AM Best Upgrades The Doctors Company to A+ Following ProAssurance Acquisition

October 28, 2026 by matray

AM Best has upgraded the Financial Strength Rating of The Doctors Company Insurance Group to A+ (Superior) from A (Excellent), citing the medical professional liability insurer's strengthened market position following its acquisition of ProAssurance Corp. in June.

The rating agency also upgraded the group's Long-Term Issuer Credit Rating to “aa-” (Superior) from “a+” (Excellent), according to an Oct. 27 announcement. The outlooks for both ratings were revised to stable from positive.

The upgrades reflect AM Best's decision to raise its assessment of The Doctors Company's business profile to favorable from neutral, recognizing its position as the second-largest writer of medical professional liability insurance in the United States and the additional scale provided by the ProAssurance acquisition.

AM Best cited the group's geographic diversification and broad mix of insured healthcare providers, along with an experienced management team and innovation initiatives that are producing increasingly measurable business results.

The rating agency assessed The Doctors Company's balance sheet strength as strongest, its operating performance as adequate and its enterprise risk management as appropriate.

The group continues to maintain the strongest level of risk-adjusted capitalization, as measured by Best's Capital Adequacy Ratio. Consistent underwriting and overall operating results have supported surplus growth over the past five years.

Although AM Best expects the ProAssurance acquisition to modestly weaken underwriting performance in the near term, it anticipates that the combined organization's greater scale will contribute positively to overall earnings. Significant net investment income is expected to offset modest underwriting losses.

The Doctors Company completed its approximately $1.3 billion acquisition of ProAssurance in June, significantly expanding its presence in the U.S. medical professional liability insurance market.

The rating upgrades apply to The Doctors Company, An Interinsurance Exchange, and five core subsidiaries: TDC National Assurance Co., TDC Specialty Insurance Co., TDC Special Risks Insurance Co., The Doctors Company Risk Retention Group and Hospitals Insurance Co.

CFC Expands Affirmative AI Coverage to eHealth, Professions Policies

October 27, 2026 by matray

Specialty insurer CFC has expanded its affirmative artificial intelligence coverage to its eHealth and Professions insurance products, introducing policy language intended to clarify how coverage responds when AI contributes to an insured loss.

The company announced Oct. 27 that it has added affirmative AI language to its global eHealth product and U.S. Professions policy, with equivalent endorsements available for professional liability policies in other markets.

The eHealth enhancements address a range of AI-related exposures, including errors, algorithmic bias, AI hallucinations and failures involving technologies such as ambient clinical documentation tools and software supporting clinical trials. CFC said its entire suite of healthcare package products has been updated to include affirmative AI coverage.

The changes are intended to clarify coverage when AI is incorporated into an insured's business operations and contributes to a claim, an increasingly relevant issue as healthcare organizations adopt AI technologies for patient care, administrative functions and clinical research.

"Insurance policies must step up and clarify intent of coverage when it comes to AI related loss," said Ellie Saunders, CFC's head of healthcare and life sciences. "Our eHealth policy does exactly that, affirming our position where AI is used within an insured's business model that contributes to, or causes, loss."

Affirmative AI coverage expressly addresses AI-related exposures in policy language rather than leaving coverage questions to interpretation under existing provisions. The clarification is particularly relevant to healthcare organizations using AI-enabled technologies that may contribute to professional liability claims.

CFC also expanded its Professions product to clarify coverage for AI-related exposures arising from professional services firms' client-facing activities and routine business operations.

Ed Cole, CFC's professional liability, healthcare and life science development leader, said the growing use of AI creates risks alongside its potential benefits.

"Without the right governance, risk management and insurance protection in place, businesses may face significant exposure," Cole said. "By introducing affirmative AI coverage across our Professions policy, we're providing greater clarity around how cover responds to AI-related exposures."

The expansion is part of CFC's broader initiative to introduce affirmative AI coverage across its insurance portfolio. The company said its products now expressly address AI-related risks in media, intellectual property, financial services, cyber, healthcare and professional services.

