Featured topic and speakers
Medical liability reform remains an advocacy priority for the AMA. While some states have strengthened these protections, others are seeing significant efforts to roll back progress. In this webinar, we’ll break down what’s happening across the country, share the data that support medical liability reform, and highlight how one state medical society is responding to recent legislative challenges.
Host
- David H. Aizuss, MD, chair, AMA Board of Trustees
Speakers
- Scott Castro, senior director of health policy, Medical Society of Virginia
- Allen Hardiman, PhD, lead economist, American Medical Association
- Mike Stinson, vice president, Public Policy and Legal Affairs, Medical Professional Liability Association
Transcript
Dr. Aizuss: Hello and thank you for joining us today for the latest in the AMA Advocacy Insights webinar series. I'm Dr. David Aizuss, chair of the American Medical Association Board of Trustees and an ophthalmologist in private practice in Southern California. It's my pleasure to welcome you all and to help set the table for today's discussion, which focuses on one of the most significant challenges facing physicians today, medical liability reform.
This is an issue that affects every part of our healthcare system. Without meaningful reform and strong protections for physicians, medical liability pressures can drive a defensive approach to care, increase emotional, reputational, and financial strain on physicians, and pull critical resources away from patient care. Those are resources that could otherwise support innovation, medical research or efforts to expand access to care.
Today, we'll explore the legislative landscape around medical liability. We'll review the latest research and hear how sustained advocacy efforts are shaping reform at the state level. And we'll answer the questions we must ask. How can physicians deliver their best care when liability concerns shape clinical decisions? The answer is we cannot. When liability pressures push physicians towards defensive medicine, the system is not improving care. It is discouraging it.
Joining us to unpack this issue, the problems, and solutions are three outstanding leaders who bring national policy expertise, economic analysis and state advocacy experience. Today, we are joined by Mike Stinson from the Medical Professional Liability Association, the AMA's lead economist, Allen Hardiman, and Colleen Grady-Koerner from the Medical Society of Virginia. Thank you all for being here.
So let's dive into the discussion. I'd like to begin with a question to Allen with a big-picture look at the current medical liability landscape. So Allen, tell us about the current medical liability landscape in medicine. What have you found in your research as a PhD economist?
Hardiman: Sure. Thanks, Dr. Aizuss. So the AMA just published two new reports that looked at the medical liability landscape from two perspectives. So the first report looks into the claim frequency against physicians. And the second report looks at the recent trends in medical liability premiums.
First, I would like to talk about the claim frequency against physicians. So the report used data from the Physician Practice Benchmark Survey. And the report finds that in 2024, about 29% of physicians reported that they had been sued in their careers. And this represents a moderate decline from 34% in 2016.
We also find that the risks of being sued vary significantly by physician characteristics, such as age and specialty. Physicians with more years of practice have more exposure to risks. For example, nearly half of physicians age 55 and older reported that they had been sued compared to 11% of physicians under the age of 45. When we look at specialty, surgical specialties carry the highest risk. About 60% of obstetricians and gynecologists and just over half of general surgeons reported that they had been sued at least once in their career.
Now, when we look at physicians age 55 and over in these two specialties, nearly three out of four had been sued in their career. So when you look at the overall picture, claim frequency against physicians seems to have moderately declined over time. However, it remains relatively common, especially for certain subgroups of physicians.
Now, moving on to the second report, which looks into premiums, the report used data from the Annual Rate Survey Issues of the Medical Liability Monitor. And the report finds that there has been a continued rise in liability premiums over the past seven years, a pattern not observed since the last medical liability crisis in the early 2000s.
For context, in 2018, only 13.7% of premiums rose from the previous year. But in 2024, about half of the premiums went up. And in 2025, almost 40% of the premiums rose. These represents the most increases we've seen since 2005. And when we look at how widespread these increases were, premiums increased in 36 states in 2025. And there were 18 states in which at least half of the premiums rose.
Now, large increase in premiums, which is defined as at least one premium rising by 10% or more, occurred in 11 states. And among these 11 states, Pennsylvania and Illinois stood out, as Pennsylvania has experienced large premium increase since 2023 and Illinois has experienced similar significant increase since 2020.
