The 2026 Medical Malpractice Insurance Market: Why Many May See Increased Premiums
- 3 days ago
- 11 min read
Many doctors in our online physician community will see another rate increase at their 2026 renewal. By the Medical Liability Monitor's count, this is the eleventh straight year of upward pressure on medical malpractice rates. The increases are uneven: some states and specialties are flat, others are running double-digit. Underneath the headline, the structural story is divergence: claim frequency declined sharply through the 2000s and has held roughly flat at historically low levels since, while severity (the size of paid claims and big verdicts) keeps climbing. Below, we look at trends in the medical malpractice insurance market in 2026 to help you gauge whether your number is "normal," where the pressure is concentrated, and what to ask your broker before you sign a policy or renewal.
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Is my medical malpractice insurance premium increase normal for the 2026 market?
Maybe — but the more useful question is whether your specific increase is in line with the broader market in your state and specialty. A broker who works closely with med mal carriers can usually answer that quickly from live carrier-rate data, often without needing to put your file out for full underwriting. The answer determines what to do next: accept the increase, push back on a carrier-specific surcharge, or formally shop the market.
The Medical Liability Monitor's Annual Rate Survey, which reads carrier rate filings across every state, has now reported eleven consecutive years in which the majority of medical professional liability (MPL) filings have moved up rather than down. The 2025 edition continued that pattern heading into 2026 renewals. Most physicians get a single-digit percentage increase. A meaningful slice stay flat. A smaller slice, concentrated in certain states, certain specialties, and a few specific carriers, get double-digit percentage increases.
If your 2026 quote is roughly in line with last year, plus or minus a few points, you're in the middle of the distribution. That's not a reason to do nothing. There's still a real conversation to have about limits, retroactive date, and whether your carrier is the right one for the next five years, but it's not a fire alarm.
If your 2026 quote is meaningfully higher than the prior year, or your carrier non-renewed you outright, you're in the long tail. The rest of this article is about why that long tail exists, where it lives, and what to do about it.
A practical anchor: when your broker quotes a renewal, ask what the carrier's filed rate change is in your state and how your individual quote compares. Filed rate changes are public. State insurance departments publish them, and a good broker will pull yours without being asked.
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The number on your renewal form should sit near the filed average, adjusted for your loss runs and any specialty- or class-specific factor your carrier applies. If your individual increase is meaningfully bigger than the filed change, the gap is the conversation.
It's worth keeping in mind that "normal" in 2026 is a different baseline than "normal" in 2014. Physicians who entered practice in the soft-market window of roughly 2007 to 2014 paid relatively flat premiums for years. Returning to year-on-year increases feels like a regime change. Looked at over a longer arc (AMA and NPDB data both stretch back decades), the current environment is not unprecedented. It's the second leg of a hard-market cycle the MPL line has run before.
Why are medical malpractice insurance premiums going up?Â
Severity of the verdicts being handed down in terms of dollar amount payouts are a huge factor.Â
The size of the largest paid claims and trial verdicts has continued to climb, and severity is what carriers price against. The disproportionate trend over the past decade has been in severity, not in claim counts.
Per TransRe (one of the largest reinsurers in the medical liability market), the count of jury verdicts at $10 million or more nearly doubled between 2013–2015 and 2022–2024. Verdicts at $25 million or more grew more than threefold over the same window. Those numbers become loss reserves a few years from now, and they show up in your rate filing today.
Two structural forces sit behind that trend:
Social inflation. This is the umbrella term for the slow rise in jury awards beyond what economic inflation alone would predict. It captures shifting public attitudes toward institutions (including hospitals, health systems, and physicians as agents of those systems) and a willingness to assign blame and award damages more readily. RAND's work on the California cap (MICRA) is the cleanest natural experiment: where caps are durable, severity stays anchored; where they're absent or weakened, severity drifts. Social inflation is real, measurable, and absorbed into actuarial pricing whether or not anyone agrees on the cause.