AM Best Revises Coverys Outlook to Stable, Affirms A Rating

October 26, 2026 by matray

AM Best has revised its outlook for Coverys Companies to stable from negative, citing improved operating performance, stronger earnings and surplus growth, while affirming the medical professional liability insurer's Financial Strength Rating of A (Excellent).

The rating agency also affirmed the Long-Term Issuer Credit Ratings of “a” (Excellent) for Medical Professional Mutual Insurance Co. and its affiliated companies, collectively known as Coverys, according to an Oct. 23 announcement.

The outlook revision reflects improved operating results in recent years and through the first half of 2026, along with AM Best's expectation that Coverys' future performance will generally align with medical professional liability insurers receiving an adequate operating performance assessment.

Although challenging conditions in the MPL market continue to pressure underwriting results, Coverys has benefited from consistent and growing net investment income, allowing the company to report positive pretax earnings in each of the past three years and through the first six months of 2026. Realized capital gains also have contributed significantly to earnings in recent years.

AM Best said these developments have improved the group's overall operating ratios and measures of profitability.

The rating agency assessed Coverys' balance sheet strength as very strong, its operating performance as adequate, its business profile as neutral and its enterprise risk management as appropriate.

Coverys continues to maintain the highest level of risk-adjusted capitalization, as measured by Best's Capital Adequacy Ratio. Improved operating results also have allowed the company to increase its surplus over the past three years and through the first half of 2026.

However, AM Best noted that persistent adverse development of prior-year loss reserves prompted it to lower Coverys' balance sheet strength assessment from strongest to very strong. The agency said it will continue monitoring the company's loss reserves and related developments.

Coverys ranked as the seventh-largest U.S. MPL insurer based on direct premiums written in 2025, according to AM Best.

The company's management remains focused on improving its core U.S. MPL business while diversifying operations through expansion of its accident and health insurance lines and international MPL presence.

AM Best also cited strengthened leadership across the organization and an established enterprise risk management framework as supporting the group's operations.

The ratings and revised outlooks apply to Medical Professional Mutual Insurance Co., ProSelect Insurance Co., Preferred Professional Insurance Co., Coverys Specialty Insurance Co., Coverys Risk Retention Group Inc., Coverys Limited and Coverys International Insurance Company Designated Activity Company.

Pennsylvania Bill Would Restrict Interest, Delay Damages on Periodic Medical Malpractice Payments

October 22, 2026 by matray

Pennsylvania lawmakers have introduced legislation that would prohibit prejudgment interest, postjudgment interest and delay damages from accruing on periodic payments of future damages in medical malpractice cases before those payments become due.

House Bill 2842 would amend Section 509(b)(4) of Pennsylvania’s Medical Care Availability and Reduction of Error (Mcare) Act, which governs the payment of damages in medical professional liability cases.

Under existing law, interest does not accrue on periodic payments of future damages before the payments become due. The proposed amendment would expand the language to explicitly prohibit prejudgment interest, postjudgment interest and delay damages from accruing before a scheduled payment is due.

The legislation would retain the existing requirement that interest accrue at the legal rate beginning on the due date if a periodic payment is not made on time.

The proposed change could have financial implications for medical professional liability insurers and healthcare defendants by clarifying which additional damages may be assessed against future payments made periodically rather than in a lump sum.

Prejudgment interest generally compensates plaintiffs for the period before a judgment is entered, while postjudgment interest accrues after judgment. Delay damages are intended to compensate plaintiffs for delays in receiving compensation.

By expressly addressing all three categories, the legislation would clarify the treatment of interest and delay damages on scheduled future payments. The bill would not change the underlying damages awarded or eliminate interest on payments that become overdue.

HB 2842 was introduced Oct. 6 by Republican state Rep. Eric Nelson and three co-sponsors, Reps. David Rowe, Brian Verobish and Jamie Wallen. The measure was referred to the House Judiciary Committee on Oct. 7.

