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NEWS

Nuclear Verdicts & Social Inflation: A Broker’s Briefing for 2026 MPL Renewals

September 29, 2025

As medical groups head into 2026 renewals, one reality persists: rising jury awards and claim severity continue to push malpractice costs higher. For brokers, that translates into a twofold task—structure coverage clients can live with, and surface the risk controls that underwriters reward. That would be a tall order in any market, but it’s especially complex now, as outlier awards distort expectations and coverage adequacy alike.

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Why This Matters Now

The trend-lines aren’t subtle. The average of the top 50 medical malpractice verdicts climbed from $32 million in 2022 to $48 million in 2023—and hit $56 million in 2024. Across the broader tort system, nuclear verdicts—defined as awards exceeding $10 million—reached a multi-year high in 2023 and surged again in 2024. Industry tracking groups tallied nearly 50 verdicts over $100 million last year, with a total corporate exposure of more than $30 billion.

These numbers are not statistical noise. They are reshaping carrier assumptions about worst-case scenarios and loss cost trends. They’re also reshaping how medical groups must think about risk because coverage that once felt abundant can now look dangerously thin in the rearview mirror.

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What’s Fueling the Rise

Social inflation is amplifying both the frequency and the scale of outlier awards. Jurors today are more willing to punish corporate entities and physicians for perceived failures, especially when the injured party is sympathetic. The anchoring effect of past mega-verdicts, the broad availability of litigation financing, and a public increasingly desensitized to large dollar amounts all play a role. A few years ago, a $50 million malpractice award would have been national news. Now it’s another line item in the Marsh or KCIC database.

Carriers also point to a more aggressive plaintiff’s bar, a deteriorating tort-reform environment in certain jurisdictions, and the slow erosion of noneconomic damage caps. In this climate, traditional actuarial models often struggle to account for the tail risk introduced by one hyper-sympathetic case in a pro-plaintiff venue.

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Signal Case: $412 Million in 2024

Late last year, a jury awarded $412 million in a single medical malpractice case—an event that would have seemed implausible even five years ago. It wasn’t just the dollar figure that raised eyebrows. It was the fact that multiple lines of coverage were implicated, and the total payout exposure exceeded what any single provider or group might reasonably carry. For many carriers and brokers, that case became a pivot point in how they modeled worst-case scenarios.

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Implications for Medical Professional Liability (MPL)

For brokers working in MPL, the challenge is not just negotiating rates. It’s helping clients understand how these broader trends affect their own coverage adequacy. That means going beyond the traditional loss history analysis and taking a forward-looking view: which venues does the client operate in? What specialties are involved? How exposed are they to juror sympathy or public scrutiny?

The trend toward larger awards isn’t always tied to clinical error. Communication failures, documentation gaps, and inconsistent follow-up protocols are often the root causes of claims that spiral out of control. While these may feel like operational issues, they carry outsized weight when underwriters evaluate a practice’s risk profile.

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What Brokers Can Do

This is where the broker’s role becomes critical—not just as a placement partner but as a strategic guide. Clients need help understanding how much limit is “enough” in an era of nuclear verdicts. They also need help identifying and implementing controls that underwriters actually reward. A strong documentation protocol or quality review system may not feel like an insurance issue, but in this environment, it absolutely is.

One place to start: help clients evaluate their current coverage through the lens of frequency and severity. For high-risk specialties, that may mean building towers with multiple excess layers or exploring catastrophic coverage that would have seemed like overkill just a few years ago. Another: work closely with clients on storytelling. Underwriters want to see the signals that a practice takes risk seriously—and that it knows where it sits on the exposure curve. A clean claims history is great, but in 2026, that’s the starting line, not the finish.

Here are two ways brokers can drive real value this renewal cycle:

Structure smarter: Design limits and layers to account for outlier risk. Consider how different verdict scenarios could exhaust primary or umbrella coverage—and use modeling tools to illustrate exposures.
Package better: Present clients not just as “low-loss” but as low-risk. That means emphasizing proactive controls, staff training, patient communication protocols, and other behaviors that reduce the chance of becoming the next headline verdict.

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Looking Ahead

The frequency of nuclear verdicts dipped briefly in 2020 during the court system slowdown—but has rebounded and accelerated since. With plaintiff attorneys increasingly coordinating strategy across states, and litigation funders willing to bankroll longer, riskier trials, the pressure isn’t likely to let up soon. That means MPL renewals in 2026 aren’t just about year-over-year rate comparisons. They’re about building protection against a risk environment where the outliers aren’t so rare anymore.