Why are malpractice premiums rising as lawsuits fall?

Physicians are being sued less often than at any point in the last decade, but medical liability premiums rose for the seventh straight year in 2025. Insurers say larger payouts are driving the increases.

Here are 20 malpractice stats to know, drawn from AMA, S&P Global Market Intelligence, Medical Professional Liability Association and Milliman data:

Premiums

1. Premiums rose for the seventh straight year in 2025. The AMA said it hasn’t seen a run like this since the early 2000s.
2. Of reported premiums, 39.9% rose in 2025, down from 49.8% in 2024. Another 57% held flat and 3.1% fell.
3. Premiums rose 10% or more for 6% of reported rates.
4. Pennsylvania had the most widespread increases. Of its reported premiums, 92.2% rose and 52.9% rose 10% or more.
5. The highest listed rate was $243,988, for OB-GYNs and general surgeons in Miami-Dade County, Fla. That rate was unchanged from 2024.
6. California premiums held flat from 2024 to 2025. The AMA said the state’s cap on noneconomic damages likely keeps its premiums lower.

Lawsuits

7. Of physicians, 1.8% were sued in 2024, down from 2.3% in 2016.
8. Of physicians, 28.7% have been sued at least once in their careers, down from 34% in 2016.
9. OB-GYNs are the most likely to have been sued: 59.6% have faced at least one claim. They’re followed by general surgeons (53.1%), orthopedic surgeons (49.8%), emergency medicine physicians (42%) and radiologists (38.2%).
10. Hematologists and oncologists are the least likely, at 4.5%.
11. Among OB-GYNs and general surgeons 55 and older, nearly 75% have been sued.
12. Of male physicians, 35.1% have been sued at least once, compared with 20.6% of female physicians. The gap shrinks by about half after controlling for age, specialty and other factors.

Outcomes

13. Of claims against physicians that closed between 2016 and 2018, 65% were dropped, dismissed or withdrawn.
14. Of claims decided by a trial verdict, 89% were won by the defendant.

Payouts and insurer finances

15. Payments of $500,000 or more made up a record 36.5% of total malpractice payments in 2024, according to National Practitioner Data Bank data analyzed by S&P.
16. S&P called medical professional liability “the most severity-pressured line in casualty insurance.”
17. The industry’s combined ratio rose to 107.4% in 2025 from 103.4% in 2024, according to the Medical Professional Liability Association. A ratio above 100% means insurers paid out more in claims and expenses than they collected in premiums.
18. 2025 was the line’s 12th straight year with an underwriting loss.
19. The industry “appears to have exhausted its supply of loss reserve redundancies,” said Bill Burns, the association’s senior vice president of research and analytics.
20. In the first quarter of 2026, the combined ratio for 194 companies was 112%, according to Milliman. Direct written premiums rose about 2% year over year to $2.92 billion.

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