If enacted, the legislation would take effect in 60 days.

Lloyd’s, London Insurers Establish Joint Healthcare Claims Group

October 22, 2026 by matray

The Lloyd's Market Association (LMA) and International Underwriting Association (IUA) have established a joint healthcare claims group to address emerging risks, evolving litigation trends and increasingly complex liability issues affecting healthcare insurers.

The Joint Healthcare Claims Group brings together claims specialists from the Lloyd's insurance marketplace and London's company insurance market to share expertise, identify emerging challenges and develop best practices for handling healthcare-related claims.

The initiative comes as healthcare insurers navigate changing legal and regulatory environments and shifting claims and litigation trends, according to the organizations.

The group will be co-chaired by Xanthe Boyle, chief claims officer at Coverys London, and Georgia Billington, casualty claims manager at Dale Underwriting Partners.

"Healthcare remains a specialised and continually evolving class of business," said Janine Powell, claims director at the LMA. "By creating a single forum for healthcare claims specialists from across the Lloyd's and company markets, we can help ensure the London market continues to provide innovative and effective solutions for clients."

The group's responsibilities include identifying and investigating significant healthcare claims issues, initiating projects to address emerging challenges and developing best practice solutions for the healthcare insurance market. It also will engage with industry stakeholders and provide technical expertise to relevant underwriting committees.

The initiative could provide a forum for examining issues affecting medical professional liability insurers, including complex malpractice litigation, claims severity and evolving liability exposures. However, the organizations have not identified specific research projects or announced whether U.S. medical malpractice litigation will be among the group's priorities.

Joe Shaw, director of claims at the IUA, said the initiative will encourage greater cooperation among insurers operating in London's two principal insurance markets.

"This new group provides an opportunity to bring together expertise from both associations, encourage greater collaboration between claims practitioners and support discussion on the issues most important to the sector," Shaw said.

The LMA represents managing agents operating in the Lloyd's marketplace, while the IUA represents companies providing international and wholesale insurance and reinsurance coverage through the London company market.

The new group is part of the organizations' broader efforts to strengthen technical expertise, encourage cooperation among claims professionals and promote best practices across the London insurance market.

AM Best Maintains Negative Ratings Review for Curi Insurance Group

October 22, 2026 by matray

Medical Liability Monitor Publishes 2026 Annual Rate Survey, Finds Modest Premium Increases Despite Mounting Pressures

October 22, 2026 by matray

Medical professional liability insurance rates increased an average of just 1.8% in 2026, despite mounting concerns about claim severity, underwriting profitability and other pressures facing the industry, according to the newly published Medical Liability Monitor Annual Rate Survey.

Now in its 36th year, the Annual Rate Survey provides a comprehensive examination of medical malpractice insurance pricing across the United States, comparing premiums by insurer, state, county and medical specialty.

The 1.8% national average increase was slightly below the 1.9% recorded in 2025, continuing a period of relatively modest rate changes even as insurers confront rising liability costs.

Approximately 38% of rates reported to the Survey increased in 2026, compared with 35% in 2025. Another 53% remained unchanged, while 9% decreased.

The findings come as the medical professional liability (MPL) insurance industry continues to face underwriting challenges. The industry's combined ratio deteriorated to 107.4% in 2025, marking its 12th consecutive year of underwriting losses.

At the same time, competition for market share has prompted some insurers to reduce premiums, raising questions about the sustainability of current pricing strategies.

The Survey's Executive Summary, titled "MPL Pricing: Meet the New Rates, Same as the Old Rates," examines the apparent disconnect between rising liability costs and restrained premium increases, exploring what current market conditions may signal for the industry's future.

What the 2026 Annual Rate Survey Covers

The Survey examines mature claims-made premium rates for internal medicine, general surgery and obstetrics/gynecology, with coverage limits of $1 million per claim and $3 million annually.

For the second consecutive year, the Survey also includes medical malpractice insurance rates for nurse practitioners, allowing for comparative analysis of pricing trends in this growing segment of the healthcare workforce.