Now, it's important to note here that the trends that we see the past seven years pales in comparison to the ones that occurred in early 2000s.
Dr. Aizuss: Well, thank you very much. So Mike, given this landscape, what are some particularly problematic aspects of medical liability that need to be addressed?
Stinson: Well, there's a number of issues at this point. And from the liability insurers' perspective, one of the things we would really like to see addressed is helping people to understand medical liability insurance and the role it plays in our healthcare system. All too often, people hear "medical" and "insurance" in the same sentence, and they think of health care insurance. And they look at the medical liability insurers as part of the problem as opposed to recognizing that we work with physicians, we work with health systems and hospitals, to try to help make sure that access to care is always readily available.
Another thing is trying to help people understand the true numbers behind medical liability insurance. A lot of people don't recognize when they start discussing whether or not there should be damage caps or other tort reforms in place that roughly two-thirds of all claims that are filed are eventually determined to be non-meritorious. And yet those eat up a huge amount of resources, both in terms of time and finances, in the system. If we can find ways to weed out those non-meritorious claims, it would make it much easier to resolve other outstanding claims and to have the resources available to make payments as they're appropriate.
Another thing we think people really need to understand is that the size of the award matters. People look at, I think, professional athlete salaries, professional entertainer salaries, and they become immune to what some of these large numbers really mean. And you combine that with the populist trend we've seen throughout the country, where people tend to look at medicine as part of the healthcare system. They look at medical liability as part of the healthcare system and don't have quite the same connection to their own individual physicians as they once did.
They don't think of physicians in the healthcare system as being there for them as much as they used to. And when you combine that distance from their healthcare professionals with that lack of understanding of the numbers that get tossed out there, that's where we see juries start throwing out these absolutely astronomical damage awards, which have the potential to be devastating to both the physician and potentially the insurer as well.
Dr. Aizuss: That's interesting. So Colleen, in Virginia, there was recently a significant discussion around Senate Bill 536, which would have dramatically increased Virginia's cap on damages. Thankfully, the Medical Society of Virginia played an important role in defeating this legislation. How would this have been harmful to the physician practice environment and to patients? What arguments did you find were most effective in your advocacy on that bill?
Grady-Koerner: So the story in Virginia over the past couple months with our legislative session has really been this issue happening slowly over time and then all at once. So in 2012, a little while ago, we—the Medical Society of Virginia negotiated a deal with the Virginia Trial Lawyers Association to set the cap at $2 million and have it increase by $50,000 every year over the course of 20 years until we get to 2032. It was a very strong deal for the healthcare community.
And over the past couple years, we have seen threats not necessarily coordinated across the Trial Lawyers Association, but from individual trial attorneys, particularly within the Senate, to chip away at the cap, either repeal it entirely or eliminate the cap for patients who are 10 years old and younger. And we've been successful for the past five years, in large part thanks to some partnerships with Mike at MPLA, of containing that bill to the Senate, I think primarily focusing on the impact that it would have for OB/GYN providers. I think that was natural in terms of the original bill being focused at 10 years and younger as well as pointing out, too, not the—not just the cost to private providers, but cost to the state in terms of a fiscal impact associated with the bill for our state's state-supported medical and academic centers.
This past year, we saw that bill come through again. And then we also saw SB536, which started as just a bill that would alter prejudgment interest and essentially allow prejudgment interest to pierce through our total cap. And we attacked that with very similar playbook, focusing on obstetrics care, focusing on the cost to the state. And the bill ended up squeaking through the Senate by carving out all of our state-supported academic medical centers.
So it became a very funky bill. But for the first time, it got past the Senate and into the House, where we currently have a Speaker of the House who is a trial attorney and whose chief of staff is his retired law partner who was a med mal attorney. So this is really the first time that this bill got over to the House. And that's where we saw the bill in the last two weeks of session.
And Virginia already has a very short legislative session of only 45 days this past year. And the last two weeks, the bill went from being a small change on prejudgment interest to increasing the cap from where it currently is at $2.7 million to immediately pretty much going to $6 million and having increases on top of that.
