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A Healthcare Professional Liability Forecast: Medical Services Sector

David Huss - Sep 30, 2021

As 2021 comes to a close, I wanted to provide you with a forecast for the medical services industry. The next six to twelve months will have major impact, and Ethos is ready. Healthcare professional liability trends, often abbreviated as HPL, have been firming for some time. However, medical services have been a tumultuous industry for the past fifteen months. Aggregating underwriters’ takes on both the two-year firming trend and the medical sector resulted in this forecast.

Standard Risk Physicians

I expect modest rate increases in most states through 2022. Why? For starters, competition is stiff, and this isn’t likely to change anytime soon. Right now, carriers are looking to counter negative claim-related development on a specialty and/or jurisdictional basis.

The company ProAssurance is of particular interest in this space. They’re a publicly-traded company, which is a major contrast to the mutual model taken by many medical malpractice writers in the US. What does this actually mean? Management is held to the highest standards of accountability by investors. When ProAssurance acquired and integrated NORCAL in May 2021, it changed the game.

ProAssurance is expected to modify the playbook for their new acquisition, and I think these changes will be significant. This move could impact other states and regions around the country.

Miscellaneous Physicians

In a previous article, I provided a forecast for non-standard physicians. However, there’s still ground to cover with physician staffing and correctional medicine.

Physician staffing usually firms up first. With this in mind, I expect 10-15% rate increases over the next twelve months. However, there are always aberrations. In this case, specialty and jurisdiction could prompt significant departures from the increases we forecasted. It’s also important to keep an eye on risks with nursing home/correction medicine exposures. These mandatory deductible rates are at risk of spiking.

Correctional medicine has always been uninsurable. Physician-driven correctional medicine risks are difficult to forecast, let alone ensure. This is especially true for staffing models. On a very selective basis, there is a small amount of capacity returning here. This trend is encouraging, but it’s important to remain conscious of risks when physicians contract directly with local/county facilities.


Volatility is the name of the game for hospitals, and it always has been. However, the departure of both CNA and Zurich continues to highlight this trend.

When looking at the numbers, we at Ethos noted that claim frequency remains stable. However, severity continues to increase. What does that mean for you? Carriers will likely push a 10% average rate increase on primary and excess placements over the next year. This means significant rate increases and departures, which of course will change on a risk-by-risk and carrier-by-carrier basis.

Miscellaneous Medical Facilities

Throughout a 15-year soft market cycle, miscellaneous medical facilities went the softest. Even with this factored in, this sector performed best for most carriers. I expect to see rate increases that range between 5-10 percent over the next twelve months.

Ethos Insights

  • COVID remains a significant source of uncertainty for carriers in the HPL arena. Claim-related developments, as a result of COVID in the coming year, could have a significant impact on these forecasts.

Claim-related developments, as a result of COVID in the coming year, could have a significant impact on these forecasts.

Ethos is a true specialist wholesale brokerage when it comes to HPL. If you have healthcare-related professional liability problems, give Ethos a call.

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