Medical professionals are at risk of a malpractice claim each time they make a decision that affects patient care. Over 55,000 medical malpractice claims have been filed in Texas during the last decade, making malpractice insurance essential for any physician practicing in this state. Texas allows these claims to be based on a departure from the accepted standard of care, which may include causes such as a perceived lack of treatment or treatment discrepancies. A malpractice claim must also show that the defendant’s negligence caused harm to the patient.

The following list includes some of the most common insurance companies in Texas:

• Admiral Insurance Company
• ALTOR National Liability Insurance
• Applied Medico-Legal Solutions Risk Retention Group, Inc.
• CARE Risk Retention Group, Inc.
• CM&F Group
• Coverys
• Coverys Specialty Insurance Company
• Doctors Company Insurance Group
• Doctors Professional Liability Risk Retention Group, Inc.
• Hamilton Select Insurance Inc.
• Healthcare Professional RRG
• ISMIE Mutual Insurance Company
• Kinsale Insurance Company
• Lexington Insurance Company
• Liberty Surplus Insurance Corporation
• Lone Star Alliance, Inc., RRG
• Medical Protective Company
• MMIC Risk Retention Group, Inc.
• Positive Physicians Insurance Company
• ProAssurance Indemnity Company, Inc.
• ProAssurance Specialty Insurance Company
• Professional Solutions Ins Co
• ProSelect Insurance Company
• Skyward Specialty Insurance Group, Inc.
• StarStone Specialty Insurance Company
• TDC Specialty Insurance Company
• Texas Medical Insurance Company
• Texas Medical Liability Trust
• Tokio Marine HCC

Overview

In 2023, the requirement to carry Texas malpractice insurance primarily depends on the physician’s employer. The coverage limits for many policies are based on commonly accepted standards, but some healthcare facilities specify higher limits. The process of obtaining malpractice insurance is generally the same, although the specific steps can vary by broker. Many factors influence the cost of malpractice insurance in Texas, and tort reform may also affect the coverage that a policy could provide in the future.

Requirements

The state of Texas itself doesn’t legally require physicians to carry medical malpractice insurance, but most of them do so as a practical necessity. Healthcare facilities often require malpractice insurance as a condition of granting practice privileges to physicians and other healthcare practitioners, especially major hospitals. In addition to protecting individual practitioners, malpractice insurance also protects the practice from reputational damage and financial hardship.

Major healthcare centers in Texas that require their practitioners to carry malpractice insurance include the following:

• University of Texas MD Anderson Cancer Center
• Houston's Texas Medical Center
• Memorial Hermann Texas Medical Center
• St. Joseph’s Medical Center
• Providence Medical Center

Limits

The most common coverage limit for medical malpractice policies in Texas is $200,000 / $600,000. This limit means the insurance company covers a maximum of $200,000 per claim, with a total cap of $600,000 per year. Some hospital systems require higher limits, which can reach $1 million / $3 million.

Non-Economic Damages

Texas has a limit cap on non-economic damages in medical malpractice cases, which includes compensation for subjective losses caused by the defendant's malpractice. The cap is set at $250,000 per claimant for cases against a single healthcare provider and an overall cap of $500,000 per claimant for cases against multiple healthcare institutions. No single institution can be responsible for more than $250,000 in non-economic damages per claimant. Economic damages are not capped in Texas.

Process

A reputable broker licensed to provide coverage is the best way of obtaining medical malpractice insurance in Texas. Brokers can generate multiple quotes specific to each practitioner’s needs, allowing them to select the best coverage for their needs. Brokers can also walk their clients through the lengthy process of applying for insurance and underwriting the policy. In addition, they shouldn’t charge any fees for just providing a quote.

While you should generally solicit quotes from multiple insurance providers, this practice is particularly important for medical malpractice insurance due to the greater cost range. Multiple quotes allow you to get a more complete picture of the malpractice insurance market in Texas, so you can identify the broker that’s the best fit for you. The cost and coverage of the offered policies are certainly an important factor, but the provider’s financial condition is also a critical consideration.

Once you’re ready to obtain a free quote, you’ll submit an application with your personal and professional information. Each broker should assign an experienced agent to go over your options and answer all of your questions, ensuring you make the right decisions. Your agent will then shop your application to major malpractice insurance providers in Texas and help you select one that provides the coverage you need at the best price. When the policy comes up for renewal, you may repeat the shopping process to see if you can find a better policy than the one you have with your current provider.

