U.S. Department of Justice

Office of Justice Programs

Bureau of Justice Statistics

Special Report

March 2007, NCJ 216339

Medical Malpractice Insurance 

Claims in Seven States, 2000-2004

By Thomas H. Cohen, Ph.D.

Kristen A. Hughes, MPA

Bureau of Justice Statistics

Insurance companies in Florida, Illinois, Maine, Massachusetts, Missouri, Nevada, and Texas reported information on 

about 43,000 closed medical malpractice insurance claims 

between 2000 and 2004. In these states licensed medical 

malpractice insurance providers are required by law to submit data on closed claims to a central state agency, typically the Department of Financial and Insurance Regulation. The collection agency in these states provided the 

data to the Bureau of Justice Statistics (BJS).

Most medical malpractice claims were closed without any 

compensation provided to those claiming a medical injury 

(claimant). About a third of closed medical malpractice 

insurance claims in Maine, Missouri, and Nevada resulted 

in an insurance payout. In Illinois 12% of closed claims had 

a payout.

For closed medical malpractice insurance claims that 

resulted in compensation for the claimant, fewer than 10% 

of the claims in Florida, Maine, Missouri, and Nevada had a 

payout of $1 million or more. In Florida, Maine, and Missouri about two-thirds of the claims were closed with 

an insurance payout of less than $250,000. 

Among persons receiving compensation, insurance payouts were highest for claimants who suffered lifelong major 

or grave permanent injuries and lowest for claimants who 

suffered temporary or emotional injuries. In Florida and 

Missouri claimants with major or grave permanent injuries 

received median payouts ranging from $278,000 to 

$350,000. By comparison, claimants in these states who 

suffered various types of temporary or emotional injuries 

received median payouts ranging from $5,000 to $79,000.

Medical malpractice insurance payouts increased as the 

insurance claims advanced through the legal system. Payouts were typically lowest for claims closed prior to the

filing of a lawsuit and highest for claims closed after a trial. 

In Florida, Nevada, and Texas claims decided by trial 

resulted in median payouts that were at least 21⁄2 times 

larger than claims that were settled. Medical malpractice 

claims that closed after trial also cost more for insurance 

firms to defend than claims settled prior to trial. 

In general, claimants did not file medical malpractice claims 

with insurance companies immediately after injury. In Florida, Missouri, and Texas medical malpractice claims were 

filed with insurance companies an average of 15 to 18 

months after an injury. After claims were received, it took 

an average of 26 to 29 additional months to close the claim.

Insurance companies reported that physicians, surgeons, 

and hospitals were the most common type of medical provider named in medical malpractice insurance claims. 

These claims indicated that alleged injuries occurred more 

frequently in hospital inpatient facilities than in hospital outpatient facilities, doctors’ offices, or emergency rooms.

Few medical malpractice insurance claims resulted in payouts of $1 million or more, 2000-2004

Percent distribution of insurance payouts

State and type of health 

care provider

Under 

$100,000

$100,000-

$249,999

$250,000-

$999,999

$1 million 

or more

Any type of health care 

provider

Florida 42.7% 23.5% 28.4% 5.5%

Maine 45.7 22.4 24.4 7.4

Missouri 46.9 25.1 24.6 3.5

Texas* 32.7 28.2 28.5 10.6

Physicians and surgeons only

Illinois 20.6% 18.7% 43.7% 17.1%

Massachusetts 21.1 17.8 43.8 17.3

Nevada 32.4 20.1 39.0 8.5

Note: Based on closed medical malpractice insurance claims that 

resulted in a payout. Insurance payouts were adjusted for inflation using 

the Consumer Price Index (CPI) in 2004 dollars. CPI is available at 

<http://www.bls.gov/cpi/home.htm>.

*Includes only medical malpractice claims with insurance payouts of 

more than $10,000.
2 Medical Malpractice Insurance Claims in Seven States, 2000-2004

Seven states provided medical malpractice data to BJS

Medical malpractice has been a major issue in the Nation’s 

debate over health care costs and tort reform. Seven states 

— Florida, Maine, Missouri, Texas, Illinois, Massachusetts, 

and Nevada — were identified by the National Association 

of Insurance Commissioners (NAIC) as having comprehensive medical malpractice insurance claims databases.1 The 

information collected by these states covered a range of key 

items, including the number of claims closed with or without 

payouts, types of medical providers named in claims, facilities where alleged injury occurred, severity of alleged injury, 

court disposition of claims, amounts paid to compensate 

claimants, costs of defense counsel, and claim processing 

time. (See Appendix table A.)

The number of medical malpractice claims closed between 

2000 and 2004 differed considerably across the seven 

states. Differences in state population, number of health 

care providers, overall litigation environment, and scope of 

data collected may contribute to a higher number of closed 

claims in some states compared to other states. (See Methodology.) 

Florida, Maine, Missouri, and Texas collected medical malpractice claims data involving physicians, surgeons, hospitals, nursing homes, dentists, and other health care providers. In comparison, Illinois, Massachusetts, and Nevada 

collected data involving only physicians or surgeons. Also 

Florida and Massachusetts did not collect data on claims 

closed without an insurance payout. In Texas detailed medical malpractice insurance claims data were collected only 

for closed claims that had an insurance payout of more than 

$10,000. For these reasons, data in this report should not 

be used to compare medical malpractice insurance litigation 

across states.

