Nuclear verdicts, or jury awards over $10 million, are becoming more common across the United States. The total number of nuclear verdicts in the United States increased by 52% between 2023 and 2024.
These settlements are changing the way that healthcare providers work, plus they're raising concerns among malpractice insurers and lawmakers. With these verdicts driving up insurance premiums, many in the industry are questioning if this trend is sustainable for the future of medicine.
In this blog post, we’ll break down what nuclear verdicts in insurance are and why they’re on the rise. We’ll also look at trends, the consequences these verdicts have on healthcare providers and ways to protect yourself. Finally, we’ll explain why getting the right medical malpractice insurance is crucial to shield yourself from potential lawsuits.
A nuclear verdict is a jury-awarded lawsuit settlement that exceeds $10 million. The nuclear verdict definition refers to verdicts that are unexpectedly high given the details of the case.
Recent data shows that the median nuclear verdict in the United States has reached several million dollars, highlighting the significant financial impact these awards have on defendants and the broader legal landscape.
In healthcare, these verdicts happen in malpractice or medical negligence cases where the patient experienced severe physical injury or emotional distress as the result of a healthcare provider’s actions. Nuclear verdicts can also happen in wrongful death cases involving healthcare providers.
Unlike a more typical medical malpractice verdict, nuclear verdicts are characterized by their:
Outside of healthcare, nuclear verdicts can happen throughout the civil justice system. These exceptionally high jury awards often happen in:
There are three types of damages that are often awarded in civil cases. These include:
Economic and non-economic damages are both compensatory damages, which are intended to remedy the situation the plaintiff experienced.
Several factors are driving the rise of nuclear verdicts in medical malpractice cases. These include:
As nuclear verdicts continue to happen, medical malpractice litigation strategies are evolving to keep up. Healthcare providers and insurance carriers alike should be aware of these trends as part of their risk management strategy. Here are some of the key patterns and trends that have emerged in malpractice cases.
The following para. Is not really relevant to the US environment where contingent fee agreements have been the norm for decades. My guess is this refers more to the UK environment where this is a much bigger and more recent issue.
Many healthcare practitioners practice defensive medicine in an effort to avoid claims and lawsuits, but research hasn't confirmed whether this strategy actually limits medical malpractice cases. In defensive medicine, doctors take steps to minimize the chances of errors or missed diagnoses, which can lead to other challenges, including higher cost of healthcare.
Here's what defensive medicine can look like in practice:
While it can help protect against lawsuits, defensive medicine often results in unnecessary tests, treatments, and referrals. This can raise costs for both providers and patients, and in some cases, it can lead to over-treatment that could be potentially harmful.
The impact of nuclear verdicts on healthcare providers is significant. Such verdicts are intended to hold healthcare providers accountable for dangerous or egregious conduct, but they can also impact healthcare accessibility and affordability. In many cases, these large verdicts can threaten a company's viability by causing severe financial strain, reputational damage, and operational challenges that jeopardize ongoing stability.
Here are some of the consequences of the increase of nuclear verdicts on the healthcare industry.
One of the most immediate and noticeable consequences of nuclear verdicts is the sharp rise in medical malpractice insurance premiums. 49.8% of medical professional liability insurance premiums increased between 2023 and 2024.
This increase in premiums can be particularly hard for high-risk medical specialties, like obstetrics, neurology, and emergency medicine, where the chance of litigation is higher and potential exposures are greater.
As these high payout cases become more common, the insurance industry is adjusting by passing costs down to medical providers. Insurance companies may respond to large verdicts by tightening insurance coverage terms or increasing scrutiny of claims. Insurers are also reassessing their risk models and may limit coverage or raise premiums in response to the growing threat of nuclear verdicts. These higher premiums can drive up operating costs and potentially increase medical bills for patients too.
The fear of facing a nuclear verdict can take a severe toll on a healthcare provider’s mental and emotional well-being. With the growing frequency of large malpractice insurance claims, doctors are under immense pressure, knowing that a single lawsuit could wipe out years of hard work or even lead to bankruptcy.
Many healthcare providers are making career changes to avoid nuclear verdicts, meaning they are relocating to areas with lower litigation risks or even leaving the practice altogether. This leads to physician shortages, especially in rural or underserved areas. Some experts predict that the physician shortage in the United States could increase to 86,000 by 2036.
The significant challenges caused by nuclear verdicts can also affect entire healthcare institutions. Hospitals and practices, particularly smaller ones, may struggle to remain financially viable due to the rising costs of malpractice insurance, defense, and high compensatory awards in these cases.
Social inflation happens when the cost of insurance claims rises at a faster rate than general inflation. This results in higher insurance premiums and deductibles for policyholders, and can also lead to stricter underwriting standards.