Third-party litigation funding. In the past fifteen years, an institutional-investor class (hedge funds, specialty lenders, and dedicated litigation-finance firms) has begun financing plaintiff cases in exchange for a share of any recovery. The plaintiff's attorney still runs the case; the funder provides capital that lets the case go further than it otherwise could. Funded plaintiffs can hold out for trial rather than settle for a number an unfunded plaintiff would have accepted. The additional capital lets plaintiff teams hire stronger experts and run more sophisticated trial work. Both push verdicts higher when the case lands in front of a jury. Third-party litigation funding is now a multi-billion-dollar global industry, and it sits behind a meaningful share of the largest MPL verdicts.
For the renewal conversation, the short answer is: severity is often cited as the variable that explains your number.
Where is the pressure concentrated?
In three places: certain states, certain specialties, and a small number of carriers re-underwriting their books.
By state. The states where rate pressure is heaviest are the same states that show up on every list of high-verdict environments: places where damage caps are weak or have been struck down, where venue rules favor plaintiffs in urban courts, and where jury awards run above the national median. New York, Illinois, Florida, Georgia, New Jersey, and Pennsylvania appear on most underwriters' "watch" maps year after year, while states with strong, court-tested damage caps tend to run flatter. Miller & Zois maintains the cleanest free 50-state damage-cap tracker if you want to look up your state's rules; our coverage-limits guide walks through how those rules feed into the limit you actually need.
By specialty. Severity concentrates in specialties where the worst-case clinical outcome is catastrophic and the time horizon to resolution is long. Obstetrics, neurosurgery, emergency medicine, and general surgery have carried the heaviest severity loads for years, and, by NEJM analysis (Jena et al., 2011), the highest cumulative career risk of being sued. Frequency and severity don't always overlap. Primary-care specialties see relatively high claim frequency but lower-severity outcomes; obstetrics and neurosurgery are the canonical specialties where both stack on top of each other. What's new is how widely the specialty gap has spread between high- and low-risk specialties as severity has climbed.
By carrier. The MPL (medical professional liability) market is concentrated; per NAIC market-share data, a small number of national writers account for most of the premium written. When one of those writers re-underwrites a book (exiting a state, dropping a class, tightening eligibility) it ripples through the rate environment in a way that one regional carrier's filing wouldn't. Carrier-specific actions like the Curi non-renewals across portions of its book in 2024–2025 are part of why the 2026 environment feels uneven even where the headline state filings look benign. There's a reinsurance dimension to this too: the global reinsurers that stand behind US MPL carriers (TransRe and others) have tightened terms over the past several renewal cycles, and reinsurance pressure flows downstream into primary rates.
If you're in a high-severity state and a high-severity specialty and your carrier has just had a portfolio action, you'll feel all three forces at once. That's the long tail. If only one of the three applies, your renewal is likely closer to the modal single-digit story.
If your renewal seems high based on your circumstances, it may be worth reshopping your policy and comparing options.
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Are medical malpractice carriers stable? Should I worry about my insurer?
Most major MPL carriers remain financially solid by AM Best standards. But the line itself has been running underwriting losses for several consecutive years, and that has consequences for how the market behaves around you.
A combined ratio above 100% means a carrier is paying out more in losses and expenses than it's collecting in premium. AM Best has reported the MPL line above 100% combined for several recent years; carriers have been bridging the gap with investment income and reserve releases. That's sustainable until it isn't. Higher interest rates have helped on the investment-income side, which is why a few carriers can post a "modest profit" headline while the underlying underwriting result still looks ugly. Reserve releases, on the other hand, are finite. Most MPL carriers spent the soft-market years of the 2010s setting reserves at favorable levels and have been quietly drawing those down. That well isn't infinite.
What sustained pressure on combined ratios produces, in order, is: rate increases (where state regulators allow them), tighter underwriting on new business, exits from unprofitable states, and class-level non-renewals on segments the carrier no longer wants. We've seen all four of those in the past 24 months. The Curi non-renewals are the most-discussed example, but they aren't the only one. Several carriers have re-underwritten portions of their physician books since 2023. The pattern usually starts at the edges of a carrier's book (non-standard practice settings, certain specialties, certain states) and moves inward as pressure persists.