Prior BJS reports on medical malpractice focused on only 

those medical malpractice claims that ended in trial. (See 

box on page 3.) This report describes a broader scope of 

medical malpractice litigation by examining medical malpractice insurance claims that were settled prior to or after a 

lawsuit in addition to those ending in trial.

Few medical malpractice claims were closed 

with a payout

Most medical malpractice insurance claims were closed 

without a payout to the person seeking compensation for 

the alleged medical injury. In Maine (34%), Missouri (31%), 

and Nevada (38%), about a third of medical malpractice 

claims were closed with a payout (table 1). In Illinois about 

12% of closed claims resulted in a payout.

1NAIC is a clearinghouse for insurance regulators in all 50 states and the 

U.S. territories. Further information about NAIC may be obtained at <http://

www.naic.org/>.

What is a medical malpractice insurance claim?

A medical malpractice insurance claim arises when a 

person (the claimant) alleges that negligent medical 

treatment resulted in an injury. The treatment may 

have been provided by a physician, surgeon, or other 

health care professional or an organization, such as a 

hospital, clinic, or nursing home.

In a typical medical malpractice claim, the person 

claiming an injury or a related family member retains 

an attorney to file a claim with the medical provider’s 

insurance carrier requesting compensation for the 

injury. After a claim is filed, the insurance carrier may 

settle, negotiate with the claimant over the amount of 

compensation, or refuse to compensate the claimant. 

If the parties do not come to an agreement, the 

claimant’s attorney may file a lawsuit in the appropriate 

court or abandon the claim.

Some states require review of medical malpractice 

claims before a panel of experts prior to a lawsuit, 

while other states mandate arbitration or alternative 

dispute resolution as a means of resolving medical 

malpractice claims. The filing of a lawsuit may produce 

several outcomes. These include the settlement of the 

case prior to or during trial, a trial decision in favor of 

the claimant or the defendant, or the dismissal of the 

case by the court. Claims may also be abandoned or 

withdrawn after a lawsuit.

Table 1. Closed medical malpractice insurance claims, 

2000-2004

State and 

type of health care provider

Number 

reported

Closed claims with 

a payout

Number Percent 

Any health care providera

Floridab 8,519 8,519 ~

Maine 1,136 386 34.0%

Missouri 8,379 2,598 31.0

Texasb 6,251 6,251 ~

Physicians or surgeons onlyc

Illinois 16,016 1,945 12.1%

Massachusettsb 1,485 1,485 ~

Nevada 1,254 472 37.6

~Not applicable.

aFlorida, Maine, Missouri, and Texas collected medical malpractice claims data involving physicians, surgeons, hospitals, 

nursing homes, dentists, and other health care corporations 

and clinics.

bFlorida and Massachusetts did not collect data on closed 

claims without a payout. Texas data were limited to closed 

claims with a payout of more than $10,000.

c

Illinois, Massachusetts, and Nevada collected medical malpractice data involving physicians or surgeons only. 
Medical Malpractice Insurance Claims in Seven States, 2000-2004 3

Majority of medical malpractice claims were brought 

against physicians or surgeons 

Physicians or surgeons were the most common type of individual medical provider involved in medical malpractice 

insurance claims. They made up about half of medical providers involved in medical malpractice claims closed in 

Maine (54%) and Missouri (48%), and two-thirds of those in 

Texas (68%) (table 2). 

Hospitals were the most frequent institutional party named 

in medical malpractice insurance claims. In Maine 27% of 

claims were against hospitals, while in Missouri and Texas 

hospitals accounted for about 18% of health care providers 

in closed claims. The number of institutional providers, such 

as hospitals, may be underestimated because these institutions often self-insure and self-insured institutions are not 

required to report closed claims.

Most injuries occurred at hospital inpatient facilities 

Most medical malpractice injuries reported in closed insurance claims occurred in hospital inpatient facilities. About 

half of closed claims in Florida and Missouri and 42% of 

claims closed in Illinois involved injuries that occurred in 

hospital inpatient facilities (table 3). Physicians’ offices 

accounted for 10% of the claims closed in Florida, 20% in 

Missouri, and 24% in Illinois.

Table 3. Facility where injury occurred in closed medical 

malpractice insurance claims, by state and health care 

provider, 2000-2004

Percent of closed claims

Any health care provider

Physicians or 

surgeons only

Facility where injury 

occurred Floridaa Missourib Illinoisb

Hospital

Inpatient facility 50.6% 49.2% 42.2%

Outpatient facility 4.8 3.4 4.4

Emergency room 10.5 9.4 3.0

Nursing home 0.9 3.2 1.2

Physician's office 10.1 20.1 24.0

Otherc 23.1 10.3 24.9

Don't know 0.0 4.4 0.3

Number of closed 

insurance claims 8,519 8,379 16,016

Note: Data on facility where injury occurred were not reported from 

Maine, Massachusetts, Nevada, and Texas. 

aIncludes claims closed with an insurance payout.

bIncludes claims closed with or without an insurance payout.

c

Includes patients’ homes, other outpatient facilities, and other 

facilities not identified by the states.

