After going more than a decade without medical liability insurance premiums being a hot topic among physicians, the subject is popping up in conversation once again.
Premiums have been rising in some states for a few years now and an AMA report released in February 2025 (PDF) warned that while the nation isn’t in a hard market like it was in the early 2000s, “there are signs that such conditions may become a reality in the near future.”
Premiums are rising as so-called “nuclear verdicts”—defined as verdicts of $10 million or more—and “thermonuclear” verdicts become more common. The nation has even seen some verdicts over $100 million.
In 2024, the average of the top 50 medical malpractice verdicts in the U.S. was $56 million, according to The Doctors Co., a leading medical liability insurer. That’s up from $32 million in 2022 and $48 million in 2023, according to Wes Cleveland, a senior attorney at the AMA.
But why are these verdicts climbing higher and higher?
Cleveland detailed four trends pushing medical liability verdict awards skyward.
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.
Drivers of “social inflation”
When a medical liability insurer’s average claim amount grows faster than the overall inflation rate, it’s called social inflation and Cleveland outlined drivers of that phenomenon.
A significant loss of public esteem after the COVID-19 public health emergency. The AMA, in conjunction with state medical societies, Cleveland said, has launched the “Your Care is at Our Core” campaign as a way to reinforce the importance of the patient-physician relationship and elevates the message that trust, empathy, compassion and time caring and fighting for patients are the elements that drive physicians.
The corporatization of health care. This is making health care much more impersonal. “Part of the problem is that patients don’t even feel like they are attached to a doctor anymore,” Cleveland said. “There is no face-to-face consideration. There’s no long-standing relationship.”
Juries view things differently than in years past. Interviews with jurors show that they want to compensate plaintiffs even when there has not been any negligence.
People are used to large numbers being thrown around. “Awarding $10 million, $20 million now doesn’t even seem like it’s that much because in the news you hear athletes getting $100 million contracts … somebody is getting $20 million to make a movie,” Cleveland said.
Beyond the social inflation, plaintiffs’ attorneys are turning to techniques that can drive up verdicts. Cleveland outlined three of these tactics, each with their own colorful descriptor.
The “reptile theory”
Another contributor to escalating and excessive medical malpractice awards is the use of so-called reptile tactics by plaintiffs’ attorneys, said Cleveland. First seen in 2009, the “reptile theory” is based on an appeal to the jury’s deep-seated survival instinct. Cases are not merely argued on the basis for how a physician may have failed to meet the standard of care and adversely affected a particular patient, but for how such performance might generally endanger the public at large.
“It focuses on what could happen and not what did happen,” he said. “The idea is that you want to scare the jury to think that [for example] some negligence or some injury that occurred in the hospital doesn’t just hurt the plaintiff, it really threatens the entire community.”
Here’s how it works:
- Plaintiffs’ attorneys establish a broad, facially commonsense safety rule: “You agree that protecting patient health and safety is the health care system’s highest priority?”
- They then get the witness to agree: “You would agree that it is never appropriate to violate a patient-safety regulation?”
- Lastly, they establish the danger to the community: “Wouldn’t you also say that failing to follow patient-safety regulations puts the public at risk?”
States are starting to enact laws that address this strategy, including Florida and Texas.
Anchoring
Another widely recognized and simple explanation for these higher verdicts is a technique called anchoring. Here, plaintiffs’ attorneys ask for verdicts that are far beyond what they believe the jury will award. However, the result will be an award that is larger than what the jury would have awarded if they hadn’t heard the ask for the higher—anchor—number.
“A $30 million damage request will produce a larger award than a $20 million request,” Cleveland said.
He cited a Harvard Law School explanation of the strategy that describes how it is a common human tendency to rely too heavily on the first piece of information offered. And a study from the Boston University School of Law shows that the technique has a powerful effect on damages, and that high anchors are difficult to counter.
At least two states in 2025—Utah and Georgia—passed tort-reform laws to deal with the problem. Georgia’s law, for example, says in part that attorneys can’t argue monetary value or the worth of economic damages during the trial determining liability.
Bullying
Some plaintiffs’ attorneys make threatening remarks to physicians.
For example: “If you don’t settle, we may have to look to your private assets over your policy limits to compensate my client. You’ll put your home, savings, personal property, savings for your kids’ tuition, investments and other personal assets at risk.”
Cleveland said that, as a practical matter, it would be difficult to get hold of a physician’s personal assets.
“But that is a different issue from the threat,” he said. “A threat like this can be very, very stressful and very psychologically damaging.”
Utah recently passed a law to protect personal assets unless a physician acted willfully and maliciously or if the physician didn’t have an insurance policy of at least $1 million.
At the 2025 AMA Interim Meeting, the House of Delegates directed the AMA to develop model state legislation incorporating state medical liability tort reforms, including but not limited to provisions that:
- Limit economic damages for past medical expenses to amounts actually paid.
- Safeguard physicians’ personal assets.
- Prohibit plaintiffs from making allegations that are irrelevant, coercive or pertain to a physician’s income or personal assets.
- Address prelitigation review panels.
- Expand circumstances in which physicians are entitled to attorney fees.
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.