Beyond its detailed physician premium comparisons, the 2026 Survey examines pricing conditions across four major segments of the MPL marketplace: physicians, hospitals, other healthcare professionals and other healthcare facilities.

Additional analysis explores:

• Insurer competition and underwriting profitability
• Medical malpractice claim severity and social inflation
• Reinsurance pricing and market conditions
• The growing influence of artificial intelligence
• Regulatory rate filings and insurer pricing strategies
• Emerging pressures affecting the broader MPL marketplace

The Survey reports premium rates effective July 1, 2026, and also examines regulatory filings that may signal future pricing changes.

How to Purchase the 2026 Annual Rate Survey

The 2026 Annual Rate Survey is available for individual purchase or as part of an annual subscription to Medical Liability Monitor.

Purchase the Annual Rate Survey individually: Readers who want the 2026 Survey without an annual subscription can select the stand-alone purchase option.

Digital subscription — $499 annually: Includes the Annual Rate Survey and 12 monthly issues of Medical Liability Monitor delivered digitally.

Digital plus hardcopy subscription — $599 annually: Includes the Annual Rate Survey and 12 monthly issues in both digital and print formats.

Discounts are available for multiple subscriptions.

Purchase the 2026 Annual Rate Survey or Subscribe to Medical Liability Monitor For additional information or assistance with purchasing, contact editor@medicalliabilitymonitor.com.

AI in Patient Care: Managing Malpractice Risk

October 20, 2026 by matray

by Valerie Grove 

Editor’s Note: The following opinion article was contributed by Valerie Grove, a medical malpractice attorney with Joseph Greenwald & Laake. As states increasingly enact laws requiring disclosure of artificial intelligence use in patient care, questions surrounding medical liability remain largely unresolved. Grove examines the emerging legal risks associated with AI-assisted diagnosis and documentation, the responsibilities of physicians using these technologies and the potential implications for medical malpractice litigation. The views expressed are those of the author and do not necessarily reflect those of Medical Liability Monitor. 

In primary care and emergency departments, the use of ambient scribes – artificial intelligence tools that record and transcribe the audio of medical visits – has become standard practice, and other AI diagnostic tools, such as radiology imaging overreads, are emerging for use in the medical field as well. As these tools become more common, they will introduce new risks for physicians when errors occur. At this point, AI has only been at the center of a few medical malpractice cases, so the legal framework around these cases is still evolving – potentially exposing physicians to liability.  

Where Ambient Scribes Create Risk

While ambient scribes are helpful, they have limits. Most obviously, they can’t see or hear the physical exam, so if the physician doesn’t voice their observations, the note will have no record of it. 

Similarly, a patient’s nonverbal cues are not captured or considered by AI scribes. Limping or visible pain will not be noted in the transcript unless the provider adds it while reviewing the note. 

There is also an understated risk embedded in the way these tools are designed to function. AI is a statistical prediction tool, so it doesn’t flag ambiguous audio for uncertainty. Instead, it resolves the ambiguity independently, often inventing data and findings to resolve its uncertainty or question without notifying the provider it did so, potentially resulting in a hallucination that then enters the medical record. 

An additional layer of risk arises once physicians get used to AI. Studies suggest that when physicians become comfortable with these tools, they rely on them more, which leads to more errors. This overreliance without verifying is the leading malpractice risk with the use of scribes today. 

Informed Consent Remains Untested

Several states have enacted laws requiring physicians to disclose the use of AI tools – and paperwork that simply says a hospital “may use AI” is unlikely to withstand a legal challenge as to the sufficiency of informed consent. 

Legally, informed consent is defined as what a reasonable healthcare provider should disclose to a patient regarding a particular risk. Since the use of an AI tool in patient care creates risk, it needs to be properly disclosed. Simply Including a statement in an intake form that AI may be used likely will not be sufficient informed consent since it doesn’t inform the patient about what the tool does, the risks to the patient, its limitations nor that ability for the patient to “opt out” of the use of AI for his or her clinical care. Providers should, at a minimum, communicate with the patient about the use of the tool and the potential risks involved while clarifying to patients that the technology does not replace their own exam, assessment and diagnosis. 