Table 2. Type of health care provider involved in closed 

medical malpractice insurance claims, by state, 2000-2004

Percent of closed claims in —

Health care provider Mainea Missouria Texasb

Hospitals 27.4% 18.3% 18.3%

Nursing homes ... 2.9 4.6

Physicians or surgeons 54.1 47.6 68.3

Dentists ... 4.6 3.1

Nurses ... 2.3 ...

Otherc 17.8 24.3 5.8

Don't know 0.7 0.0 0.0

Number of closed insurance claims 1,136 8,379 6,251

Note: The percentage of medical malpractice claims involving hospitals 

and other medical organizations may be underestimated as hospitals 

and other medical groups typically self-insure. Self-insured groups are 

typically not required to report closed claim information to state insurance regulators. Health care provider data were not reported from Florida. Illinois, Massachusetts, and Nevada collected medical malpractice 

data involving physicians or surgeons only. 

... Data were not available.

aIncludes claims closed with or without an insurance payout.

bIncludes only claims with insurance payouts of more than $10,000.

c

Includes other types of medical providers not identified by the states.

Prior BJS medical malpractice data collections

Prior BJS reports on medical malpractice estimated 

that about 7% of medical malpractice lawsuits ended 

in a trial. (See Tort Cases in Large Counties, 1992.) 

BJS has also provided detailed information about 

medical malpractice trials in several reports 

examining civil trial litigation in the Nation's 75 most 

populous counties. (See Civil Trial Cases and 

Verdicts in Large Counties, 2001; Medical 

Malpractice Trials and Verdicts in Large Counties, 

2001; and Tort Trials and Verdicts in Large Counties, 

2001. These reports are available at <http://

www.ojp.usdoj.gov/bjs/civil.htm>.)

These reports highlight three key findings:

• Plaintiffs won in about a quarter of medical malpractice trials.

• The estimated median trial award was about 

$425,000.

• Between 1992 and 2001 the number of medical malpractice jury trials remained fairly stable but median 

trial awards increased by about 70%.
4 Medical Malpractice Insurance Claims in Seven States, 2000-2004

Females made up over half of insurance claimants

For states that provided data on gender, females comprised 

between 54% and 56% of medical malpractice claimants 

(table 4).

Few medical malpractice claims resulted in payouts of 

$1 million or more

Insurance payouts typically compensate claimants for lost 

wages and medical bills (economic damages); pain, suffering and other emotional damages (noneconomic damages); 

and attorney fees and costs. In cases where the medical 

provider engaged in reckless or criminal behavior, punitive 

damages may be awarded to the claimant.

Overall, medical malpractice insurance claims with payouts 

of $1 million or more occurred infrequently. Fewer than 10% 

of compensated medical malpractice claims resulted in payouts of $1 million or more in Florida, Maine, Missouri, and 

Nevada (table 5). Insurance payouts of $1 million or more 

accounted for 17% of paid claims in Illinois and Massachusetts, and 11% of paid claims in Texas.

Table 4. Gender of claimant in closed medical malpractice 

insurance claims, by health care provider and state, 2000-

2004

Percent of closed insurance claims

Any health care provider

Physicians or surgeons only

Gender of claimant Floridaa Missourib Illinoisb Nevadab

Male 45.5% 44.4% 43.6% 46.1%

Female 54.5 55.6 56.4 53.9

Number of closed 

insurance claims 8,519 8,155 15,758 1,251

Note: Claimant gender data were available for 100% of claims in Florida, 97% in Missouri, 98% in Illinois, and 99.8% in Nevada. Claimant 

gender data were unavailable for Maine, Massachusetts, and Texas. 

aIncludes claims closed with an insurance payout.

bIncludes claims closed with or without an insurance payout.

In Missouri fewer claims involved temporary injuries; larger portions of claims involved wrongful death

In Missouri the percentage of claimants alleging more 

serious injuries has increased. In 1990 about half of 

closed medical malpractice claims involved temporary 

injuries, while wrongful deaths accounted for 20% of 

closed claims. By 2004 temporary and wrongful death 

injuries each accounted for about a third of closed 

medical malpractice claims.

The percentage of claims involving permanent injuries 

remained relatively stable between 1990 and 2004. 

On average about a third of closed medical 

malpractice claims involved permanent injuries. 

Increased expenses in litigating medical malpractice 

claims and changes in the strategies of plaintiff's 

lawyers in deciding which claims to litigate may 

explain this convergence of claims involving 

temporary and wrongful death injuries. 1990 1992 1994 1996 1998 2000 2002 2004

0%

10%

20%

30%

40%

50%

60%

Percentage of claims

Year claim closed

Temporary injury alleged

Permanent injury alleged

Wrongful death injury alleged

Note: Data are limited to medical malpractice claims closed

 with insurance payouts.
Medical Malpractice Insurance Claims in Seven States, 2000-2004 5

In states where data were collected on all health care providers, the majority of compensated medical malpractice 

insurance claims resulted in payouts of less than $250,000. 

