At first glance, insights from Candello’s national medical malpractice database presents an encouraging narrative of progress. The declining frequency of claims suggests that fewer cases are being filed year after year across various healthcare settings, highlighting a positive shift that many in healthcare risk management and safety have strived to achieve for years. Yet, when reviewing 2025 data next to the prior decade, a more intricate reality comes to light.

While claims are becoming less common, they are also becoming more costly and more severe. That trend was at the center of a recent Candello discussion, where national data sparked a thoughtful conversation about where risk may be shifting next and what that means for healthcare leaders.

A familiar trend, with an unfamiliar edge

Over the last decade, the rate at which malpractice claims are filed has steadily declined across multiple measures and care settings. But beneath that trend lies a counterbalance: more cases are closing with payment, and average indemnity payments along with defense expenses are rising, even after adjusting for inflation.

The distribution of malpractice costs is not uniform. A limited number of cases, specifically those involving higher indemnity payments, represent a disproportionately large portion of total costs associated with malpractice. While these high-value claims are not as frequent, their financial repercussions are increasingly significant.

One of the more striking insights from the 2025 data is where that growth is occurring. While the most extreme verdicts draw headlines, much of the increase is now concentrated in what many consider the “middle” range of high-cost cases. These are not outliers, but they are frequent enough to reshape an organization’s overall exposure.

Severity, selectivity, and what gets paid

Another signal worth watching is the rising percentage of cases closing with an indemnity payment. This suggests that selectivity by both plaintiffs’ counsel and defense strategies may be evolving. Fewer weak cases advance, while those that do are more likely to result in payment.

The clinical severity of a condition still matters, but it's not as straightforward as before. We're seeing high-cost claims that don't always match the worst outcomes, raising questions about how financial risk is handled and which cases get the most attention.

During the study group discussion, this prompted a broader reflection: Are we focusing our prevention and mitigation efforts in the right places—or have certain types of cases become easier to pursue, settle, or overlook?

Diagnosis, clinical judgment, and persistent patterns

Across the data, diagnosis-related allegations remain a dominant driver of total losses. Whether tied to delayed or missed diagnoses, these cases continue to surface across care settings, particularly in ambulatory environments.

When exploring the factors affecting patient care, some themes consistently stand out. Clinical judgment is the most frequently cited issue, followed by lapses in communication and patient assessment. While these rates may vary annually, the overall trend remains stable, indicating that certain risks are entrenched in how care is delivered.

Even small shifts within these patterns can reveal emerging vulnerabilities long before they're noticeable at the organizational level, highlighting the need for ongoing vigilance in patient care.

Where cases happen

One of the more nuanced discussions focused on where claims arise and how their financial profiles differ.

Inpatient, ambulatory, and emergency department cases trend differently, not just in frequency but in likelihood of payment and the average indemnity amount. Emergency department cases, for example, are less likely to close with payment, but their average costs are often higher when they do.

These distinctions matter for targeting improvement efforts. Risk does not look the same across settings, and strategies that work in one environment may be ineffective in another.

The value of seeing the full picture

What made this conversation resonate was not any single metric, but the ability to view national data through multiple lenses at once: frequency and severity, clinical and financial drivers, care settings, and contributing factors.

The data raises important questions that cannot be answered in a single webinar or blog post. Where is risk accumulating next? Are mid-range claims becoming the new pressure point? How should organizations balance attention between rare catastrophic losses and the steady creep of costly “everyday” cases?

Those are exactly the conversations continuing inside the Candello Community.

For members, these discussions go deeper into the data behind the trends, the hypotheses worth testing, and the practical strategies peers are using to respond. Because when the landscape is shifting, insight alone is not enough. What matters is learning together.