Few med mal claims lead to settlement

Healthcare providers know that many medical malpractice claims are without merit, but the common wisdom is that a great many of those are settled anyway. A new report, however, indicates that only one in five malpractice claims against doctors leads to a settlement or other payout.

Each year about one in 14 doctors is the target of a claim, and most physicians and virtually every surgeon will face at least one in their careers, according to the report in The New England Journal of Medicine. (The full text of the report is available free online at http://tinyurl.com/4x2khw8.)

The study was one of the largest ever to assess the risk and impact of malpractice claims. Researchers used data from one of the nation's largest national malpractice insurers and analyzed the experiences of about 41,000 physicians who bought coverage from 1991-2005.

The study found that about 7.5% of doctors have a claim filed against them each year, a figure a bit higher than that in the recent American Medical Association survey, in which 5% of doctors said they had dealt with a malpractice claim in the previous year.

Fewer than 2% of doctors each year were the subject of a successful claim, in which the insurer had to pay a settlement or court judgment. About 19% of neurosurgeons and heart surgeons were sued every year, which makes them the most targeted specialties. Pediatricians and psychiatrists were sued the least, with only about 3% of them facing a claim each year. However, when pediatricians did pay a claim, it was much more than other doctors. The average pediatric claim was more than $520,000, while the average for all other physicians was about $275,000.

"Our study uncovered an important aspect of malpractice liability: the high likelihood of claims that do not result in payments to a plaintiff. Annual rates of claims leading to indemnity payments ranged from 1% to 5% across specialties, whereas rates of all claims ranged from 5% to 22%," the authors write. "Our projections suggest that nearly all physicians in high-risk specialties will face at least one claim during their career; however, a substantial minority will not have to make an indemnity payment."

The authors note, however, that the low percentage of claims resulting in payout does not ameliorate the malpractice fear among physicians. Even those claims that do not result in payment still take a toll on physicians, they say.

"The perceived threat of malpractice among physicians may boil down to three factors: the risk of a claim, the probability of a claim leading to a payment, and the size of payment. Although the frequency and average size of paid claims may not fully explain perceptions among physicians, one may speculate that the large number of claims that do not lead to payment may shape perceived malpractice risk," they write. "Physicians can insure against indemnity payments through malpractice insurance, but they cannot insure against the indirect costs of litigation, such as time, stress, added work, and reputational damage."