Medical Malpractice Rates Rise 1.8% as Insurers Record 12th Year of Losses

Premium growth remains modest

Medical malpractice premiums edged up 1.8% by midyear 2026, while insurers in the sector posted a 107.4% combined ratio for 2025—their 12th straight year of underwriting losses. The gap points to a market where worsening claims costs have yet to translate into broad rate increases. A combined ratio above 100% means an insurer’s claims and expenses exceeded the premiums it earned over the period, before investment income is considered. It’s a useful measure of underwriting performance, though it doesn’t capture every source of an insurer’s earnings.

That average increase was just below 2025’s 1.9%, according to Medical Liability Monitor’s 36th annual rate survey. Rates rose in 38% of the cases reported, up from 35% a year earlier. More than half were flat at 53%, while 9% fell. Those shares describe the direction of reported premiums, not the size of every change or the experience of every clinician. An average can obscure meaningful differences among specialties, locations, insurers and individual accounts.

Rising claims severity and larger court awards and settlements are weighing on results. Competition, however, is limiting insurers’ pricing power; some are cutting premiums to hold or grow market share. Here’s the tension: persistent underwriting losses haven’t prevented discounts in parts of the market. This is more significant than it looks: an insurer may face rising expected claim costs and still decide that a smaller premium increase, or no increase, is the better commercial choice for a particular account.

Why claims costs and premiums can diverge

Insurance pricing doesn’t adjust instantly to a change in losses. Premiums are generally set with future claims and expenses in mind, while the combined ratio reported for 2025 reflects business written and losses recognized under accounting and reserving practices. The two measures therefore describe related but different parts of the market. A poor underwriting result can signal pressure without guaranteeing that every customer will see an immediate rate increase.

Claims severity refers to the cost of claims, including the amounts paid to resolve them and the expenses associated with handling them. In medical liability, a rise in severe claims or in the size of awards and settlements can put pressure on an insurer’s results even when the number of claims isn’t rising. The source identifies larger awards and settlements as a concern, but doesn’t quantify how much they contributed to the reported ratio or premium change. That distinction matters: the direction of pressure is clear, while its exact scale isn’t established by these figures.

There can also be a time lag between claims experience and pricing decisions. Insurers must assess what current premiums need to cover, while competing for business and accounting for uncertainty in claims that may take time to resolve. If estimates of future costs change, pricing may respond gradually. And yet, a pricing decision still has to work in the market as it exists: a carrier that raises rates more aggressively than competitors may risk losing customers, while a carrier that discounts may accept thinner underwriting results in pursuit of retention or growth.

That trade-off helps explain why an industrywide loss measure can sit alongside premium cuts in some parts of the market. It doesn’t establish that those cuts are widespread or that every insurer is pursuing the same strategy. The survey’s figures show a mixed picture: increases were reported more often than a year earlier, but flat rates remained the majority, and some rates declined. The numbers here are underwhelming as evidence of a broad repricing in response to years of losses.

What the survey measures

Conducted with the Medical Professional Liability Association, the survey tracks mature claims-made premiums for internal medicine, general surgery and obstetrics/gynecology, using limits of $1 million per claim and $3 million annually. Rates are measured as of July 1. The report also provides a second year of comparative premium data for nurse practitioners and reviews pricing across the broader medical professional liability market. These details define the survey’s scope and make clear that its headline change is tied to specified coverage and measurement conventions.

A mature claims-made premium is a price for coverage under a claims-made policy once it has reached the mature stage described in the survey. Claims-made coverage generally depends on a claim being made and reported during the policy period, subject to the policy’s terms. That structure can make comparisons sensitive to coverage details and the stage of the policy being examined. The survey’s use of defined limits and mature premiums gives readers a consistent basis for the reported comparisons, but it doesn’t mean every policy or clinician faces the same price.

The three named specialties also provide a focused view, rather than a census of every medical professional or every coverage arrangement. Nurse practitioner data adds a second year of comparison, which can help readers track movement across a limited period, but two years alone can’t establish a long-term trend. If you’re working in this space, the practical question is whether the survey’s categories match the accounts you’re evaluating. A market average is a starting point for discussion, not a substitute for account-level detail.

Implications for insurers and policyholders

For insurers, the figures describe a difficult balance between underwriting discipline and competition. Persistent losses put pressure on the case for higher prices, while the survey indicates that competitive conditions are restraining increases in at least some situations. Insurers may differ in their view of claims costs, their appetite for particular business and their willingness to defend market share. The article’s data doesn’t identify those differences, so it can’t show which considerations drove any specific rate decision.

For medical professionals and organizations buying coverage, the headline increase doesn’t predict an individual renewal. The reported distribution—38% of cases rising, 53% flat and 9% falling—shows why a single average can be a poor guide to any one premium. Coverage limits, specialty, insurer and the details of a particular account can all matter. That said, the figures offer a useful signal: broad pricing movement remained modest even as the sector recorded a sustained run of underwriting losses.

The outlook in the source is therefore one of tension, not a settled turn in the cycle. Claims severity and larger awards and settlements are weighing on results, but competition is limiting insurers’ ability or willingness to pass those pressures through uniformly. Whether that balance changes will depend on how costs, competition and pricing decisions develop; the survey figures alone don’t settle the question. A long record of underwriting losses is serious. Whether it produces materially higher premiums across the market is less certain.

For details, visit www.medicalliabilitymonitor.com.