There is plenty of credible evidence that noneconomic damage caps are key to keeping medical liability insurance rates stable for physicians. Now research shows that real damage is done when those laws on medical liability—often called medical malpractice, or med-mal for short—are repealed or overturned.
In what’s believed to be a first-of-its-kind study, researchers discovered “large and persistent increases in malpractice insurance premiums” when laws in Illinois and Georgia were overturned by their respective state supreme courts. And those increases were even greater than the premium reductions physicians experienced after the laws were passed.
When noneconomic-damage caps damage caps are introduced, premiums decrease by about 6% to 13%, research shows. When Illinois and Georgia repealed laws, ob-gyns and general surgeons saw medical liability insurance premium increases of about 20% to 23%, while internists saw about a 16% rise in premiums.
“This suggests that, compared with the introduction of noneconomic damage caps, repealing the caps results in behavioral responses remarkably larger in magnitude, providing the first suggestive evidence of asymmetric effects between introducing and repealing damage caps,” according to the study, “The Repeal of Noneconomic Damage Caps and Medical Malpractice Insurance Premiums.”
The findings—published in the Sept. 19 issue of the respected, peer-reviewed journal Health Economics—should give pause to those considering doing away with noneconomic-damage caps, wrote the study’s authors.
“Given that malpractice insurance premiums reflect physician liability risk and practice costs, states considering the repeal of their caps may need to understand the potential ramifications of their policy actions for malpractice insurance premiums and subsequent consequences for physician practice and patient health care,” they wrote.
The Health Economics study comes at a time when liability insurance experts are concerned the nation’s physicians may be hurling toward a hard insurance market—a market where premium rise quickly and where insurance can be difficult to find—because the period of stability seen after the early 2000s has been slowing down since 2019.
The AMA’s 2025 “Medical Liability Reform NOW!” (PDF) gives physicians and physician advocates the facts they need to know to address the broken medical liability system, including information needed to advocate for and defend proven medical liability reform legislation.
Discover the Litigation Center of the American Medical Association and State Medical Societies and find out about the cases in which the AMA Litigation Center is providing assistance and learn about the Litigation Center’s case-selection criteria.
Breaking down the numbers
Study authors identified seven states that repealed, through the courts or by statute, their noneconomic damage caps between 2005 and 2019—Georgia, Illinois, Missouri, Mississippi, Utah, Kansas and Florida. They homed in on two for the study—Georgia and Illinois.
The lifting of noneconomic-damage caps were fully binding in those states, affecting all cases and not just those filed in a portion of the state after a lower-court ruling. Also, the caps overturned were for noneconomic damages stemming from medical liability broadly, unlike some states that lifted their caps only for specific liabilities such as wrongful deaths.
In Georgia in 2005, lawmakers put a $350,000 cap on noneconomic damages awarded in medical liability cases, including wrongful deaths. In 2010, the Georgia Supreme Court ruled that the noneconomic damages cap was unconstitutional.
The repeal, relative to control counties from the pre- to post-repeal period, is associated with an increase in premiums by:
- 23.12% for ob-gyns—a $14,132 increase.
- 19.6% for general surgeons—a $9,015 increase.
- 16.18% for internists—a $2,153 increase.
In Illinois in 2005, lawmakers implemented a $1 million noneconomic-damage cap on cases stemming from medical liability for hospitals and a $500,000 cap for physicians or their businesses. The Illinois Supreme Court ruled the law unconstitutional in 2010.
The repeal, relative to control counties from the pre- to post-repeal period, was linked to a rise in premiums of:
- 25.11% for general surgeons—a $12,310 increase.
- 21.17% for ob-gyns—a $13,647 increase.
- 9.86% for internists—a $1,416 increase.
“This paper is one of the first that puts forward very convincing evidence on the impact of repealing caps. Previous studies have looked into what happens with the state puts in a cap and in this case, this study looks into specifically would happen if the cap is repealed,” said Allen Hardiman, PhD, a senior economist for the AMA.
Study authors used data on medical liability insurance premiums from the Medical Liability Monitor for the years between 2005 and 2019. Medical Liability Monitor—considered the most comprehensive source of data on medical liability insurance premiums from a national perspective—annually surveys major U.S. liability insurers and reports manual premiums for obstetrics and gynecology, general surgery and internal medicine in each state where those insurers provide coverage. The AMA last issued a report with analysis of the Medical Liability Monitor data (PDF) in February 2025, and a similar report is expected early in 2026.
