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NEWS

Diagnostic Error Is Still the Top Driver of MPL Claims

October 1, 2025

Medical malpractice isn’t always about high-risk procedures or catastrophic injury. More often than not, it’s about a simple breakdown in the diagnostic process—a missed lab follow-up, a delayed referral, a wrong assumption. Year after year, diagnostic error continues to top the list of causes behind MPL claims, especially those with the highest indemnity payouts. And while some errors are inevitable, many are preventable—which puts brokers in a powerful position to help clients get ahead of the risk.

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The Case for Paying Attention

The data tells a consistent story. In nearly every recent national study, diagnostic error ranks among the leading causes of malpractice claims. A 2023 analysis by The Doctors Company found that failures in diagnosis—including patient assessment, communication, and test result management—were among the primary drivers in high-severity MPL cases. Similarly, Coverys reported that diagnostic-related allegations made up over a quarter of all closed events and accounted for more than 40% of indemnity paid across its portfolio. Primary care, internal medicine, radiology, emergency medicine, and oncology remain among the most exposed specialties.

It’s not just the frequency—it’s the nature of the failures. These claims often involve conditions that were misjudged or missed entirely: cancers not caught early, strokes mistaken for migraines, infections misread as routine. And while the clinical consequences can be serious, what drives litigation is often the feeling that something basic was overlooked. That’s why juries respond the way they do. A delayed diagnosis feels avoidable, especially when the patient’s own documentation or follow-up could have prevented it. That gap between what “should have” happened and what did is where claims take root.

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What Brokers Can Help Package

For brokers, diagnostic error presents a tricky but tractable risk. Unlike some exposures—like venue volatility or outlier jury awards—diagnostic failures often stem from breakdowns in systems, communication, and workflow. That makes them targetable. And while brokers can’t control how a physician thinks, they can help shape how clients present themselves to underwriters and what operational changes may reduce future claims.

Here are two areas where packaging risk control adds value:

Process safeguards: Structured protocols for patient assessment, differential diagnosis, and referral tracking can materially reduce diagnostic risk. When supported by peer review or case audits, these practices show underwriters that a client is serious about quality—not just outcomes, but process integrity. Follow-up systems for abnormal tests, standardized symptom checklists, and closed-loop referral communications are all signals worth surfacing.
Cognitive and cultural support: Diagnostic error isn’t always a technical failure—it’s often a thinking failure. Cognitive bias (anchoring, confirmation, availability bias) plays a role. Forward-thinking clients are building training and review models that help providers reflect more critically on uncertainty and blind spots. Some are layering in AI decision support or diagnostic triggers within EHRs to catch missed steps. Others are using near-miss data as part of internal learning programs. These moves, when documented, don’t just improve care—they improve how underwriters assess the risk.

The broker’s role is to pull those threads together—to translate internal practices into coverage value. That may mean encouraging clients to adopt or expand diagnostic safety programs. It may mean flagging specialty-specific diagnostic exposure in underwriting memos. And it almost always means asking tougher questions during renewal prep: How are test results communicated? What happens when a referral goes dark? How many days does it take, on average, to close the loop on an abnormal finding?

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Strategic Leverage in 2026 Renewals

As verdict severity climbs and carriers scrutinize tail risk more closely, diagnostic error should be a focal point in renewal conversations. Brokers who can surface credible, documented controls give underwriters something concrete to work with. And clients who treat diagnostic accuracy as a quality and risk issue—not just a medical one—are more likely to find favorable terms, especially in high-risk specialties.

This isn’t about creating new paperwork. It’s about helping clients see that what they already do to protect patients can—and should—help protect their coverage. The work is already happening. The broker’s job is to make it count.