All of that happened at the very last minute. So there were a lot of process arguments that we made in terms of needing more time in order to understand the real impacts of the bill. And then I also think that everything happening right now at the federal level with H.R. 1 and the corresponding impacts to states that we are certainly still working through in terms of our budget—there was definitely a message of, there's—we're never going to think it's a good time to make any changes to the cap, but certainly not right now, where there's so much instability related to health care, particularly in terms of rural populations and the OB/GYN population.
So those are the core issues that we came back to on a very roller coaster ride of the bill.
Dr. Aizuss: Wow. That sounds exhausting. So Mike, can you distill for us any particular legislative trends regarding medical liability reform at present?
Stinson: Sure. There are a couple of different things. We were just talking about caps on damages. There certainly has been an increasing trend over the last few years of the plaintiff's bar attacking damage caps where they're in place. We've seen a number of case that—states that have been forced to increase their caps substantially.
This year was a little quieter, with Virginia being the only real threat. But we think that threat is still looming out there. And we don't think any state that has a cap in place should be too complacent about their cap and should always be ready to try to defend it going forward.
In terms of other threats, we've seen a number of things across the country. We've seen challenges to wrongful death statutes, particularly in terms of trying to expand the damages that are available in wrongful death cases, extend the statute of limitations in wrongful death cases, and in a number of states, laws that would expand who is eligible. So as opposed to just immediate family, that would extend it out to aunts, uncles, grandparents, cousins, et cetera. Those are the threats we've seen all around the country.
In terms of more positive developments, we have seen some newer reforms pop up in a number of states. And they're starting to get some traction, even if they haven't been enacted in too many places. We're seeing a really strong effort to pass third-party litigation funding reform to prevent private equity entities from funding lawsuits to keep less than meritorious cases alive when they really shouldn't be.
We've seen a fairly substantial effort in a number of states to enact what we call truth in damages or phantom damages reforms. And this is where plaintiff's attorneys try to enter into evidence the amount of medical expenses that were billed to their client as opposed to the amounts that were actually paid. We don't mind paying medical expenses. But we want to pay the amounts that are appropriate, not an inflated number that doesn't really have any relation to what was actually paid.
And then we've also seen in some states—not very many yet, but it's starting to get a little bit of steam—anti-anchoring legislation. And this legislation says that during arguments when you're in litigation, the plaintiff's attorneys can't start throwing out numbers that have no relevance to the case, that they've got to be based on the actual damages incurred, and in some cases, saying you can't even mention damages at all until negligence has been determined.
And the goal there is to prevent a relatively new plaintiff's attorneys tactic where they will throw out numbers, in some cases, just talking about how much Taylor Swift made on her last tour to plant the idea of really, really large numbers in the jurors' heads so that the numbers that they are asking for in terms of compensation don't appear to be as large to them. And therefore, when they go into deliberations, the juries are a little more likely to give higher awards. We've actually seen some statistical analysis of juries through mock juries and such that show that when they do these kind of things, it does lead to inflation in the damage award.
So those are the latest things we're seeing in terms of ways to try to strengthen our hand a little bit in litigation and try to keep the playing field a little more balanced.
Dr. Aizuss: Well, I certainly don't know too many physicians doing as well as Taylor Swift financially. Colleen, in defeating SB536, what political strategies proved to be most effective? Was grassroots physician engagement—did that play a part?
Grady-Koerner: Yeah, the grassroots story on this bill was pretty interesting because I think that it's a good example of what Mike mentioned in terms of making sure that our membership is not complacent at all in terms of because we had this 20-year-long deal, we've had a lot of stability in terms of what folks are expecting from the cap. And we've also been successful for the past four years in defeating efforts to try to repeal the cap, particularly for those patients 10 years of age or younger.
And I think initially, we did not see a very high level of engagement when the bill was just focused on prejudgment interest. I think it's a little bit wonkier and not something that the average physician may be as clued into. But once the bill changed to be increasing the cap, then the floodgates really opened. And I think that folks who—we'd been ringing the bell for the past couple of years, and doing work, and having works groups meetings and involving folks because we understand that there was going to be a change coming in terms of the political headwinds. And I think that once it got to a point where there was legislation on the cap going up, I think we saw a lot of members really stay engaged and get engaged and want to be involved.
