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Two very different stories today. Claims frequency is at historic lows. The

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number of claims against physicians is about one doctor in 21

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nationally was sued in

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2025.

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Welcome to Off the Chart, a business and medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Latrell, and the associate editor of Medical Economics, and I'd like to thank you for joining us today. In today's episode, Medical Economics managing editor Todd Shryock sat down with Robert White, president of the Doctors' Company and TDC Group, to talk about the two numbers that define medical malpractice right now, and the fact that they're moving in opposite directions. Fewer physicians are getting sued than at any point since 1973, roughly one in 21 nationally. But the cases that do get filed have never cost more, and White walks through why falling claims frequency has quietly been holding premiums down, and what happens when it stops falling. They also get into the rise of nuclear and thermonuclear verdicts, including the largest medical liability award ever handed down, why artificial intelligence is the emerging liability risk that White is watching most closely, and the one question that he thinks every physician should ask before choosing a carrier. With that said, Robert, thank you for joining us. Let's get into the episode.

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I'm here with Robert White, president of the Doctors Company and the TDC Group, to talk about current trends in malpractice. Robert, thanks for joining me.

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Happy to be here, Tom.

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So, what do you see with the current trends in in malpractice as far as claims frequency and and severity?

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Two very different stories today.

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Claims frequency is at historic lows. The

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number of claims against physicians is about one doctor in 21

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nationally will be sued in 2025, or was sued in 2025. You have to understand that when you look back to 1999, if you remember, that was the year that the Institute of Medicine published its famous report to Err as Human.

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One in five doctors was getting sued in 1999. So between

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a real push to elevate patient safety in the practice of medicine,

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tort reform, and other things that we did as advocates for physicians,

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we got claims frequency down from one in five doctors being sued in 1999 to one in 14 doctors being sued in 2016,

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and today it's one in 21 doctors can expect to be sued nationally. That's the lowest claims frequency's been since 1973.

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On the other hand, you have claim severity. Claim severity has never been higher.

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In fact, if you isolate physician payments to the and reports to the National Practitioners Data Bank in 2025. The average physician

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payment or a payment made on behalf of physicians that was reported to the National Practitioners Data Bank

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was $514,000

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per closed report,

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that's up about 20% from 2022.

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Oddly enough, that about matches inflation for the time frame 2022 to 2025. But remember, in 2022, inflation was 8%

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and and and and you also have to remember that when we're making rates, we don't use closed claim payments by year. We match the premiums that were paid in that year to the losses that were generated from that year and what they cost. So when we make when we charge a rate today, we don't know whether that rate is right or not for three to five years after we actually start charging it. So when you lay the the

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the flat frequency trend that we're currently experiencing with the losses that will come from these years, you see severity trending up about 5% per year, and that's well ahead of inflation. And the good news is low claims frequency. The bad news is in 2026 we're seeing early signs in bellwether states

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of.

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Increased claims frequency, which is

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not to

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be-it's not unexpected with social inflation

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rearing its ugly head

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in the medical professional liability line of insurance.

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I hear the term nuclear verdicts. Can you define what a nuclear verdict is and how that impacts malpractice insurers? Yes, nuclear verdicts is a verdict in excess of $10 million.

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They were relatively unheard of.

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In fact, when you when you look at what's happened

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with social inflation

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and nuclear verdicts? You can go back to 2009 when there was a book that was written by a plaintiffs lawyer and a jury consultant, a psychologist who helps plaintiffs' lawyers pick jurors to sit on in trial,

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it was called 2009

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reptile,

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the plaintiffs' revolution. Okay, and this this is where the reptile theory comes from.

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It it it plays off of the social inflation aspects of

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people thinking that there should be compensation for every bad thing that happens to a human being,

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and that spurred this era of nuclear verdicts.

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And and what they do for us is you have to remember

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that only 7% of all malpractice cases ever go to trial in any given year,

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and we win six out of those seven. Okay, so we're losing

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one out of the seven cases we try every year

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as an industry, but those

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losses-that one loss

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for that winds up in a plaintiff's verdict ends up setting the bar for what every case that settles of that same factual pattern and type of injury winds up settling for in the future becomes those verdicts become

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the benchmark, the yardstick by which all settlements are measured. So even though we only see those big verdicts in a relatively small number of cases, and it's it averages a nuclear verdict

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happens in the medical professional liability line of business about once per week somewhere in the United States, and and going back

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to 2015,

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that can happen in any state in America. There have only been five states since 2015 that have never had a nuclear verdict.

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Every other state has, and and some of them have them have multiple verdicts. So what these verdicts do is they drive up the cost of every settlement, and and you will never see

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that average payment reported to the

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National Practitioners Data Bank go below $500,000 again. This is a steadily increasing line,

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and and we expect it to continue.

