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The MPL Association assesses the current state of political races around the U.S. and what they may mean for public policy efforts in 2027 and beyond.

Exploring the National Practitioner Data Bank

The MPL Association Research and Analytics Department looks beyond its Data Sharing Project to the National Practitioner Data Bank (NPDB) to better understand the medical professional liability (MPL) landscape. Using NPDB data, we analyzed state-level average indemnity payments for all paid claims. What we found points to a familiar story: severity is rising, variation across states is increasing, and both mid-size and large losses are putting pressure on the system.

 

1990s Low severity, high frequency.
2000s Peak frequency, moderate severity growth.
2010s Declining frequency, steady increases in severity.
2020s High severity + rising number of large claims.

 

 

1990s Dominated by low severity claims. ($250K)
Early 2000s Expansion across all bands.
Late 2000s-Early 2010s Declining frequency of <$250K claims, $250K-$1M holds steady, and ≥$2M claims fluctuate.
High Mid-2010s Shift toward higher severity, clear migration from low to mid/high severity bands.
2020s Systemic shift to higher-cost claims, severity distribution is now top-heavy compared to prior decades. Mid-size claims ($500K-$1M) elevated and strong growth in $1M and $2M bands.

 

 

To smooth out the year-to-year swings, particularly around COVID (2020-2021), we grouped the data into five-year periods across specialties and states. Similar to the figures above, indemnity severity has increased steadily over time, with the strongest growth occurring in the early 2000s, when we saw nearly 30% increases in consecutive periods. Growth has continued since then but at a more moderate pace. The most recent period (2021-2025) shows an uptick with severity increasing at 16.3%, reaching its highest levels since the early 2000s.

 

 

 
Figure 3 and Figure 4 illustrate this trend across specialty groups. Physicians (MDs and DOs) still have the highest average indemnity payments, but they are not alone in seeing increases. Nursing (practical and registered nurses), advanced practice professionals (APPs), and dental providers are all showing similar or faster growth rates. Dental providers in particular stand out. While their average indemnity payments are lower, their growth has been significant, increasing more than six times since 1990. That’s faster than physicians (3.2x), nursing (3.5x), and APPs (1.3x).

 

 

At the state level, the picture is mixed. Figure 5, a comparison of claims counts between 2016-2020 and 2021-2025 shows that the largest MPL states continue to dominate between the two periods, accounting for 59% of the total paid claims in the most recent period. However, the changes in paid claims vary across these states: New York (-23%), Florida (+1.4%), California (-10.8%), Pennsylvania (-3.7%), New Jersey (-4.6%), Texas (+2.1%), Illinois (+10.7%), Michigan (+2.3%), and Georgia (+0.1%).

Beyond the largest states, the differences are more noticeable. States with the highest increases include New Mexico (+54%), Idaho (+39%), Alabama (+33%), and District of Columbia (+26%), while states with large decreases include Iowa (-28.8%), Wyoming (-27.4%), West Virginia (-25.4%), and Minnesota (-25.2%).

 

 

When it comes to severity, the trend is more consistent. Figure 6. shows indemnity severity has increased in all states over time, with long-term growth (1991-1995 vs. 2016-2020) often exceeding 150-300% with several states experiencing increases of more than 300%. Recent growth (2021-2025 vs. 2016-2020) is more mixed with only a few states showing a decline. Even among the large MPL states, severity is rising in most cases (with Illinois as the exception): New York (+16%), Florida (+25%), California (+37%), Pennsylvania (+12%), New Jersey (+13%), Texas (+11%), Illinois (-11%), Michigan (+28%), Georgia (+33%), and Indiana (+1%).

 

Table 2 provides claim counts and average indemnity for the most recent 5-year period (2021-2025) organized by state.

 

For more information, contact:
Kwon Miller, Research and Analytics Manager, kmiller@MPLassociation.org