August 22, 2018

Missouri Department of Insurance Releases Annual Report on Medical Professional Liability

Malpractice actions drop to an historic low

Jefferson City, Mo – The Missouri Department of Insurance has issued the Annual Report on Medical Professional Liability. This report is based upon data provided by insurers and self-insured hospitals to the department. The data includes open and closed claims that insurance companies and self-insured hospitals are required to report under Section 383.105 RSMo.

The highlights of this report include:

  • In 2017, poor underwriting results in Missouri were partially offset by higher investment returns, and insurers barely eked out a profit, earning a 0.2 percent return on net worth.  Last year, insurers were in the red by 1.5 percent of net worth.
  • In spite of this relatively poor financial showing, the number of malpractice actions dropped to an historic low.   In 2017, 734 claims were closed, of which 321 resulted in a payout to an injured party.  A total of 658 new claims were opened.  This compares with a high of 1,278 claims closed in 2007, and 1,514 claims reported in 2005. (See details in Chapter 1 of the report).
  • The average payout declined somewhat in 2017 to $403,222, compared with an average of $465,055 during the prior year.
  • Since 2005 (the earliest year for which data exists), all payouts exceeding $500,000 involved significant injuries, the most common of which were significant cognitive impairment, paraplegia and quadriplegia, amputations of one or more limbs, and loss of vision, hearing or other significant organ function.
  • Missouri implemented new caps for the amount that may be awarded in medical malpractice cases for non-economic damages (pain and suffering, loss of enjoyment of activities, and other nonpecuniary losses) in 2015.  Separate limits were established for non-severe injuries and catastrophic injuries, and were initially set at $400,000 and $700,000 respectively.   These caps are increased by a constant rate of 1.7 percent annually, and currently stand at $420,749 and $736,310. Amounts calculated out to 2050 can be found at   
  • New to the report is data related to “never events.”  As defined by the National Quality Forum[1], never events are adverse medical errors that are unambiguous, serious and usually preventable. The DIFP data suggests that never events are more common than their name might imply.  The most common, as well as the most costly, never event associated with malpractice actions is serious injuries due to falls, of which there were 597 since 2005, resulting in $62 million in payouts.  Other common never events were the retention of surgical material (350 actions with $24.9 million in payouts), medication errors (wrong medication/dose, 248 claims, $59 million payouts), serious injuries associated with pressure ulcers (272 / $40.7 million), and performing an invasive procedure/surgery on the wrong body part (128 / $22.7 million). 

The full report contains detailed tables extending back to 1990, including details regarding the nature and scope of injuries, the nature of alleged medical errors, frequency of claims and size of payouts.

[1] The National Quality Forum (NQF) was created in 1999 to allow both public and private healthcare leaders to provide guidance on best practices.   Governments at all levels have implemented NQF’s recommendations.  For example, Medicare will not reimburse for injuries caused by some “never events.”