In Missouri 72% of medical malpractice claims were closed 

with payouts of less than $250,000, while in Florida and 

Maine about two-thirds of the claims had payouts of less 

than $250,000. Sixty-one percent of closed claims in Texas 

also had payouts of less than $250,000.

In Illinois, Massachusetts, and Nevada, where data were 

available on physicians or surgeons only, approximately 

40% to 50% of claims resulted in payouts of less than 

$250,000.

Table 5. Percent of insurance payouts in closed medical malpractice insurance claims, 

by health care provider and state, 2000-2004 

Any health care provider Physicians or surgeons only

Payout amount Florida Mainea Missouri Texasb Illinois Massachusetts Nevada

Under $100,000 42.7% 45.7% 46.9% 32.7% 20.6% 21.1% 32.4%

100,000 to 249,999 23.5 22.4 25.1 28.2 18.7 17.8 20.1

250,000 to 499,999 19.6 14.2 16.2 15.6 20.4 22.9 23.1

500,000 to 999,999 8.8 10.2 8.4 12.9 23.3 20.9 15.9

$1 million or more 5.5 7.4 3.5 10.6 17.1 17.3 8.5

Median insurance payouts $133,000 $110,000 $107,000 $195,000 $350,000 $341,000 $225,000

Number of claims closed 

with a payout 8,519 352 2,598 6,251 1,945 1,485 472

Note: Data include medical malpractice insurance claims closed with an insurance payout. Insurance payouts were adjusted 

for inflation using the Consumer Price Index (CPI) in 2004 dollars. CPI available at <http://www.bls.gov/cpi/home.htm>.

aActual dollar amounts were available for 91% (352 of 386) of claims closed with a payout.

bIncludes only medical malpractice insurance claims with an insurance payout of more than $10,000.

In Nevada diminished life expectancy and disfiguring injuries were more likely to result in a payout than nonphysical emotional injuries 

States differ in the way that they collect information on 

the type of physical injury reported in a medical 

malpractice claim. Nevada, Maine, Massachusetts, and 

Texas use their own coding schemes and detailed text 

fields to describe the type of injury alleged by the 

claimant. Florida, Missouri, and Illinois use the National 

Association of Insurance Commissioners' (NAIC’s) 

injury scale to describe injuries alleged in medical 

malpractice claims. (See scale on page 6.) 

In Nevada death is the most common type of medical 

malpractice injury reported in closed claims. This is 

followed by injuries resulting in “prolonged care or 

recovery” and “nervous system damage.”

In Nevada over a third of all medical malpractice claims 

closed between 2000 and 2004 resulted in a payout. 

“Diminished life expectancy” and “disfigurement” 

injuries were more likely to result in a payout compared 

to those claims in which the claimant died. “Nonphysical injuries” and “pain” resulted in a payout for 

claimants about 15% of the time.

Percent of injuries where 

claimant — 

Type of injury

Total number of claimsReceived 

payment

Did not receive 

payment

Total 1,226 38.0% 62.0%

Death 331 36.9% 63.1%

Physical injuries

Diminished life expectancy 30 66.7% 33.3%

Disfigurement 55 54.5 45.5

Nervous system damage 108 53.7 46.3

Reproductive system damage 12 50.0 50.0

Foreign body left after surgery 34 47.1 52.9

Birth injury 32 46.9 53.1

Organ injury 54 46.3 53.7

Diminished use of limbs 52 46.2 53.8

Loss of limb/organ 38 42.1 57.9

Optical/sensory injury 34 41.2 58.8

Circulatory injury 27 40.7 59.3

Disease 31 38.7 61.3

Prolonged care or recovery 137 30.7 69.3

Infection 60 26.7 73.3

Side effects 38 18.4 81.6

Bone damage 23 17.4 82.6

Pain 41 14.6 85.4

Other* 26 46.2 53.8

Non-physical emotional injuries 63 15.9% 84.1%

Note: Injury data were available for 98% of closed claims.

*Includes dental injuries, dermal injuries, muscular/limb injuries, and 

cases where the wrong organ was removed.
6 Medical Malpractice Insurance Claims in Seven States, 2000-2004

Medical malpractice insurance payouts were higher for major or grave permanent injuries than

for temporary or emotional injuries

States using the National Association of Insurance Commissioners’ (NAIC’s) injury scale rank medical malpractice 

injuries according to escalating levels of severity. The 

NAIC’s injury scale codes injuries with values that range 

from one for emotional injury only to nine indicating that the 

claimant died. (See adjacent description for scale and type 

of injuries.) 

Excluding wrongful death, the major and grave permanent 

categories include the most serious types of injuries that 

may occur in medical malpractice insurance claims. Claimants who suffer these types of injuries often have sizeable 

medical bills, require potentially lifelong medical care, or 

incur substantial losses in earned income. The median 

insurance payouts for claimants who had major or grave 

permanent injuries ranged from $278,000 to $350,000 in 

Florida and Missouri and approached nearly $1 million in 

Illinois. By comparison, the median insurance payouts for 

claimants who suffered emotional, insignificant, or minor 

temporary injuries ranged from $5,000 in Missouri to 

$64,000 in Illinois.