And I think with the bill, fortunately, not being successful this year, we're in a position where we have a lot of members, our component societies, our specialty societies who are heavily motivated to be engaged with us as we lead up into this next legislative session because SB536 ended up becoming a data transparency and reporting bill for insurance carriers and hospitals to, essentially, provide some information that we know certain members of the general assembly will use as fodder to try to increase the cap this coming January in our legislative session.
So we've got a really high level of engagement, which is great. And right now, our team is really trying to harness that energy as much as we can. We're meeting with practices and really trying to match-make some small practices with legislators in the area and sit down and tell the story and really give those real numbers about what a change in the cap would have on their practices and the difficult decisions they would need to make on access to care and services they're able to provide.
Dr. Aizuss: Interesting. So Allen, do you have any ideas on why we continue to see increases in medical liability insurance premiums? I assume the increase in caps are one reason. Are there other reasons?
Hardiman: Yeah. It's definitely a concerning trend. And it's something that the AMA continues to monitor closely. And although there is no conclusive evidence for why premiums have continued to rise, one possible factor is the growth of nuclear verdicts and claim severity over time.
For example, an analysis by The Doctors Company finds that in 2024, the average of the top 50 medical malpractice verdicts in the U.S. was $56 million. And this is up from $32 million in 2022 and $48 million in 2023. And claims exceeding $2 million have increased more than tenfold since 1990, from 0.3% of all paid claims to 3.2%.
So more importantly, the key question is how we can slow down this trend in rising premiums, which is where I believe tort reform plays an important role. We talk about caps. The caps on non-economic damages, for example, have been consistently shown in previous research to be associated with meaningful reductions in premiums. Another study that was just published last year shows that repeals in caps on non-economic damages significantly increased premiums by around 16% to 23%, depending on specialty.
Dr. Aizuss: So Mike, in what ways do you think that the MPLA, the AMA, and state and specialty medical associations can work together to enact or defend medical liability reforms?
Stinson: I think there's a number of things we can do—first and foremost, communicate with each other. Reach out. The Virginia situation this year, I think, was a great example. As soon as we heard about the legislation and about the changes that have been made in the House on it, I reached out to the medical society, got an almost immediate response. We were able to quickly set up a conference call and sit down. And they were able to catch me up on what had been going on.
And then we had a little bit of time to discuss strategy and plans and where things were going and where they might go. And that was incredibly helpful in helping to bring a lot of stakeholders together to keep working on the issue and eventually get the much more positive result we did. And I think we can replicate that in any state where significant challenge comes up or where you might be looking to promote a positive type of reform.
One of the things I'd stress is that you folks are the medical professionals. You know medicine. We certainly wouldn't get involved in debates related to the changes in medicine. So if legislators reach out to you and ask you about possible changes to tort reforms or to insurance regulation or anything like that, we'd ask you, reach out to us. Reach out to the dominant insurers in your state.
The benefit of reaching out to me is that I can then contact all the insurers in your state and bring them all together and quickly create a unified front on our part so that we can help you with things like determining what the impact of a proposal might be on premiums, how it might affect litigation strategies going forward, and things like that so that coming together, when we can present both the medical side of things and the insurance side of things as a united front and show them that we're all working together, I think we can be a lot more effective in trying to get our points across.
And like I said, Virginia was a great example of that. I had the opportunity to interact with some legislative and leaders within some of the executive agencies in New Mexico earlier this year. And we saw some real positive reforms come together through that where, again, we worked with the state medical society, brought the insurers in together. And working as a united front, we were much more effective than I think we would have been otherwise.
Dr. Aizuss: All right. Well, thanks. Colleen, do you have anything to add to that?
Grady-Koerner: Yeah. I just really want to echo all of Mike's comments. I think our relationship with MPLA during the legislative session was so valuable—also, incredibly valuable that our organizations have been working together for the past couple years on this issue. And we've also been working with carriers within Virginia, particularly The Doctors Company, worked with us on an actuarial study that we commissioned to get some real numbers on what would happen in Virginia if the cap went away.