While including this type of disclosure may satisfy the requirements of informed consent, it would, of course, be fact specific, and AI informed consent requirements have not been tested in court. 

A Tool in the Eyes of the Law 

With little case law in this area to date, the law treats AI like any other instrument a physician uses. Any shift in this approach is likely to be narrow and tied to specific facts – for example, proof that no reasonable physician in similar circumstances would have relied on a particular output such as an imaging result that they would have recognized as wrong on review. 

Who Gets Named in a Claim 

When a patient becomes the victim of an AI error, the physician who delivered their care becomes the target of the medical malpractice claim, not the AI software company. Because the patient has no direct contractual relationship with the AI company, any claim against the software company would not likely survive a motion to dismiss. Unlike a product liability case where, for example, a manufacturer of a defective toaster would be held liable because the product was marketed and sold directly to consumers for their use, AI software is used by the physician rather than his or her patients. 

Best Practices for Physicians

The guidance for physicians is clear: Proceed with extreme caution and review every output, every time. An AI diagnostic result is not a replacement for a consultation with a specialist; and that initial AI output still requires an independent review. Physicians must continue to apply their training, experience and judgment and avoid overreliance on artificial intelligence that can introduce errors. 

Physicians should read their professional liability policies and ensure they understand their coverage. Carriers are regularly rewriting terms in response to AI and the changes it’s bringing. Some policies contain clauses that exclude coverage for incidents involving certain AI situations while others require a separate rider for AI coverage. Providers should confirm with their broker or agent that their policies cover AI hallucinations and negligence actions that sound in AI errors.  

The law around AI and malpractice is still developing, but for now, the risk rests with the physician. Review every output, disclose AI use to patients and confirm coverage before a claim forces the question. Errors will happen, but preparation can prevent a manageable incident from becoming a costly one.   

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Valerie Grove is a principal at law firm Joseph Greenwald & Laake, where she focuses her practice on representing injured victims of medical malpractice using her 20 years of experience litigating medical negligence cases. She previously represented providers in malpractice litigation and related health law issues. She can be reached at vgrove@jgllaw.com. 

Iowa Appeals Court Reverses $250,000 Damages Cap in Stillbirth Malpractice Case 

October 20, 2026 by matray

The Iowa Court of Appeals ruled that a trial judge improperly limited the damages recoverable by parents whose baby was stillborn following alleged medical negligence. The appellate court found that a jury should determine whether the case qualifies for exceptions to Iowa’s $250,000 noneconomic damages cap, including death, substantial impairment of bodily function and substantial disfigurement. The court reversed the ruling and remanded the case for further proceedings. 

Case: Anderson v. Posthuma, No. 25-0865, 10/07/2026, published.  

Facts: Miranda Anderson was 34 weeks pregnant on April 13, 2021, when she first showed troubling symptoms with her pregnancy. Anderson saw Dr. Richard Posthuma at Pella Regional Health Center. He diagnosed Anderson with preeclampsia.  

Anderson was in and out of the hospital over the course of the next few days.  

On April 21, 2021, an ultrasound revealed Anderson’s baby no longer had a heartbeat. Anderson underwent emergency cesarean surgery to deliver her stillborn child.  

Procedural history: Anderson and her husband filed suit against Posthuma and PRHC for medical malpractice.   Prior to trial, Posthuma and PRHC filed a joint motion for partial summary judgment arguing that Iowa Code Section 147.136A(2) capped the Andersons’ damages at $250,000.  

The statute limits the total amount recoverable in any civil action against a healthcare provider for noneconomic damages for personal injury, unless the jury determines that there is a substantial or permanent loss or impairment of a bodily function, substantial disfigurement or death.  

A trial judge grated the motion.  