The median insurance payouts in medical malpractice 

cases with wrongful death claims were lower than in cases 

in which the claimant suffered major or grave injuries. 

Since wrongful death claims would not involve more costly 

long term medical care, they often result in less compensation than claims in which long term medical care is needed. 

National Association of Insurance Commissioners’ 

(NAIC’s) severity of injury scale and type of injuries:

• Death (09) — resulted in death of claimant.

• Permanent injury

- grave (08) — quadraplegia, severe brain damage, 

lifelong care or fatal prognosis.

- major (07) — paraplegia, blindness, loss of two 

limbs, brain damage.

- significant (06) — deafness, loss of limb, loss of 

eye, loss of one kidney or lung.

- minor (05) — loss of fingers, loss or damage to 

organs. Includes non-disabling injuries.

• Temporary injury

- major (04) — burns, surgical material left, drug side 

effects, brain damage. Recovery delayed.

- minor (03) — infections, misset fractures, fall in hospital. Recovery delayed.

- insignificant/slight (02) — lacerations, contusions, 

minor scars, and rash. No delay in recovery.

• Emotional injury only (01) — fright, no physical 

damage.

Number and median payout of medical malpractice insurance claims, by severity of injury, 

2000-2004

Any health care provider Physicians or surgeons only

Florida Missouri Illinois

NAIC’s severity

of injury scale Number

Median 

payout Number

Median 

payout Number

Median 

payout

Total 8,519 $133,000 2,598 $107,000 1,945 $350,000

Death (09) 2,450 $216,000 811 $172,000 687 $457,000

Permanent 3,281 $210,000 893 $193,000 879 $420,000

Grave (08) 424 278,000 99 333,000 152 989,000

Major (07) 591 321,000 193 350,000 225 618,000

Significant (06) 860 250,000 255 210,000 243 400,000

Minor (05) 1,406 108,000 346 83,000 259 220,000

Temporary 2,582 $50,000 846 $28,000 362 $124,000

Major (04) 842 79,000 308 48,000 207 210,000

Minor (03) 1,371 50,000 452 25,000 130 64,000

Insignificant/slight (02) 369 16,000 86 5,000 25 16,000

Emotional only (01) 206 $25,000 48 $26,000 17 $33,000

Note: Injury severity data were not presented for Maine, Massachusetts, Nevada, and Texas because they do 

not code injuries according to the NAIC’s injury severity scale. Insurance payouts were adjusted for inflation 

using the Consumer Price Index (CPI) in 2004 dollars. The CPI is available at <http://www.bls.gov/cpi/

home.htm>.
Medical Malpractice Insurance Claims in Seven States, 2000-2004 7

About 95% of medical malpractice insurance claims 

settled prior to trial

Most medical malpractice insurance claims that resulted in 

a payout were settled prior to being decided by a jury or 

bench (judge) trial. In Florida, Maine, Missouri, and Texas 

5% or less of these claims reached a trial decision (table 6). 

For claims that were settled prior to a trial decision, the settlement was reached in most cases after a lawsuit had been 

filed in court. Of the nearly 8,300 claims settled in Florida, 

about 6,300 were concluded after a lawsuit was filed, but 

prior to a trial decision.

Insurance payouts increased as claims moved through 

the legal system

Insurance payouts for medical malpractice insurance claims 

decided by trial were substantially larger than claims that 

were settled. In Florida, Texas, and Nevada the median 

insurance payouts were at least 21⁄2 times larger for claims 

that reached a trial decision compared to claims that were 

settled. In Maine and Missouri median payouts were at least 

3 times larger for claims decided by trial than claims that 

were settled. By comparison, in Florida, Missouri, and Texas 

median settlement payouts were lowest for medical malpractice claims settled prior to the filing of a lawsuit.

In Texas median payouts for claims resolved through 

alternative dispute resolution (ADR) were nearly the 

same as non-ADR claims

Nearly a third of the medical malpractice claims closed in 

Texas between 2000 and 2004 were resolved through alternative dispute resolution (ADR). This procedure refers to 

settling disputes by means other than formal litigation. The 

litigants typically meet with a third party who assists in 

resolving the dispute. Although Texas does not require that 

medical malpractice claims be referred to ADR, many parties participated in various ADR programs. 

The decision to seek resolution through an ADR program 

did not impact overall payout amounts. Medical malpractice 

claims settled through ADR prior to a lawsuit produced 

slightly lower payouts ($50,000) compared to claims that 

were not resolved through ADR ($55,000). Among medical 

malpractice claims that settled after a lawsuit was filed in 

trial court, the median insurance payouts were slightly 

higher for ADR ($210,000) as opposed to non-ADR 

($200,000) resolved claims.

Number 

of claims

Median insurance 

payouts

Settled prior to lawsuit 543 $53,000

Alternative dispute resolution 219 50,000

No alternative dispute resolution 324 55,000

Settled after lawsuit filed in trial 

court 5,546 $202,000

Alternative dispute resolution 1,686 210,000

No alternative dispute resolutiona 3,860 200,000

Trial verdict or judgmentb 162 $497,000

Note: Insurance payouts adjusted for inflation in 2004 dollars using the 

CPI index and rounded to the nearest thousand. Texas data limited to 

medical malpractice claims with insurance payouts of more than $10,000.

aIncludes claims settled during trial but before verdict or judgment.

bIncludes claims closed after trial verdict or judgment.

