Nuclear verdicts are growing at an alarming pace. Healthcare risk managers face increasing challenges in purchasing an insurance tower sufficient to withstand a nuclear verdict. Filling the tower can be difficult as insurers assess their willingness to bear nuclear verdict risk, and existing insurance towers may not provide adequate coverage in this new environment. Stress testing your organization’s current insurance program, including limits, retentions, and deductibles, and benchmarking now will help assess your organization’s exposure. Reviewing available coverage for punitive and exemplary damages will help avoid unpleasant surprises. And scrutinizing certain key policy terms and negotiating better terms can reduce your organization’s potential exposure to a nuclear verdict. Finally, educating your legal department and outside defense counsel will help to avoid disputes with your insurers when developing legal strategy.
Nuclear Verdicts Are on the Rise
A “nuclear verdict” — generally a jury award of $10 million or more — used to be a rare event in healthcare litigation. The average of the top 50 medical malpractice verdicts nationally rose from $32 million in 2022 to $48 million in 2023 and reached $56 million in 2024. By August 2025, the median verdict among awards of $5 million or more had climbed to $16 million, up from $13 million in 2018. “Thermonuclear” verdicts — those exceeding $100 million — are now a regular event. The American Medical Association reports that medical malpractice verdicts of $10 million or more rose roughly 67% between 2013 and 2023, and states recording at least one nuclear verdict climbed from 19 to 21 between 2018 and 2024 as the annual count of these verdicts rose from 25 to 52. Industry-wide, hospital and physician professional liability benchmarking now tracks well over $30 billion in incurred losses.
Examples include a $951 million default judgment for a birth injury at a Utah hospital, a $207.6 million verdict for a birth injury at a Pennsylvania hospital, and a $70.8 million award against a Florida hospital for a delayed-stroke-diagnosis case. Analysts point to litigation funding, anchoring tactics at trial, broader theories of corporate and systemic liability, and declining juror trust in large institutions. These forces raise verdicts even where an individual organization’s own safety record and claim frequency have not changed.
Stress Test Your Organization’s Coverage Tower
Given this expanding risk, consider re-assessing your insurance tower. Evaluate the impact of a single worst plausible claim type (a birth injury, a failure-to-diagnose case, an elder-neglect claim) through years of litigation and mounting defense costs, on your coverage limits as well as your organization’s ability to fund any verdict or settlement exceeding the limits. Hospital and physician professional liability policies are typically “defense-within-limits” policies, unlike standard general liability policies, which usually provide defense in addition to the limit. That structural difference matters a great deal here: Industry benchmarking projects the average cost to defend a malpractice claim at roughly $442,000, and a handful of hard-fought, expert-heavy cases can consume a meaningful share of a limit before a dollar reaches a plaintiff.
Because nuclear verdicts have grown so rapidly in just a few years, consider benchmarking your tower’s limits now if more than two years have passed since the last benchmarking exercise. Limits that could have been adequate just two years ago may not be adequate today. Revisit self-insured retentions and deductibles — are they properly set for your organization?
Evaluate Policy Terms
Take time before your next renewal to evaluate key definitions and terms. Ensure that your policies’ definitions of “damages” or “loss” include punitive and exemplary damages, including “most favored venue” wording, which permits coverage under the law of whichever connected jurisdiction is most favorable to coverage for punitive damages. If coverage is not available, consider purchasing punitive wraps as protection for this exposure.
Educate Your Organization’s Legal Staff and Outside Counsel
Finally, ensure that in-house legal staff, as well as outside counsel, charged with defending bodily injury claims understand the limits — financial and substantive — of your organization’s insurance program to avoid missteps during litigation. Educate them on critical exclusions that could torpedo otherwise available insurance coverage if proven at trial, and ensure that they understand your insurers’ rights under the policy to monitor or even participate in or control defense and settlement. Establishing a smooth working relationship with your insurers while litigating a claim could minimize insurer resistance to settlement or defense counsel’s recommendation to proceed to trial.
A Few Steps Now for Better Results Later
While these steps will not avoid a nuclear verdict, they can protect your organization from the financial blow resulting from a jury verdict that could otherwise cost your organization millions or hundreds of millions of dollars. Turning to this task well before policy renewal could make a difference for your organization when faced with this expanding risk.