The Washington State Midwifery and Birthing Center Joint Underwriting Authority ("JUA") was enacted on March 23rd 1994. The RCW (Revised Code of Washington) explains the background for its creation:


RCW 48.87.010


Certified nurse midwives and licensed midwives experience a major problem in both the availability and affordability of malpractice insurance. In particular midwives practicing outside hospital settings are unable to obtain malpractice insurance at any price in this state at this time. Licensed midwives have been unable to obtain hospital privileges due in part to the requirement of almost all Washington hospitals that professional staff members have liability insurance.

The services performed by midwives are in demand by many women for childbirth and prenatal care. Women often choose to have a home or birth center birth instead of a hospital birth. Women are entitled to the provider of their choice at such a critical life event. Studies document the safety of midwife-attended births and the safety of home births for low-risk women.

At a time when safety, cost-effectiveness, and individual choice are of paramount concern to the citizens of Washington state, midwifery care in a variety of settings must be available to the public. This is essential to the goals of increased access to maternity care and increased cost-effectiveness of care, as well as addressing problems of provider shortage. One of the primary impediments to the availability of maternity services performed by midwives is the lack of available and affordable malpractice liability insurance coverage.

This chapter is intended to increase the availability of cost-effective, high-quality maternity care by making malpractice insurance available for midwives. This chapter is implemented by requiring all insurers authorized to write commercial or professional liability insurance to be members of a joint underwriting association created to provide malpractice insurance for midwives.


How the JUA Functions

The JUA is administered by a governing board made up of members of the insurance industry and midwives. The current board members are:


Christine Tindal, LM, CPM (Chair)

Whitney McKenna, Physicians Insurance (Secretary)

Kathryn Yerry, FCAS, Liberty Mutual (Treasurer)

Heather Chorley, LM, CPM

Marlene Icenhower, BSN, JD, CPHRM, Coverys

Nancy Spencer, LM


Day to day administration is done by a service company appointed by the board. The current administrator is:

Melonie S. Ramsey, Intercare Insurance Services, Inc.


Premiums are paid by policyholders. In the event that premiums are insufficient to meet losses, all insurers doing liability business in Washington State pay an assessment to the JUA. There has been no assessment since 2004.