And so I think building that relationship really helped so that when everything went haywire this session, our team was able to quickly connect with Mike, get everyone up to speed, and make real movement together. I also think working with the AMA was incredibly helpful. I think particularly because things did move so fast this legislative session, it was so helpful to just immediately be connected with society staff in other states, I think particularly New Mexico, and talk about their different structures.
And we—because everything was moving so quickly, we had a million different policy options thrown out, potentially looking at a two-tiered cap structure. And that was something New Mexico had dealt with. So we were able to just quickly cut through to the source and talk with the experts, which was just so invaluable in terms of us being able to respond quickly.
Dr. Aizuss: Well, thank you for those valuable insights. So what we're going to do now is we're going to bring in our virtual audience and listen to some of the questions, and respond to them, that are shaping the conversation beyond this webinar. I'm going to start off with, from the national perspective—Allen, this may be best suited to you—do we have any data on the average proportion of med mal award dollars that lawyers keep or take as their payment?
Hardiman: Unfortunately, I don't have any insights to that.
Dr. Aizuss: Mike, do you have any data on that?
Stinson: I don't have any data. But anecdotally, it's been widely assessed at somewhere between 33% and 40% as an average. There are probably some of the more widely known and more—I don't want to say successful, but more aggressive medical liability attorneys out there who are probably charging a little bit more than that.
Dr. Aizuss: A Virginia physician writes that he has concerns that should the Virginia cap be raised from $2.7 to $6 million and with declining reimbursement, physician practices will close and Virginia will have a physician access problem. Also, he says the cap was not defeated and likely will be reintroduced in the next legislative session. Colleen, do you have any comments about that?
Grady-Koerner: Yeah, absolutely. Well, I really appreciate this physician hopping on and echo that we share those concerns and are on the road spreading that message and with our members to tell that story and really make sure that—because our legislature is so dominant with attorneys, particularly trial attorneys, making sure that folks also have an inside view to the reality, like the financial realities of declining Medicaid values, and the overall picture that will take place of it's not just a premium increase, it's a premium increase combined with dozens of other financial pressures on the practice of medicine, and that we are also, assuming that this effort will be continued next session and have not taken our foot off the gas at all on this—and encourage this person to reach out to us and help us keep working on this.
Dr. Aizuss: Another question is, are we seeing a shift from claims made to occurrence liability insurance policies? Mike, do you have any insight on that?
Stinson: I haven't seen any kind of shift. Our members are pretty much continuing along the way they always have been in terms of the split between claims made and occurrence policies.
Dr. Aizuss: Another question is, should medical liability be done by tribunal instead of long, drawn-out legal processes that take years to settle? This individual has a case still in process five years later with no clear answers. Anybody want to respond to that?
Stinson: I'll jump on that one because it's one we've dealt with several times over the years that I've been with the association. It's hard to say. I certainly see the potential benefit of a tribunal approach. But given that it's untested, insurers are a little bit hesitant about anything that's an unknown risk. And given that we currently win between 80% and 90% of cases that go to court, we're rather comfortable with the current environment.
That said, we would certainly love to see ways that we could try to prevent cases from dragging out so long. I'm not sure, depending on how you set up a tribunal situation, whether or not you'd actually be able to abbreviate that time. You might be able to abbreviate the trials. I'm not sure you'd be able to abbreviate the lengthy buildup to litigation, where you're negotiating, where you're digging deep into the situation to get evidence of what actually happened and what didn't happen and the like.
So I think there's still a lot of questions out there about whether or not a tribunal or a health court approach, as they've discussed in the past, would lead to better results.
Dr. Aizuss: Well, as you know, AI is always in the news on a daily basis. And the AMA has had significant interest on the impact of AI on liability issues. How is liability being addressed with both new and emerging AI software? Any of the three of you can respond to that. I know we—the AMA has position statements on the issue of ensuring that physicians don't hold the liability ball, as it were, since we don't have a role in determining what goes into the software. However, we will be using the software in the care of our patients. So there is some shared liability there.
Stinson: From the insurers' perspective, one, we're not seeing a jump in AI-related cases yet. As you're aware, there's usually a bit of a gap. It's a long tail line of insurance. It takes a few years for cases to build up when there's a change in the protocols for care.
