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Digital EditionPhysical Therapy Liability Claims Grow Costlier as Manual Therapy and Supervision Failures Drive Losses
The average total incurred cost of a physical therapy professional liability claim reached $162,174 in the latest dataset, up from $134,761 in the 2020 dataset, a 20.3% increase, according to the Physical Therapy Professional Liability Claim Report, published by CNA in collaboration with Healthcare Providers Service Organization (HPSO) and with input from the American Physical Therapy Association.
The report analyzed 497 closed professional liability claims with indemnity payments above $10,000, which represented 53.4% of the full 2026 dataset, alongside 229 licensure defense matters and claims that closed without indemnity payments. CNA and HPSO attributed part of the rising severity to broader social and tort inflation, including high jury verdicts that are often disproportionate to the underlying facts of a case.
Practice Owners and PTAs Face Outsized Exposure
Physical therapy practices accounted for 63.8% of closed claims, compared with 36.2% for individually insured practitioners, and carried a 15.4% higher average total incurred than individually insured physical therapists, physical therapy assistants and PT students: $170,418 vs. $147,655, the report found. CNA and HPSO linked that gap to vicarious liability, since practice owners can be held responsible for employees’ and supervisees’ negligent acts, as well as direct liability tied to hiring, credentialing, onboarding and supervision.
Failure-to-monitor claims were especially costly for practices, which saw a 42.7% higher average total incurred than individually insured practitioners for that allegation ($249,817 vs. $175,082), with inadequate supervision of a PTA or PT student alone averaging $355,666.
Claims against physical therapist assistants were also disproportionately severe. PTAs accounted for just 16.5% of total claims compared with 76.5% for PTs, yet claims against PTAs averaged 40.4% more: $208,546 vs. $148,507, the report said. The distribution of PTA claims alleging failure to monitor, at 31.7%, was almost double the rate for PTs, at 16.3%, and the average total incurred for those PTA claims, $291,613, was 47.4% higher than the PT average of $197,783.
CNA and HPSO said the elevated severity among PTAs is often tied to improper delegation, inadequate supervision and scope-of-practice issues.
Manual Therapy, Dry Needling and Fractures Top the List
Improper performance of manual therapy was the single most common allegation against PTs, representing 27.9% of claims, with average severity rising 35.6% since 2020, to $161,317 from $118,957, according to the report.
Within that category, injuries during manual therapy attributed to improper technique comprised half of all claims within the improper performance of manual therapy allegation class and averaged $218,684, often involving high-velocity maneuvers or techniques the report said were contraindicated given a patient’s age, body mass, osteoporosis or recent surgery. Dry needling injuries accounted for 26.4% of manual therapy allegations, a trend CNA and HPSO tied to the treatment’s growing use and state-by-state variability in training and competency requirements.
Equipment-related claims nearly tripled in distribution, rising to 11.6% of PT claims in the 2026 dataset from 4.0% in 2020, while average severity increased 33.0%, to $158,628 from $119,228. Fractures were the most frequent injury type overall, representing 24.2% of PT claim injuries with an average total incurred of $179,484, some 20.9% above the overall PT claim average. Among fracture claims specifically, failure-to-monitor allegations, often tied to falls, accounted for 32.6% of cases and averaged $225,829, the highest severity of any fracture-related allegation category.
Licensure Complaints Center on Professional Conduct
Separate from civil liability claims, licensure defense expenses before a State Board of Physical Therapy rose to an average of $7,369 in the 2026 dataset, up 14.8% from $6,420 in the 2020 dataset, across 229 matters. Complaints related to professional conduct made up the largest share, at 46.7% of all licensure defense expenses, with allegations of physical, sexual or emotional abuse or misconduct the most frequent subcategory at 16.2%.
Improper performance of treatment and improper management over the course of treatment accounted for an additional 24.0% and 16.2%, respectively. Most licensure matters ended favorably for practitioners: 55.0% closed with no action taken by the board, up from 47.6% in the 2020 dataset, according to the report.
Obtain the full report here. &