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You can look around and and and see

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a state like Georgia, for example, which before 2022 never had more than four nuclear verdicts in a year,

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but in 2022 it had eight. In 2023 it had eight.

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In 2024 it dropped to six. But in 2025 it

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had 11. So it's just had 33 nuclear verdicts in the last four years, and of of all the states in the United States, Georgia has become in the short term the hottest spot since 2015. Illinois has had the most; it's had I think the number is 58 nuclear verdicts, but but Georgia is quickly catching up, and it's second with 50.

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After that, it's New York with 44, Florida with 39, Pennsylvania with 35, and California with 27. So,

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but it can happen anywhere, and and they drive up the cost of doing business on the severity side. This is the severity side of the rate making process. Okay,

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it's constantly going up, and and we expect it to continue to go up because of social inflation.

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So it sounds like the fear

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of going to trial and and losing and having a judgment, a thermal or a nuclear verdict against you, drives up.

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The settlement cost because it's like well we better settle for

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you know 75 cents on the dollar instead of going to trial.

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Am I getting that that right that it's just pushing everything up?

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As insurers who who try lots of cases every year,

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we're thinking twice about trying any case,

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and if you're a doctor who has a policy limit that will probably, in no way, shape, or form cover the eventual verdict that could come,

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you're more worried than we are. Okay,

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and and we have to listen to that doctor at trial time or or in the process of getting ready to go to trial about how strongly they feel about defending themselves. We actually have a consent policy. We write a consent policy in all 50 states. We can't settle a case without our doctor giving permission. Well, we don't have any trouble getting permission from doctors in most in most cases today because they're looking at these verdicts. They're reading about them in the newspaper. They're hearing about them on the radio and TV, and it and it it makes you think twice, especially when you're putting your own personal assets on the line.

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I I heard a term a few months ago,

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thermonuclear verdict.

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Is does that mean there's verdicts out there that are so big they don't even fit the definition of nuclear verdict anymore. A thermonuclear verdict is any verdict in excess of $100 million.

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In medical professional liability, we don't see them very often. In 2022, there were two. In 2023, there were four. In 2024, there were five. In 2025, there were only two, but already in April of 2026, we've already seen three, and the biggest thermonuclear verdict ever was just last year

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in Utah,

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963 million dollars

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against a hospital, and that was you know we talk about juries all the time and and and how juries are inflating these awards. Well, this case was tried before a judge, so a judge made that particular award. So somebody who knows the price of tea in China, okay, because this is like a commodity. In settling these cases, you have to know what they go for. If you're on either side, the plaintiff or the defense side, you have to know what these cases are worth. And and here is somebody who knows the price of tea in China, and he thought that case was worth $963 million. That's the biggest verdict ever in a medical professional liability case.

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I think we all know the answer to this next question, but what do all these trends mean for malpractice rates?

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Well, the good news is

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because frequency is an all-time low. Okay, it has dampened a lot of the pressure that

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nuclear verdicts and social inflation have been putting on the rate-making process.

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I talked about 2016, where

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frequency had fallen to one in 14 claims against physicians. Well, what happened

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is social inflation and nuclear verdicts had had had been happening all along, and because of falling claims frequency, it sort of dampened the effect on on rates, so that

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rates were neutral, even though there was all this pressure on severity,

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rates rates were stable because frequency was falling. Then we hit this period in 2016

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where frequency

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stabilizes and remains flat. And what happens in 2018, 19, and 20 because we have flat claims frequency,

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we get rate increases because there's no longer this downward trend in frequency to offset the upward trend on severity. So

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we see rates go up. Every carrier was taking rate from 2018 to 2020,

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and and the silver lining for at least our line of business was COVID came along, okay, and and it drove claims frequency even lower from that one in 14

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claims per doctor to one in 21. So guess what? It

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takes the pressure that social inflation and nuclear verdicts would put on the rate-making process, and it it diminishes

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that pressure again. So now we're out here in a period where we have flat claims frequency, and I think most people, most observers of this market, would tell you

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that.

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Medical professional liability line of business is in a neutral market, not soft, not hard. Okay, it's neutral. If you're talking about hospitals, definitely hardening to hard. Okay, but for physicians, neutral market, which means you'll probably see if you see any rate increases at all, they'll more likely than not be in the one to 3% range. Okay, and it depends what state you're in and and so forth. But generally speaking, nationwide, a carrier can expect to see its rates go up by about one to 3% in a market like this. But that concern I mentioned a little earlier with early signs of increasing increasing claims frequency because remember it's never been lower, it's never been lower than it is right now,

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and with all of the pressure

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that nuclear verdicts bring, with all of the advertising that plaintiffs' lawyers do with the third-party litigation funding that's happening with the assault on tort reform to make these cases richer from the plaintiff's perspective.