Analysis: The Iowa Court of Appeals noted that under Iowa law, a survival action for wrongful death cannot be brought on behalf of an unborn child, but a parent can bring a loss of consortium claim for an unborn child. The court reasoned the Andersons could sue for the expense and actual loss of services, companionship and society resulting from the in-utero demise of their baby.  

The court further said a reasonable jury could find Section 147.136A(2)’s death exception applied to this case, and the judge erred in finding it did not apply as a matter of law.  

The court said there was sufficient evidence to allow reasonable jury to find that Miranda Anderson’s ability to give birth only through cesarean section because of the defendants’ alleged negligence was a substantial or permanent loss or impairment of bodily function as well, so the erred in finding this exception inapplicable.  

Whether Miranda Anderson’s scar from the cesarean section is a substantial disfigurement also should have been left to a jury, the court said. “While a scar is not substantial disfigurement per se, it can rise to such a level and is for the jury to decide.”  

Disposition: Reversed and remanded.  

To read the court’s decision, click here. 

AMA Calls for Stronger FDA Oversight of Generative AI in Clinical Care

October 20, 2026 by matray

The American Medical Association has called on the U.S. Food & Drug Administration to establish a risk-based regulatory framework for generative artificial intelligence in medicine, emphasizing the need for clinical evidence, ongoing performance monitoring and manufacturer accountability as AI systems assume increasingly complex roles in patient care.

In an Oct. 19 letter to Rick Abramson, MD, director of the FDA’s Digital Health Center of Excellence, the AMA outlined recommendations for evaluating and regulating generative AI-enabled medical devices. The recommendations respond to an FDA discussion paper released Aug. 18 seeking public input on how the agency should oversee the emerging technology.

The AMA urged regulators to balance technological innovation with patient safety, warning that more flexible regulatory approaches must not weaken standards for demonstrating the safety and effectiveness of AI-enabled medical devices.

The organization identified two central principles for FDA oversight: Regulatory flexibility should not compromise patient safety, and physician involvement in evaluating AI technologies should not substitute for manufacturers demonstrating that their products perform safely and reliably.

The AMA recommended that regulatory requirements reflect a device’s intended clinical use, potential for patient harm and performance throughout its operational life. It also called for stronger post-market surveillance to identify problems that may emerge after AI systems enter clinical practice.

Unlike conventional medical software, generative AI systems can produce new content and perform increasingly sophisticated clinical functions, raising questions about how regulators should assess their reliability and monitor changes in performance over time.

The AMA emphasized that physicians should play a central role in developing clinical performance standards and identifying potential risks. However, it cautioned against relying on physician oversight as the primary safeguard against deficiencies in AI systems.

According to the organization, physician expertise should inform how AI performance is evaluated, but manufacturers must remain responsible for establishing that their products meet appropriate safety and effectiveness standards.

"Manufacturers must remain accountable for the performance of their products, and patients and physicians deserve the confidence that these technologies are safe and effective," said AMA president Willie Underwood, MD.

The AMA offered to collaborate with the FDA and other stakeholders to develop standards for physician evaluation of AI-generated clinical information, ongoing performance assessments and identification of AI failures that could affect patient care.

The recommendations come as the FDA considers new approaches to regulating generative AI-enabled medical devices. Its August discussion paper proposed a framework for assessing device risks, evaluating clinical performance before products reach the market and monitoring their safety after deployment.

The agency also sought feedback on the regulatory implications of increasingly autonomous AI systems capable of performing clinical tasks.

The AMA supports an approach that minimizes unnecessary regulatory burdens while maintaining safeguards proportionate to the risks posed by individual technologies.

The organization's recommendations also have implications for medical professional liability as AI systems take on more consequential clinical responsibilities, raising questions about the respective roles of physicians, technology developers and manufacturers when AI-generated information contributes to patient care.

The AMA has separately developed a governance framework addressing liability, licensure and regulation as increasingly capable AI systems assume clinical functions.

The organization said it intends to continue working with federal regulators, technology developers and physicians to establish standards that support innovation while protecting patients.