But in the case of AI, our recommendation is really just that no one take it for granted, no one assume that it's right. And we usually recommend to our insureds that they're always making sure that they're using their judgment and only using AI as a tool to help inform them as they're making their own opinions based on their own education and experience.
Grady-Koerner: This is—
Dr. Aizuss: Go ahead, Colleen.
Grady-Koerner: This is something I heard echoed last night. I was giving an update on medical malpractice in Virginia. And there was also a defense attorney representing physicians there talking about the importance of documentation. And I know this is something that came up from a number of folks as AI note-taking is becoming increasingly used and just increasingly relied on.
And so I know it's something—he made comments very similar to Mike in terms of using it as a tool, making sure that you're having that human-level review that everything that needs to be in there is in there and everything that is documented is appropriate in terms of the situation that occurred. But I was just going to say that I know this is something that is definitely weighing on the minds of clinicians as this change is going to effect.
Dr. Aizuss: I know that physicians are concerned about punitive damages. There's a question here on, how does one manage punitive damages? And do other states have a patient compensation fund? Do any of you have any knowledge about that?
Stinson: In terms of punitive damages, they're not generally that relevant in medical liability claims. Usually, you have to show some kind of intentional act or intentional disregard of the patient's well-being, which is pretty rare, even in medical liability cases.
What we have seen in states like New Mexico, which had pretty loose rules in terms of punitive damages, was they're sometimes used as a threat to hold over the physician's head, especially in New Mexico. I don't remember the numbers off the top of my head. But it was something like 95% or 90%—or 98% of claims came in with a punitive damage request with the knowledge that insurance doesn't cover punitive damages.
So that could potentially intimidate a physician defendant into trying to negotiate a settlement, even when they had practiced good medicine, because they didn't want that risk of having to bear the brunt of punitive damages themselves. And fortunately, New Mexico has taken some significant steps to addressing that. But we haven't seen punitive damages being a huge problem outside of a couple outliers like that.
In terms of the patient compensation funds, I am not going to be able to rattle off all the states that have them. There's six or seven that have them. I think that's roughly the ballpark number. They vary a fair amount in how they work and what kind of numbers they work with in terms of when the compensation fund kicks in versus when the liability policy has to kick in. So I can't really give you a broad-based yea or nay on the benefits of patient compensation funds.
Hardiman: There are six states, Mike, that have a patient compensation fund. You're right.
Stinson: Thanks, Allen.
Dr. Aizuss: We just got another interesting question. I know this is a subject of a report at the AMA House of Delegates in a couple of weeks. Venue shifting, especially in Pennsylvania, has been an issue where attorneys do not file the claim in the county where the incident occurred, but instead file in big cities like Philadelphia, where the potential for rewards and success is greater. Have any states taken steps to stop venue shifting that you're all aware of?
Stinson: There are a handful of states that I'm aware of. But we haven't seen anything quite like Pennsylvania just because for a decade, Pennsylvania had rules in place that said the lawsuit had to be filed somewhere in relation to where the injury occurred, either where the physician practiced, where the injury was alleged to have actually occurred, where the patient lived, et cetera. And then the state Supreme Court unilaterally pulled that rule back. And since, we've just seen a skyrocketing number of claims in Philadelphia, which is notorious as a jurisdiction for giving out large awards.
So we certainly are concerned about venue shopping anywhere it can happen. Obviously, there are some states—Cook County in Illinois is notorious for being plaintiff-friendly. And we always like to see any efforts, whether it's judicial rules or state statutes, that would ensure—excuse me—that claims are actually heard in the vicinity of where they actually—the incident actually happened.
Dr. Aizuss: Well, thank you for that answer. And I want to thank our audience for the interesting questions this afternoon. And thank you again to Mike Stinson, Allen Hardiman and Colleen Grady-Koerner for such an important conversation.
Medical Liability Reform—Now! and the AMA Advocacy Resource Center provide extensive data, legislative resources, and research to support physicians and medical societies across the country. I encourage all of you to take advantage of these tools and remain actively engaged in this work. And please join us for future AMA Advocacy Insights webinars as we are continuing to take you inside the most important policy issues that affect physicians, patients and our healthcare system. Thank you. And thank you for attending today.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