Social inflation happens across the entire insurance industry. In addition to medical malpractice insurance, this trend is also present in commercial auto, property, and health insurance, as well as various types of corporate insurance.
Nuclear verdicts are one of many contributing factors to social inflation. There are also many shifting societal attitudes impacting corporate defendants, leaving consumers less sensitive to large verdicts. This also increases the risk of nuclear verdicts.
Nuclear verdicts refer to settlements over $10 million, but awards can be significantly higher in severe malpractice cases. Here are some notable recent medical malpractice cases.
A New Mexico jury has awarded over $412 million in a medical malpractice case against NuMale Medical Center, a men’s health clinic with locations across the U.S. The plaintiff, who went to the clinic for help with fatigue and weight loss, was misdiagnosed and given unnecessary and harmful penile injections.
His lawyers called the verdict a national record and said it sends a powerful message against fraud in healthcare. They claimed the clinic used fear tactics to convince patients to undergo treatments they didn’t need. NuMale Medical Center disagrees with the ruling and plans to appeal.
The jury found that the clinic’s actions were not only fraudulent and negligent but also violated the Unfair Practices Act. This case underscores the importance of putting patient care before profits.
A Florida jury awarded $261 million in damages to the Kowalski family after Johns Hopkins All Children’s Hospital was found liable for medical negligence, false imprisonment, and emotional distress. The case centered on Maya Kowalski, who was hospitalized in 2016 for a rare pain condition.
The hospital accused her parents of abuse, leading to months of isolation and restricted visitation. Maya’s mother, Beata, died by suicide in 2017, shortly after having a brief visit with her daughter. The jury awarded $211 million in compensatory damages and $50 million in punitive damages.
A Philadelphia judge upheld a record-breaking $183 million medical malpractice verdict against the Hospital of the University of Pennsylvania (HUP). The case, dating back to 2018, involved a child who suffered severe brain birth injury because of a delayed C-section.
The mother claimed HUP’s 45-minute delay in performing the surgery caused her baby to develop cerebral palsy, along with other neurological injuries. The court found that the hospital’s failure to act promptly led to lifelong medical and developmental issues for the child.
The jury awarded $183 million in damages, covering past pain, future medical costs, and suffering. Penn Medicine’s request to dismiss the case or reduce the verdict was rejected. The award is considered the largest malpractice settlement in Pennsylvania’s history, and the child will receive the funds over their lifetime to cover ongoing care needs.
A Michigan jury awarded $120 million to a Detroit-area mother and son after obstetricians and nurses at Henry Ford Health failed to perform a necessary C-section in a timely manner. The mother, Kristen Drake, waited over 2 hours for a C-section in 2010. Her son, K’Jon Drake, now lives with several severe medical conditions, including cerebral palsy, permanent brain damage, and blindness as a result of the delayed procedure.
Drake took legal action in 2024, seeking damages to cover her son’s ongoing medical care. The verdict includes economic damages to cover the cost of care and lost earning potential, as well as non-economic damages for the pain and suffering the Drake family experienced. Part of the damages were paid directly to the Michigan Department of Health and Human Services to cover K’Jon’s care. Henry Ford Health expressed plans to appeal the verdict.
In 2019, a Texas man sought care at Baptist Beaumont Hospital for severe back and neck pain. Despite the intensity of his symptoms, the hospital failed to perform a necessary MRI for over 20 hours. The patient eventually needed surgery to remove a mass on his spine, but the surgery was too late, and the patient ended up permanently paralyzed.
The jury determined that the hospital and two doctors involved were negligent, and that the patient’s paralysis could have been prevented with timely diagnosis and action. The total settlement of $59.7 million included economic damages for medical expenses and lost wages, as well as non-economic damages for pain, physical impairment, and mental anguish.
Jake Gleeson, a professional goalkeeper for the Portland Timbers, was awarded $20 million by an Oregon jury as a result of malpractice during a leg surgery in 2018. Gleeson needed steel plates to treat stress fractures in his legs, but they were not sterilized properly.
This led to severe infections, leg pain, and over a dozen additional surgeries, which ended his career as a professional athlete. Gleeson was awarded damages for past and future medical procedures, past and future lost wages, and non-economic damages for physical and emotional suffering.
Some states see higher volumes of nuclear verdicts than others. While exact numbers can fluctuate from year to year, California, New York, Florida, Texas, and Georgia tend to see the most nuclear verdicts each year, although California and Texas particularly have longstanding tort reform which caps non-economic damages in medical negligence cases.
There are a few reasons why these states tend to have high average award amounts. These include:
Again, some states have implemented tort reform to cap the amount of non-economic damages in liability cases and limit the possibility of nuclear verdicts. However, the exact cap amount will vary by state and by type of case.