Table 6. Number of closed claims with an insurance payout and median payout, by type of disposition, 2000-2004

Claims closed by settlement

All settlements Prior to lawsuit

After lawsuit but prior to 

trial verdict or judgment

Claims closed after trial 

verdict or judgment

State and type of health care 

provider Number

Median 

payout Number

Median 

payout Number

Median

payout Number

Median

payout

Any health care provider

Floridaa 8,298 $131,000 2,014 $72,000 6,284 $158,000 156 $322,000

Maineb 332 107,000 -- -- -- -- 16 418,000

Missouric 2,516 105,000 627 18,000 1,889 150,000 81 342,000

Texasd 6,089 191,000 543 53,000 5,546 202,000 162 497,000

Physicians or surgeons only

Nevada 448 $218,000 -- -- -- -- 24 $551,000

Note: Insurance payouts were adjusted for inflation using the Consumer Price Index (CPI) in 2004 dollars and rounded to the 

nearest thousand. Medical malpractice insurance claim disposition data were unavailable for Illinois and Massachusetts. 

 -- Data not available.

aDisposition data were available for 99% (8,454 of 8,519) of claims closed with an insurance payout.

bDisposition data were available for 90% (348 of 386) of claims closed with an insurance payout.

c

Disposition for one paid claim was unknown.

dIncludes only medical malpractice insurance claims with insurance payouts of more than $10,000.
8 Medical Malpractice Insurance Claims in Seven States, 2000-2004

Medical malpractice insurance payouts have increased 

The median damages paid to medical malpractice claimants 

have increased since the early to late 1990s. In Missouri, for 

example, the median insurance payouts grew from $33,000 

in 1990 to $150,000 in 2004, an increase of more than 

350%. During the various time periods, median payouts 

also increased by 57% in Massachusetts, 49% in Illinois, 

36% in Florida, 26% in Nevada, and 27% in Texas (figures 1 

and 2). Growing health care costs and an increasing effort 

by many attorneys to litigate only those medical malpractice 

claims involving severe injuries or wrongful death claims 

may explain some of these increases. 

Medical malpractice claims closed after trial cost more 

to defend than claims settled prior to trial

The median loss adjustments paid to defense counsel were 

higher for claims closed through trials than settlements. 

Loss adjustments cover the amount insurance companies 

pay their legal counsel for investigating, settling, and trying 

their insurance claims. In Florida, Maine, and Nevada, 

median loss adjustments were at least 4 times greater for 

medical malpractice claims closed after trial than they were 

for claims settled prior to trial (table 7). The expenses associated with litigating a claim to the completion of a trial — 

including completed discovery, preparation of key witnesses, expert testimony, and jury selection — all contribute 

to higher defense counsel costs for claims decided by trial. 

Trends in payouts in medical malpractice insurance claims 

in states with only physician or surgeon data

Figure 2

Note: Insurance payouts were adjusted for inflation in 2004 dollars using the

CPI and rounded to the nearest thousand.

Year claim closed

Median payout

1994 1996 1998 2000 2002 2004

$0

$100,000

$200,000

$300,000

$400,000

$500,000

Illinois

Nevada

Massachusetts

Trends in payouts in medical malpractice insurance claims 

in states with any health care provider data 

Figure 1

1990 1992 1994 1996 1998 2000 2002 2004

$0

$50,000

$100,000

$150,000

$200,000

$250,000

Texas

Florida

Missouri

Note: Insurance payouts were adjusted for inflation in 2004 dollars

using the CPI and rounded to the nearest thousand. Texas data are

limited to medical malpractice insurance claims with insurance payouts

of more than $10,000. Maine had too few cases for analysis.

Median payout

Year claim closed

Table 7. Median loss adjustment expenses by type of claim 

disposition in closed medical malpractice insurance claims 

with insurance payouts, 2000-2004

States and type of 

health care provider

Prior to trial verdict or 

judgment (settled)

After trial verdict or 

judgment (trial)

Number 

of claims

Median loss 

adjustment 

expense

Number 

of claims

Median loss 

adjustment 

expense

Any type of health 

care provider

Florida 6,624 $30,000 142 $136,000

Maine 298 19,000 15 94,000

Missouri 1,717 21,000 79 54,000

Texas* 5,831 46,000 160 127,000

Physicians or 

surgeons only

Nevada 386 $23,000 22 $85,000

Note: Loss adjustments cover the amount insurance companies pay 

to their legal counsel for investigating and settling insurance claims, 

including cost of defending a lawsuit in court. Not all claims closed 

with an insurance payout resulted in a loss adjustment expense. 

Loss adjustment expenses were adjusted for inflation in 2004 dollars using the Consumer Price Index (CPI) and were rounded to the 

nearest thousand. Loss adjustment and claim disposition data were 

unavailable for Illinois and Massachusetts.