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To me,

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those are early signs that there will be rate increases in the future. That that they're not putting all this effort

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out there for nothing. When when they get the market where they want it,

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they're going to come back to it in a way we haven't seen in a couple of decades,

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and I'm talking about the plaintiffs' lawyers.

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Hey there, Keith Reynolds here, and welcome to the P2 Management Minute. In just 60 seconds, we deliver proven, real-world tactics you can plug into your practice today. Whether that means speeding up check-in, lifting staff morale, or nudging patient satisfaction north, no theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom; they come from you. Got a clever workflow hack, an employee engagement win, or a lesson learned the hard way? I want to be true. Shoot me an email at kreynolds@mjhlifesciences.com with your topic, a quick outline, or even a smartphone clip, we'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next P2 Management Minute.

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Are there certain specialties that are experiencing the

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greatest risk, and and are there emerging areas of liability

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that doctors need to be aware of? And what comes to mind to me is is all these AI tools that are out there. Well, I would say that

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the areas of specialty are the are the same ones we're always talking about. They're generally surgical specialties,

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cardiovascular surgery, for example, orthopedic surgery, particularly low back surgery,

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general surgery.

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Those those are risky areas, and their rates reflect the fact that they're considered to be risky areas.

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OB/GYN.

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again, particularly from the obstetrics perspective, because of

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the the

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value that's placed on these claims involving neurologically impaired infant as a consequence of labor or delivery.

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Those are the usual suspects, and they're the same ones we see.

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As an emerging area of liability, we of course have our eye on how artificial intelligence will impact the practice of medicine. We we know it's out there, and we know it's embedded in a lot of particularly diagnostic imaging equipment, where there are things in the equipment itself to help a diagnostician make the

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proper read from the equipment, but now we're beginning to see the actual implementation

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of

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AI in the diagnostic process and the treatment process itself, and so

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we we expect that

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the the wider implementation of that to become an issue in claims for the first time, and and the problem with it all it's always the same. The

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legal system takes a a while to catch up

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to to the to medical profession and and and medical treatment and how the legal system deals with these claims is a is a risk okay and and how it's going to be

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utilized by the plaintiff.

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How quickly we can

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adopt the tactics to defend against the manner in which they choose to bring these claims.

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We're all going to be learning about what the technology captures that we don't appreciate today, and how it can be used in an individual fact pattern to help establish liability or causation in these cases, but

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that remains to be seen, and it is an area of risk for us that we're watching very, very closely.

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So, with all these trends, what would you tell a physician out there? Do you have any advice for them? Well, I think it's important for every physician to think about who I'm going to buy insurance from, okay, and and how dedicated are they to protecting my professional reputation, okay?

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Are

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am I going to pick a carrier that

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won't go to bat for me when I feel like what I did in handling an individual patient deserves to be defended in court, or am I just going to be a statistic that the carrier is going to look at is how cheaply they can get out of my claim? So do,

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and in my case, I I would want a carrier that's going to fight for me when I thought I did nothing wrong, because the carrier's name isn't going to get sent to the National Practitioners Data Bank. It's going to be my name. Okay, so we we we

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take it very seriously.

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The

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practice of of defending good medicine, the desire to protect the doctor.

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What what kind of carrier are you going to trust your professional reputation to? And that's that's the real question you have to ask yourself when you're buying insurance because you are protecting your assets, but your name is the biggest asset you possess. And if your name is out there on a list, and it's not just the National Practitioners Data Bank. Certain states have closed claim databases where they collect claims information and publish it on the internet, so that a patient can look at your claims history before they decide whether or not you're you're someone they want to trust their their life and health too,

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so those are the kinds of things you need to think about. And if it's just if insurance is just transactional to you, and and you want to get out of a claim at the lowest possible cost with the least amount of of wear and tear, pick one of those carriers that settles lots of cases and and and

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go with that carrier, but if you care about your name, pick a carrier that will protect you when you think you're right.

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Very good, Robert. Thank you for your time. I appreciate it. All right, Todd. It's my pleasure.

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Once again, that was a conversation between Medical Economics Managing Editor Todd Shryock and Robert White, president of the Doctors Company and TDC Group.

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My name is Austin Latrell, and on behalf of the whole Medical Economics and Physicians Practice Teams, I'd like to thank you for listening to the show and ask that you subscribe so you don't miss the next episode.

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As always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts sharing strategies, stories, and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts.

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Also, if you'd like the best stories that Medical Economics and Physicians Practice published, delivered straight to your email six days of the week, subscribe to our newsletters at medicaleconomics.com and PhysiciansPractice.com. Off the chart, a business and medicine podcast is executive produced by Chris Masolini and Keith Reynolds, and produced by Austin Latrell. Medical Economics and Physicians Practice are both members of the MJH Life Sciences family. Thank you.