For you, the practical implications are smaller than the headline suggests:
Confirm your carrier's current AM Best rating annually. A- or better is the comfortable threshold; below A-, ask your broker why. A rating downgrade typically lags the underlying problem by months. By the time it shows up, the carrier has been under stress for a while.
Watch for class-level signals. If your specialty or practice setting is moving toward a non-standard market, you may want to reshop ahead of a non-renewal rather than after. Brokers see these signals early; ask yours directly.
Read your renewal letter for any change in coverage terms beyond rate. Quietly tightened defense provisions, exclusions, or sublimits can be more consequential than a price increase.
If the worst happens and you do receive a non-renewal notice, we have an upcoming article with a step-by-step guide on what to do in this situation. Sign up for our weekly newsletter to know when it deploys.
What does this mean for my 2026 medical malpractice renewal?
Three things, in order.
Expect an increase, and gauge whether yours is in range. A flat to single-digit renewal, in most states and specialties, is the modal outcome and not worth losing sleep over. A double-digit renewal deserves a conversation. Ask your broker what the carrier filed in your state, how your loss runs compare to the rest of the carrier's book, and whether anything specific to you is driving the number. Three pieces of leverage are worth knowing about: clean loss runs (no paid claims, no open incidents) carry weight; long tenure with a carrier carries some weight; specialty-society membership and risk-management course completion can carry weight at the margin. None of those will reverse a market-driven increase, but together they can move the carrier-specific portion of the rate by a few points.
What's worth pushing back on, and what isn't: a market-wide rate filing approved by your state insurance department isn't going to move because you ask. Carrier-specific surcharges (for a closed claim, a class change, or a minor underwriting flag) sometimes will, especially if the underlying event is older or contextually different than the surcharge assumes.
Confirm your limits still fit. This is the part of the renewal conversation that gets skipped most often, and it's the most expensive thing to skip. The standard $1M / $3M policy limit is a 1995 default that most physicians have never revisited. Given the severity trend covered above, the question of "is $1M / $3M still enough?" is real, and it's specific to your state, specialty, hospital credentialing requirements, and personal-asset exposure.
Confirm you're not leaving money on the table. Fully re-underwriting your policy with multiple carriers may be unnecessary in a year your premium is flat. But the range of premiums across MPL carriers is broad enough that you may still be leaving money on the table without knowing it. A broker with med mal expertise can usually answer the question quickly because they have premium data across carriers and can benchmark yours without putting your file out to formal quote. The conversation is free; the coverage review that comes with it tends to be useful regardless. If your premium is meaningfully higher this year, or your carrier non-renewed you, formally shopping the market is the obvious next step.
A small but useful reframe: the goal of the 2026 renewal isn't to win a number. It's to confirm that the policy you're paying for still matches the practice you're running and the assets you have to protect. Often that means a small rate increase you accept and move on. Sometimes it means a real conversation about limits or carriers. The article is meant to help you tell which one this year is.
What to do next in this 2026 medical malpractice insurance market
A short checklist for your renewal:
Confirm your 2026 rate change vs. prior year and ask your broker how it compares to the carrier's filed average in your state.
Pull your loss runs from your current carrier: every claim, inquiry, and incident on file. You'll want them whether or not you reshop.
Ask your broker to benchmark your renewal against the broader market, even if you plan to stay. The conversation is free, and it surfaces whether the renewal is genuinely competitive.
Confirm your limits still match your state's verdict environment, your specialty, and your hospital's credentialing minimum.
Note your carrier's current AM Best rating and outlook. If anything has changed since last year, ask your broker why.
If a class or state-level action is on your radar, start making a backup plan before a non-renewal notice arrives, not after.
Conclusion
The 2026 medical malpractice market is not defined by a sudden spike in claim frequency for a collapse in carrier stability. It’s defined by a slower, more structural shift: increasingly expensive claims, regional pressures, and a market that is becoming more selective. For most physicians, this translates into a renewal that is higher than last year’s but still manageable. For others, it may mean significantly higher premiums or a need to reshop coverage entirely. A renewal game plan in 2026 is less about chasing the lowest premium and more about confirming that your limits, carrier stability, and long-term coverage structure still fit the realities of the practice you’re running today.
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