*Includes only medical malpractice claims with insurance payouts of 

more than $10,000. Texas loss adjustments include costs insurers 

pay to defense counsel and other administrative costs for processing insurance claims.
Medical Malpractice Insurance Claims in Seven States, 2000-2004 9

On average, 15 to 24 months elapsed before a medical 

injury was reported to insurance carriers

Medical malpractice insurance claims were typically not 

reported to insurance carriers immediately after injury. In 

Florida an average of 15 months passed before claimants 

reported the injury to insurance providers. In Nevada an 

average of 24 months passed before medical injuries were 

reported.

In Florida, Texas, and Missouri, an average of nearly 4 

years passed from initial injury to the closure of the claim. 

Once the insurance company received a claim in these 

three states, an average of 26 to 29 additional months 

passed before claims were closed and the claimant compensated. 

For Nevada and Illinois medical malpractice claims took 

slightly more than 5 years to close after injury. In these 

states an average of 22 to 24 months passed before claims 

were reported to the insurance carrier. An additional 38 to 

45 months passed before the claims were closed. 

Several factors influence the decision concerning when to 

file a medical malpractice claim, including statute of limitations restrictions and the need to ascertain various medical, 

work-related, and pain and suffering expenses.

Methodology

Prior BJS reports on medical malpractice estimated that 

about 7% of medical malpractice lawsuits ended in a trial. 

(See Tort Cases in Large Counties, 1992.) BJS has provided detailed information about medical malpractice trials 

in several reports examining civil trial litigation in the 

Nation’s 75 most populous counties. (See Civil Trial Cases 

and Verdicts in Large Counties, 2001; Medical Malpractice 

Trials and Verdicts in the Large Counties, 2001.) 

These BJS reports did not examine the characteristics or 

outcomes of the estimated 93% of medical malpractice 

claims that settled or were closed without compensation 

prior to reaching the trial stage. This BJS special report 

expands the scope of inquiry about medical malpractice litigation by providing information on medical malpractice 

claims that settled prior to or during litigation, were dismissed or abandoned without compensation, or reached the 

trial stage.

Medical malpractice claim data limitations

Limitations apply to the medical malpractice claim databases summarized in this report. One limitation is the extent 

to which these medical malpractice databases contain 

claims in which no compensation was demanded by the 

claimant. While most medical malpractice insurance claims 

involve requests for compensation, it is possible that significant numbers of medical malpractice insurance claims do 

not involve any compensation demands.2 Some insurance 

companies will open claims in response to medical procedures that resulted in injuries, irrespective of whether the 

injured party decides to pursue a claim. It was not possible 

to identify medical malpractice claims that did not involve 

demands for compensation. 

The underreporting of medical malpractice insurance claims 

represents another limitation. The Departments of Financial 

and Insurance Regulation of the states providing data typically require that only licensed insurance companies submit 

closed claim medical malpractice data. The medical liability 

insurance market consists of other non-licensed entities and 

groups that provide medical liability insurance. These 

groups are not required to report closed claims medical malpractice data and include “self insured hospitals, hospitals 

that insure their employee physicians and surgeons, captive 

insurers, risk retention groups and surplus lines insurers.”3 

The percentage of unreported medical malpractice insurance claims was generally not discernible; however, the 

Missouri Department of Insurance estimated that 15% to 

20% of claims go unreported every year for that state.4

2Bernard Black, Charles Silver, David Hyman, and William Sage. July 

2005. “Stability Not Crises: Medical Malpractice Claim Outcomes in Texas, 

1988–2002.” Journal of Empirical Legal Studies. 2(2): 207–259.

3Department of Financial and Professional Regulation – Division of Insurance. 2006. 2005 Medical Malpractice Claims Report. Springfield, IL: p. 3.

4Missouri Department of Insurance. 2005. Missouri Medical Malpractice 

Insurance Report. Jefferson City, MO. 

Average number of months from — Percent of total 

time from injury 

to reporting date

State and type of 

health care provider

Injury to 

reporting

Reporting to 

closing 

Injury to 

closing

Any type of health 

care provider

Florida 15 mos. 26mos. 41 mos. 36.6%

Missouri 18 28 45 40.0

Texas 16 29 45 35.6

Physicians or surgeons only

Nevada 24 mos. 38mos. 62 mos. 38.7%

Illinois 22 45 67 32.8

Note: Claim processing time shown only for those claims closed with an 

insurance payout. Claim processing time was not available for Maine and 

Massachusetts.
10 Medical Malpractice Insurance Claims in Seven States, 2000-2004

Another limitation is that this study involves an examination 

of closed rather than opened medical malpractice insurance 

claims. As previously shown, a substantial amount of time 

can pass from the date of injury to the date that the medical 

malpractice claim is reported and subsequently closed by 

the insurance carrier. As a result of these time lags, this 

report should be viewed as presenting a picture of the past 

as opposed to the present medical malpractice insurance litigation environment.5

Another limitation is unknown variation in data quality. Some 

of these datasets have never been audited for consistency 

and accuracy. Medical malpractice claims often involve several defendants and insurance carriers filing multiple claims 

stemming from the same injury. While some states attempt 

to identify multiple claims that hail from the same incident, 

other states do not have procedures for identifying and 

purging these duplicate claims. This analysis was unable to 

determine the extent that duplicate claims were represented 

in these datasets. 

