Eleven straight years of underwriting losses. Top-50 verdicts averaging $56 million. Here's what physicians, health systems, and senior-living operators need to know — and do — before their next renewal lands on the desk.
The Medical Liability Monitor's latest Annual Rate Survey confirms what our brokers are seeing at the renewal table: the majority of medical professional liability filings ticked upward again in 2025, marking the seventh consecutive year of widespread premium increases and the sector's eleventh straight year of underwriting losses. Frequency is at multi-decade lows. Severity, however, is breaking records — and that gap is the entire story of the 2026 market.
Most rate increases remain in the single digits. But for high-risk specialties in the wrong zip codes, double-digit hikes are now routine. For senior-living operators, the math has gotten so much worse that whole carriers are walking away from the segment. Below: where the pressure is coming from, where it's landing hardest, and the levers that actually move the renewal.
Between 2010 and 2018, medical liability premiums were boringly stable. Year-over-year, only about one in seven filings reported any increase at all. That ended abruptly in 2019, when the share of premiums going up nearly doubled — and it hasn't returned to the old baseline since.
The trend peaked in 2024 with 49.8% of reported premiums rising, the highest share since 2005's 65.5%. The 2025 reading of 39.9% looks like relief on paper but is still nearly three times the pre-surge norm. Combine that with eleven consecutive years of MPL industry underwriting losses — the 2024 combined ratio sat at 103% — and you understand why carriers are unwilling to give back the ground they've taken.
Figure 1. Share of MPL premiums that rose year-over-year, 2015–2025. Source: AMA / Medical Liability Monitor.
Here is the paradox shaping every renewal conversation in 2026: claim frequency has been quietly falling for a generation. In 2024, just 1.8% of physicians reported being sued in the prior twelve months — down from 7.4% across 1991–2005. The share of doctors who have ever been sued fell from 34% in 2016 to 28.7% in 2024.
Severity, meanwhile, has gone vertical. The Doctors Company, working with Moore Actuarial, reports the average of the top 50 U.S. malpractice verdicts rose from $27 million in 2019 to $56 million in 2024 — and the count of "nuclear" verdicts (those above $10 million) jumped 52% from 2023 to 2024 alone. Claims exceeding $2 million are now more than ten times as common as they were in 1990.
Frequency tells you how often the matchstick is struck. Severity tells you what burns down when it lights.
The 2025 docket gave us the largest awards on record: a $951 million default verdict in Utah against Steward Health Care; a $120 million obstetrics verdict against Henry Ford Health in Michigan; a $60 million paraplegia verdict in New York. None of these is a typical case — but every one of them resets what plaintiffs' attorneys, and reinsurers, consider thinkable. Social inflation, third-party litigation funding, "reptile" trial tactics, and anchoring strategies have collectively added an estimated $4 billion in losses to the physician malpractice market over the past decade.
Figure 2. Average of the top 50 U.S. medical malpractice verdicts. Source: The Doctors Company / Moore Actuarial.
The national averages hide enormous geographic variation. In 2025, eleven states had at least one premium filing increase of 10% or more — concentrated in jurisdictions with eroding tort reform, active plaintiffs' bars, and high jury awards. Rhode Island and Utah led the table, with a quarter of their reported premiums absorbing double-digit hikes. Florida, Kentucky, South Carolina, Georgia, and Illinois all appeared again — many for the third or fourth consecutive year.
California remains the persistent counter-example: thanks to MICRA's revised noneconomic damages cap, average premiums there were unchanged year over year in 2025 and rose just 1.5% the year prior. The specialty gap is also widening — Florida obstetricians and general surgeons face base premiums around $244,000, while internists in the same state pay about $60,000.
Figure 3. Share of MPL premiums that rose ≥10% in 2025, by state. Source: AMA Policy Research Perspectives, 2026.
Premium pressure is a market story. What ends up paying it is a clinical and operational story. Candello — the malpractice data collaborative operated by CRICO that represents roughly a third of all open and closed U.S. MPL claims — released its 2025 Benchmarking Report in November. Its headline finding is sobering: communication failures now factor into 40% of asserted malpractice cases, up from roughly 30% a decade ago, despite years of investment in EHRs and digital handoff tools.
The pattern repeats across data sources. Diagnostic errors remain the single largest claim category. Surgery and treatment errors follow. Medication errors, documentation gaps, and scope-of-practice missteps round out the picture. Most claims involve multiple contributing factors — which is why a single broken handoff or unwritten phone-call instruction can drag a case from defensible into seven-figure territory.
Figure 4. Factors appearing in U.S. medical malpractice claims. Source: Candello 2025 / industry composite.
Three of those six categories — communication, documentation, and scope-of-practice — are the most directly addressable inside a practice. Insurers know this, and they reward providers who can demonstrate disciplined risk programs with credits, lower retentions, or broader limits at renewal.
Senior living and skilled nursing have become a market unto themselves. Medical Liability Monitor identifies the segment as the fastest-growing MPL category, with a 15% compound annual growth rate since 2016. Industry estimates put nursing-home professional liability rate increases at roughly 300% since 2020, with average settlements rising from about $406,000 in 2018 to over $1.2 million in 2024. More than 40% of traditional senior-care carriers have either exited the segment or curtailed their appetite — leaving operators with a fragmented field of newer entrants, captives, and risk-retention groups to navigate.
The high-risk physician specialties — obstetrics, neurosurgery, emergency medicine, general surgery — continue to absorb the largest rate increases. In several states, base premiums for OB/GYN and general surgery now run three to four times the rate for internal medicine. For these specialties, the renewal conversation in 2026 is less about whether rates will rise and more about which carrier still has appetite at all.
Rising rates don't have to mean accepting a rising bill. The carriers shedding business are not the only carriers in the market, and the placement that worked last year is rarely the placement that works best this year. Homewood's MPL practice operates on three disciplines:
A no-obligation look at your placement, your peers' placements, and the markets you haven't seen yet. Most reviews take 30 minutes. Many clients walk away with 5–12% in identified savings or stronger limits at the same spend — simply by shopping the right carriers at the right time. We'll show you what your current submission looks like to an underwriter, and what it could look like instead.
Sources: American Medical Association Policy Research Perspectives (2025, 2026); Medical Liability Monitor Annual Rate Survey (2025); The Doctors Company / Moore Actuarial Consulting, Nuclear Verdicts and Rising Costs (Sept. 2025); Candello / CRICO 2025 Benchmarking Report: Malpractice Risks from Communication Failures; Becker's ASC 2025 Nuclear Verdicts Survey; Amwins Market Insights, Senior Care Liability Outlook 2026.
This article is published for informational purposes and does not constitute insurance, legal, or financial advice. Policies vary by carrier, jurisdiction, and exposure profile.