Nuclear medical malpractice verdicts have sparked heated discussions. Are they a necessary way to hold healthcare providers accountable, or do they go too far and harm the healthcare system? Let's look at both sides of the debate.
Wrongful death and medical malpractice lawsuits are among the leading causes of nuclear verdicts in the United States. When a patient’s life is lost due to a healthcare provider’s negligence, juries are often moved to award exceptionally high jury awards to the victim’s family. This growing trend reflects shifting jury attitudes, with jurors increasingly willing to hold medical professionals and institutions accountable for preventable tragedies. In recent years, some wrongful death verdicts in medical malpractice cases have soared past $100 million, underscoring the significant challenge these claims pose for healthcare providers and their insurers.
To address the risk of such verdicts, robust risk management is essential. Healthcare organizations must implement comprehensive patient safety protocols, ensure thorough documentation of every medical procedure, and foster a culture of transparency and accountability. By prioritizing these strategies, providers can reduce the likelihood of medical errors that lead to wrongful death lawsuits and minimize their exposure to costly nuclear verdicts. Insurers, too, play a critical role by supporting best practices and helping providers stay ahead of evolving jury expectations in wrongful death and medical malpractice cases.
To prevent severe malpractice cases that result in nuclear verdicts, healthcare providers should implement robust safety and documentation protocols. Following best practice guidelines in risk management is essential to prevent nuclear verdicts and ensure compliance with industry standards. Here’s what these prevention strategies look like.
Effective documentation is a critical defense during a malpractice claim. Maintaining detailed medical records of patient interactions, decisions, and medical care plans creates a paper trail that can protect doctors from baseless claims.
Additionally, clear communication with patients ensures alignment of expectations from the start, reducing the chances of future disputes.
Implementing robust patient safety protocols is another key strategy for reducing malpractice risk. Hospitals and clinics should establish checklists, implement peer reviews, and regularly audit care procedures based on the latest research. System directors and officers can help in enforcing these protocols and encouraging compliance.
Building strong, trusting relationships with patients can dramatically reduce the likelihood of lawsuits. When patients feel heard and understood, they are less likely to resort to litigation. Doctors should make an effort to explain procedures and address patient concerns in detail.
One of the best ways to manage expectations and reduce the chance of litigation is through informed consent. Patients should fully understand their treatment options, including possible risks and benefits, to set expectations and prevent misunderstandings.
Medical malpractice insurance is a must for doctors and healthcare institutions—it shields them from the legal costs and damages that come with malpractice claims. The average verdict size is increasing and nuclear verdicts have become more common, with profound implications for traditional insurers.
Premiums for high-risk specialties are soaring as insurers try to manage the risk of these massive payouts. Smaller practices and solo providers are finding it harder and harder to keep up with rising insurance costs, as well as the risk of costly jury trials.
Medical malpractice insurance is often seen as an outdated industry, slow to embrace new technology. Indigo, a fresh insurance platform, is changing that by using cutting-edge technology, including AI, to offer personalized pricing and a smoother experience for both physicians and brokers.
Jared Kaplan, co-founder and CEO of Indigo, explains that the idea for the company stemmed from the need to modernize an industry that has been slow to innovate. While the $12 billion medical malpractice market is stable, it’s stuck in old-school practices, which is where Indigo comes in. The company combines expertise from both medical malpractice and financial technology to offer a solution that meets the needs of today’s physicians and brokers.
Indigo uses advanced AI technology to tailor insurance pricing based on a doctor’s unique risk profile, ensuring fair and accurate coverage. Brokers benefit from fast quoting and binding services, making the process more efficient. Kaplan highlights two key trends shaping the industry: automation and machine learning. These technologies automate tasks like underwriting and use data-driven insights to make better predictions about risk, moving away from the traditional methods of manual processing and paperwork.
Indigo pulls data from multiple sources—socioeconomic, political, and healthcare claims—to assess the risk of a physician more accurately. Machine learning helps the company continuously refine its models, predict future losses and adjust pricing. This means doctors get insurance customized to their specialties, whether they're plastic surgeons, neurosurgeons, or dermatologists.
“At the end of the day, we want to take the hassle out of buying a required line of insurance for your business so you can focus on much more important things like life and death decisions,” Kaplan said.
Medical malpractice insurance offers crucial coverage and support for physicians navigating medical malpractice claims. Indigo streamlines the process of getting medical malpractice coverage so you can focus on what you do best—seeing patients.
Indigo leverages robust data sets and artificial intelligence in its proprietary underwriting model to quickly analyze thousands of data points, providing individualized pricing to physicians in all medical specialties. Indigo rewards physicians that practice good medicine with bigger potential savings.
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