Inflation Drives $4 Billion Surge in Medical Malpractice Losses Over Past Decade

Inflation has added $4 billion to insured losses for physician-focused medical malpractice insurers over decade ending in 2024, representing 11% of total booked losses, according to a new report by The Doctors Company, a physician-owned medical malpractice insurer.
The medical malpractice insurance sector faces mounting pressure as both economic and social inflation drive claim values higher. The TDC analysis reveals that inflationary impacts on medical malpractice claims have increased by $1.6 billion from just three years earlier, when inflation-related losses totaled $2.4 billion for the decade ending in 2021.
Federal data confirms the troubling trajectory. Over the 20 years ending in 2020, U.S. economic inflation ranged from -0.3% to 3.8%, the report noted. However, economic inflation exceeded in 4% in each of the next three years, including an 8.0% increase in 2022.
Information from the National Practitioner Data Bank, which tracks malpractice judgments, shows average medical malpractice payments reaching their highest levels in nearly two decades following the pandemic. The frequency of claims exceeding $2 million surged 67% between 2013 and 2023, even after adjusting for economic inflation.
Claim severity rose an average of 5% annually between 2014 and 2023, driven in particular by claims in excess of $5 million, the TDC report noted, citing research from consulting firm Milliman. The percentage of claims settling above $5 million has approximately tripled during this period.
“Nuclear verdicts continue to increase at a drastic rate: The average of the top 50 medical malpractice verdicts was $32 million in 2022, $48 million in 2023, and an alarming $56 million in 2024,” said Robert E. White Jr., president of TDC Group. “Physicians are facing rising premiums driven by both economic pressures and the continued increase in large settlements. We will continue to research and raise awareness of this concerning trend that affects physicians and patients.”
Insurers Face Profitability Challenges Amid Rising Verdicts
The financial strain on carriers has become increasingly evident. Medical malpractice insurers recorded an underwriting loss of 10% of direct premiums earned in 2023, substantially worse than the prior two years and exceeding the 10-year average loss of 6.6% of premiums.
Rate increases have accelerated in response. Nearly half of medical liability insurers raised premiums in 2024, a dramatic shift from 2018 when only 13.7% implemented increases. States without malpractice liability caps experienced average rate hikes of 4.5%, compared to 1.2% in states with caps.
The pandemic temporarily masked inflationary pressures, with claim activity declining during 2020 and 2021. However, the post-pandemic period has seen a sharp rebound, TDC noted. Analysis of loss development factors—key metrics that measure how claims mature over time—shows significant acceleration in 2022 through 2024, with losses emerging 21.8% faster than expected during this period.
Market Forces Reshape Risk Landscape
Several factors contribute to the evolving claims environment beyond traditional economic inflation, according to the TDC report. Third-party litigation financing has emerged as a significant catalyst, with one estimate suggesting it could cost insurers between $13 billion and $18 billion over the next five years. These investors, who fund lawsuits in exchange for a share of settlements, report internal rates of return exceeding 20%, the report noted.
Additional pressures include increased attorney advertising, changing public attitudes toward litigation, and the rollback of tort reforms in some jurisdictions. The percentage of inflation-adjusted dollars paid on claims exceeding $2 million reached 24% of total payments in 2023, the highest level since the 2001 malpractice crisis.
Obtain the full report here. &