The seven states also do not collect or report medical malpractice claim data in a uniform or consistent manner. Some 

states have more extensive medical malpractice data collection programs. Florida, Maine, Missouri, and Texas collect medical malpractice claims data involving physicians, 

surgeons, hospitals, nursing homes, dentists, and other 

health care providers. Illinois, Massachusetts, and Nevada 

only collect medical malpractice claim data involving physicians and surgeons. 

Another important issue is whether the states collect data 

for claims that did not result in any compensation being 

awarded to the claimants. Florida and Massachusetts do 

not collect data on claims closed without an insurance payout. Texas collects only aggregate statistics on claims 

closed without an insurance payout or claims closed with 

insurance payouts of $10,000 or less. Detailed medical malpractice data in Texas are collected only for those medical 

malpractice cases closed with insurance payouts of more 

than $10,000. 

For these reasons, this report should not be used to compare medical malpractice insurance litigation across the 

seven states. Rather, this report can be used to examine the 

general profile of medical malpractice insurance litigation.

5Neil Vidmar, Paul Lee, Kara MacKillop, Kieran McCarthy, and Gerald 

McGwin. 2004 – 2005. “Uncovering the Invisible Profile of Medical Malpractice Litigation: Insights from Florida.” DePaul Law Review 54: 315 – 

356.

Definitions of terms

Claim characteristics

Insurance payouts: Insurance claim closed with claimant 

being compensated for losses sustained from malpractice 

injury. Losses can include economic (lost wages and 

medical expenses), noneconomic (emotional or pain and 

suffering), and attorney fees and costs. 

Claimant: Party filing medical malpractice claim with 

insurance carrier seeking compensation for alleged injury 

committed by the negligent acts or omissions of physician, 

surgeon, or other health care provider. 

Defendant: Physician, surgeon, or other health care 

provider named by claimant in medical malpractice 

insurance claim as responsible for the claimant’s injury. 

Insurance carrier: Company that provides malpractice 

coverage to physician, surgeon, or other health care 

provider.

Loss adjustment: The amount insurance companies pay to 

their legal counsel for investigating and settling insurance 

claims, including defending a lawsuit in court. In some 

states loss adjustments have a broader definition and 

include other administrative costs for processing insurance 

claim.

State Insurance Commissioner: State insurance regulator 

responsible for managing the insurance industry and market 

for a particular state.

Claim disposition

Settled prior to lawsuit filed: Refers to insurance claims 

that are settled by the parties for specified dollar amounts 

prior to the claim being filed as a lawsuit in state or federal 

trial court. 

Settled after lawsuit filed: Refers to insurance claims that 

are settled by the parties for specified dollar amounts after 

the claim is filed as a lawsuit in state or federal trial court but 

before the claim reaches a trial decision.

Trial verdict or judgment: Refers to insurance claims that 

are closed after a jury or judge (bench) trial has reached a 

verdict or judgment. 

Claim processing time

Injury to reporting date: Time period between date health 

care provider’s malpractice act/omission caused injury to 

the claimant and date claimant files claim with the insurance 

carrier seeking compensation.

Reporting to closing date: Time period between date 

health care provider’s insurance carrier received medical 

malpractice claim to the date the health care provider’s 
Medical Malpractice Insurance Claims in Seven States, 2000-2004 11

insurance carrier closed the claim. The closing date can 

refer to the date the insurance carrier paid out on the policy, 

the date the claimant abandoned the claim, or the date of 

administrative closure. 

Appendix table A. Data fields provided in medical malpractice insurance datasets, by State 

Florida Illinois Maine Massachusetts Missouri Nevada Texas

Number of claims 

With payout   

Without payout  

Gender  

Injury location  

Type of medical provider  

Payout amounta   

NAIC’s injury severity scale  

Court disposition   

Loss adjustment   

Date of — 

Injury occurrence  

Filingb  

Closingc  

aPayout amounts in U.S. dollars.

bDate filed with insurance company.

c

Date insurance company closed claim.
U.S. Department of Justice

Office of Justice Programs

Bureau of Justice Statistics

Washington, DC 20531

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12 Medical Malpractice Insurance Claims in Seven States, 2000-2004

The Bureau of Justice Statistics is 

the statistical agency of the U.S. 

Department of Justice. Jeffrey L. 

Sedgwick is director.

This Special Report was written by 

Thomas H. Cohen and Kristen A. 

Hughes, under the supervision of 

Steven K. Smith. Lynn Langton 

provided statistical assistance and 

review. Special thanks to the 

Departments of Financial and 

Insurance Regulation in Florida, 

Illinois, Maine, Massachusetts, 

Missouri, Nevada, and Texas for 

providing the medical malpractice 

insurance claims data. Some of 

these agencies also provided data 

assistance and comment. Carolyn 

C. Williams produced and edited 

the report and Jayne Robinson 

prepared the report for final 

printing, under the supervision of 

Doris J. James.

March 2007, NCJ 216339

This report in portable document format and in 

ASCII and its related statistical data and tables 

are available at the BJS World Wide Web 

Internet site: <http://www.ojp.usdoj.gov/bjs/

abstract/mmicss04.htm>.

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