Cost Factors

The cost of medical malpractice insurance in Texas is highly dependent on your practice location, although it's generally lower than in most other states. Areas with a lower population density generally have higher rates due to the reduced competition among brokers.

In addition to location, other factors affect your insurance premium, like a history of previous claims. Insurance companies will regard physicians with more claims against them as a greater risk and will therefore charge them a higher premium. Medical procedures that pose a greater risk to the patient will also increase the insurance premiums for these specialists. Physicians who need more coverage or work longer hours will also have higher premiums. The average annual malpractice premiums in Texas range from $9,000 for anesthesiology to $29,000 for major gynecological surgery.

Medical malpractice policies are thus more highly customized than other types of insurance policies. As a result, two practitioners who appear to be similar can easily have significantly different premiums.

Tort Reform

A tort is a civil act that causes loss or harm to a claimant, creating legal liability for the person committing the tortious act. Insurance changes comprise a major portion of tort reform in Texas, especially for medical malpractice.

Many options for insurance are currently available in this state, although that hasn’t been the case until fairly recently. The Medical Malpractice and Tort Reform Act (MMTRA) of 2003 included comprehensive changes to medical malpractice claims, including limiting damages to incurred costs and caps on non-economic damages. In addition, this legislation included changes to joint and several liability, as well as evidentiary procedures.

The MMTRA’s effect on medical malpractice was particularly great. It immediately validated its new damage caps through the use of a ballot initiative. Insurers in other states often delay their response to tort reform because the state supreme court may find the new measures unconstitutional, which most recently occurred in Georgia and Illinois. In Texas, however, the damage caps were passed by a constitutional amendment, which the voters approved. As a result, it’s unlikely these caps will change in the near future.

Claim Data

The National Practitioner Databank (NPDB) is a repository of medical malpractice claim information for healthcare providers in the United States. Following is a summary of data where we can observe the number of malpractice payments, adverse actions, and other disciplinary actions taken against healthcare professionals.

Year	Payment Count	Total Payments	Average Payment	Max Payment	Over 500K Count	Over 1M Count	Over 5M Count
1995	1074	$158,119,850	$147,225	$1,450,000	51	4	0
1996	1160	$217,023,600	$187,089	$4,950,000	67	16	0
1997	933	$155,297,250	$166,449	$4,150,000	47	10	0
1998	1006	$178,479,400	$177,415	$2,950,000	54	7	0
1999	1050	$228,573,150	$217,689	$14,500,000	69	11	3
2000	1149	$220,118,450	$191,574	$2,350,000	72	8	0
2001	1218	$372,067,800	$305,474	$22,500,000	126	20	5
2002	1138	$267,934,550	$235,443	$4,850,000	106	17	0
2003	1153	$266,258,450	$230,927	$6,750,000	101	14	2
2004	1156	$267,873,600	$231,725	$16,500,000	92	11	2
2005	1124	$218,290,050	$194,208	$3,950,000	56	9	0
2006	736	$127,342,000	$173,019	$1,950,000	38	2	0
2007	655	$105,197,600	$160,607	$3,450,000	20	3	0
2008	548	$92,809,600	$169,361	$2,850,000	23	5	0
2009	565	$92,718,550	$164,104	$4,250,000	18	5	0
2010	555	$93,745,000	$168,910	$2,750,000	21	2	0
2011	500	$82,579,500	$165,159	$4,950,000	15	3	0
2012	499	$76,970,300	$154,249	$5,750,000	16	3	1
2013	470	$80,190,000	$170,617	$2,950,000	20	4	0
2014	464	$89,141,300	$192,115	$5,150,000	21	3	1
2015	418	$71,557,800	$171,191	$1,850,000	18	1	0
2016	422	$83,076,000	$196,863	$4,950,000	25	5	0
2017	484	$115,527,300	$238,693	$8,950,000	32	11	3
2018	461	$100,323,500	$217,621	$3,950,000	41	8	0
2019	458	$119,094,000	$260,031	$6,450,000	50	9	1
2020	410	$91,654,800	$223,548	$4,750,000	26	6	0
2021	427	$92,930,300	$217,635	$4,450,000	34	5	0
2022	505	$121,117,700	$239,837	$7,950,000	34	8	2
2023	534	$126,650,000	$237,172	$4,450,000	40	8	0

Summary

Texas has a relatively favorable malpractice environment for medical practitioners compared to other states. Adequate malpractice insurance is highly recommended in this state due to the risk of impacting patient care. It’s also important to conduct significant research on the available options before selecting a policy.