality
Read the geography rules before agreeing to treat anyone abroad
If you take insurer work, budget for the higher limits and for six years of run-off
Keep the records that defend a claim. Contemporaneous, attributable, and amendable only in a way that leaves the original visible. Systems like Atlacare lock a note on sign off and keep a versioned audit trail, which is what an indemnity provider will ask for first

The general rule: your membership cover is probably enough until something about your practice changes shape. Incorporating, growing, adding a modality, teaching a class under a different name, or treating someone abroad are all changes of shape. Each one is worth ten minutes checking rather than a year assuming.

This is general information about insurance arrangements, not advice on your own cover. Scheme terms, limits and exclusions change, and the position depends on your structure, turnover and scope of practice. Confirm the current terms with the CSP or your insurer, and check any contractual requirement in writing with the organisation imposing it.

Sources: CSP, insurance and running a business · CSP, insurance exclusions · CSP, Pilates and yoga · HCPC, professional indemnity