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Physicians’ Insurance Limits and Malpractice Payments: Evidence 

from Texas Closed Claims, 1990-2003

Kathryn Zeiler,* Georgetown University 

Charles Silver,** University of Texas 

Bernard Black,*** University of Texas 

David A. Hyman,**** University of Illinois 

William M. Sage,***** Columbia University 

(draft May 2006)

 

ABSTRACT 

Although tort liability is supposed to encourage health care providers to reduce the risk 

of patient injuries, medical malpractice insurance is thought to dampen this deterrent 

effect by insulating physicians from the costs of claims. The degree to which 

malpractice insurance protects physicians from these costs has never been quantified, 

however, and the oft-heard claim that every physician is “one lawsuit away from 

financial disaster” suggests that doctors face significant exposure in malpractice 

lawsuits, despite being insured. This study quantifies the frequency with which insured 

physicians pay out of their own pockets to satisfy malpractice claims. Using Texas 

Department of Insurance data on closed medical malpractice claims for 1990-2003, we 

find that claimants frequently received the available primary coverage and rarely 

recovered more. Physicians almost never used personal assets to cover paid claims. In 

addition, we find that even though Texas physicians with paid claims purchased less 

real coverage over time, claim rates and average payments remained relatively stable 

over the period of study.

Physicians’ Insurance Limits and Malpractice Payments: Evidence 

from Texas Closed Claims, 1990-2003

Kathryn Zeiler, Charles Silver, Bernard Black, David A. Hyman & William M. Sage*

I. INTRODUCTION 

Although tort liability is supposed to exert pressure on physicians to improve 

patient safety, “the evidence that the [malpractice] system deters medical negligence can 

be characterized as limited at best.”1

 The problem may have many causes, including 

malpractice insurance. Because it insulates physicians from the direct costs of errors, 

malpractice insurance is thought to dampen their incentives to exercise reasonable care.2

The degree to which insurance protects physicians has never been quantified, 

however, and the oft-heard lament that every physician is “one lawsuit away from 

financial disaster” suggests that the protection they enjoy is far from complete.3

 If 

physicians bear considerable personal exposure despite being insured, the liability system 

should generate at least some pressure to improve safety. Alternatively, if their personal 

exposure to malpractice claims is small, liability would have no deterrent effect unless its 

*

 Please address correspondence to Kathryn Zeiler at [e-mail]. 

We benefited greatly from helpful discussions with the Georgetown Junior Group (James Forman, Kris 

Henning, Greg Klass, John Mikhail, Nick Rosencrantz and David Vladeck), and received comments from 

Stephen Salop. We presented earlier versions of this article at the Georgetown University Law Center, New 

York University School of Law, the Northwestern University Law School, and the University of Texas 

School of Law, and are grateful for comments received on those occasions. We owe special thanks to 

Vicky Knox at the Texas Department of Insurance. Thanks also to JaeJoon Han, An-Shih Liu, and Rachel 

Miras-Wilson for excellent research assistance. Funding for this study was provided by [include funding 

sources here]. 

1

 David M. Studdert, Michelle M. Mello, and Troyen A. Brennan, Medical Malpractice, N. Engl. J. Med. 

350:3 283, 286 (Jan. 15, 2004) 

2

 Paul C. Weiler et al., A Measure of Malpractice: Medical Injury, Malpractice Litigation, and Patient 

Compensation 114 (1993). Uninsured costs of litigation, such as psychological stress and reputational loss, 

may nonetheless motivate physicians to protect patients from harm. 

3

 Robert Lowes. Protect your assets before you're sued. Medical Economics Feb. 21, 2003, pp. 80-82. [add 

additional cites]

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