After a pandemic dip in plaintiff medical malpractice trial verdicts, jury awards of more than $10 million and $25 million have surged since 2022. The spike has led many insurers to cut coverage limits, leaving hospitals and healthcare institutions to patch together coverage from more carriers.
According to global reinsurance company TransRe, there were 160 verdicts of at least $10 million from 2022 to 2024 — the benchmark commonly used to define nuclear verdicts. That compares with 116 verdicts from 2016 to 2018.
Nearly half of the recent verdicts were even larger: 79 awards of at least $25 million, up from 38 in the earlier period.
Richard Henderson, senior vice president at TransRe, said while some verdicts are appealed successfully, the trend is straining hospitals and healthcare providers.
“In the past, a hospital seeking $150 to $200 million in its medical malpractice liability tower of coverage might maintain a $5 million self-insured retention (SIR) and be able to fill out the tower with perhaps eight to nine insurers providing anywhere from $10 million to $25 million in limits,” Henderson said.
Now, he explained, insurers are more cautious. Hospitals often must accept a larger SIR — sometimes $10 million or more — and spread excess coverage across multiple insurers. Many are unwilling to provide more than $5 million in limits, with only a few willing to go as high as $10 million.
Reinsurer concerns
The impact extends to reinsurers, Henderson said, who must watch for “aggregation risk.”
“As a reinsurer, we take on much smaller bites of risk,” he said. “Even though our contracted limits are smaller, if we take on too much risk on a specific hospital, healthcare network or other related organization, we have to be mindful of what we call ‘aggregation risk.’”
He added that reinsurers must evaluate not only the quality of underwriting but also whether insurers have the capacity to handle claims effectively.
While most high-verdict cases ultimately settle, Henderson said the percentage paid in settlements has climbed. Plaintiff verdicts settled for 32% of gross value in 2018 and 28% in 2019, but jumped to 38% in 2022 and 47% in 2023. The percentage dipped to 31% in 2024 due to one large case that settled at a steep discount — but the payout was still significant.
“Several other very large verdicts remain open on appeal and the final number for 2024 is far from set in stone,” he said.
Juror attitudes shift
Daniel Huff, a partner at Huff, Powell & Bailey, said “social inflation” and distrust of institutions have made juries more open to large awards.
“In the past, if a plaintiff was seeking a $50 million verdict, jurors might have been appalled,” said Huff. “Now they don’t flinch.”
Speaking on an April panel at the 2025 Crittenden Medical Liability Conference, Huff said the decision to try or settle a case has grown more difficult given the rise in jury verdicts.
“Juror attitudes toward medicine are partially from a pandemic hangover when many people began questioning medical experts and distrusting institutions,” he said. “I also think there is an indifference to large jury awards. This is described as social inflation.
“Part of our job is to educate jurors in specific cases that large awards are not without consequences.”
According to TransRe, the largest verdicts from 2015 to 2024 most often involved surgery-related claims (38) or birth injuries (29).
Birth injury cases that leave babies with permanent neurological damage, such as cerebral palsy, are especially difficult to defend, Huff said. Neurological injuries to adults also often result in large verdicts.
“These incidents result in the need for lifelong medical care and impact the lives of the patient and caregiver,” Huff said. “Jurors are compelled to help the plaintiffs in these cases and a small amount of evidence or a minor mistake is used as justification to help the injured plaintiff.
“Once seen as ambulance chasers, plaintiff attorneys are now seen as crusaders for the helpless and perceived more positively than ever before.”
Sexual abuse claims add pressure
Hospitals and insurers are also grappling with sexual abuse and molestation claims, which can involve hundreds or even thousands of plaintiffs.
“These claims can involve hundreds, if not thousands, of plaintiffs, and often involve allegations of abuse which may stretch back decades — in some instances 30 years or more,” Henderson said.
In New York City, for example, sexual abuse claims against OBGYN Dr. Robert Hadden resulted in more than $1 billion in settlements for about 1,000 plaintiffs. Across the country, other settlements have reached mid-nine figures.
“These are literally tower-busting exposures, and insurers have increasingly pushed back on a going-forward basis,” Henderson said. Some carriers are now requiring additional retentions, adding co-insurance, or excluding coverage for future abuse exposures.
He noted that the #MeToo movement prompted many states to pass “reviver statutes,” which reopened windows for claims previously barred by statutes of limitation.
Strategies for defense
Regardless of the claim type, Huff said strong defense depends on prompt communication and collaboration.
“When we are contacted about a potential claim, we ensure that all the stakeholders in the insurance tower are aware of the claim,” he said. “We then evaluate the facts, nature of the claim and the venue — some counties and states are more plaintiff-friendly than others — to determine whether settling is prudent or if it makes strategic sense to go to trial.”
He said the best trial cases are those where defendants can show care met medical standards or prove they were not responsible for the injury.
Still, competition among insurers can hinder collaboration, especially as the number of carriers involved in towers grows.
“The plaintiff’s bar is known for sharing strategies, experts and techniques, but many insurers are not so quick to give away to other insurers the trade secrets or other strategies they have honed, oftentimes at considerable time and expense,” Huff said.
The expanded number of insurers, combined with reduced limits, has also created more friction in settlement negotiations.
“For example, the increase in jury verdicts and ultimate settlements has not surprisingly led to ever-increasing settlement demands on future claims,” Henderson said. That pressure can cause insurers higher in the tower to issue “hammer” letters to those lower in the stack, demanding settlement.
“The insurer sitting in an excess position may issue a demand to settle upon the underlying insurer(s),” he said. “If the underlying insurer refuses to do so, it faces the threat of being pursued for a bad faith claim.”
Looking forward
Despite the competition, Henderson and Huff agreed that more collaboration is critical.
“Revisit the existing barriers to collaboration and implement strategies for the benefit of all,” Henderson said.
“The stakeholders in these catastrophic cases need to collaborate to find new ways to defend and settle them,” Huff added. “This will require new ideas and strategies and diverse thinking.”
