US malpractice payment risk map
Where medical malpractice payments happen, how large they are, and which way each state is heading. Built from the National Practitioner Data Bank Public Use Data File, covering 2017–2026.
Turn on the overlays to add payment size, the five-year trend, and each state’s cap on noneconomic damages. Drag the year slider to move through time. The map opens on 2025, the most recent complete year. 2026 is on the slider but covers only 3 months so far, and scaling three months up to twelve exaggerates ordinary quarter-to-quarter swings — read it as provisional.
What the colors mean
ranges shown for 2025Fill color — how often payments happenwhy0.23 per 1,000 physiciansMaine · from 1 payment17.97 per 1,000 physiciansNew Mexico · from 93 payments
Each state is shaded by malpractice payments per 1,000 patient-care physicians. Dividing by physician count is what keeps the comparison fair between large and small states — Texas has far more payments than Wyoming and far more doctors to go with them.
$ symbol — the average payment sizeoff$32,500North Dakota · average of 1 payment$1,356,296Wisconsin · average of 27 payments
The AVERAGE size of a single payment that year — total paid divided by number of payments — shown as a colored “$” at each state’s centre. Not the total paid out, which is a much bigger number. Kept separate from the fill color on purpose: a state can have many small payments (dark fill, green $) or rare but enormous ones (pale fill, red $). Those are different environments, and a single blended score would hide the difference. Small states swing a lot here — one very large settlement moves a state that saw only a handful of payments all year.
Inner glow — which way it is headingoff-92.6%Maine · from 1 payment+108.3%New Jersey · from 254 payments
Change in the payment RATE over five years — not in the raw number of payments, which would partly be measuring growth in the physician workforce. Green is steady or falling, amber is moderate growth, red is rising fast. The glow points inward so each state’s reading stays inside its own borders; an outward glow would sit on the line shared with its neighbour, describing neither state clearly.
Weather icon — the state’s damages capoffHostileWeakMixedFavorableNo enforceable capStrong, broad, stable cap
A single-factor read on the statutory environment: how strong the state’s cap on noneconomic (pain-and-suffering) damages is. Strong caps limit the ceiling on an award; weak or absent caps leave it open. This is hand-curated legal research, not payment data, and it does not change with the year slider. It is a research tool, not legal advice — verify any row with counsel before relying on it.
Hover or tap a state to preview it; click to keep it selected while you move to its link.
State rankings
Ranked by payments per 1,000 physicians in 2025 — the same measure as the map’s fill color.
| # | State | Payments per 1,000 physicians | Mean payment | Payments reported | 5-yr trend | Damages cap |
|---|---|---|---|---|---|---|
| 1 | New Mexico | 17.97 | $325,336 | 93 | +93.2% | Favorable |
| 2 | Pennsylvania | 13.22 | $455,476 | 605 | +29.0% | Hostile |
| 3 | Louisiana | 11.96 | $503,792 | 165 | -5.2% | Favorable |
| 4 | Florida | 9.01 | $393,825 | 576 | -2.1% | Mixed |
| 5 | New Jersey | 8.34 | $647,564 | 254 | +108.3% | Hostile |
| 6 | New York | 8.21 | $651,551 | 651 | -35.0% | Hostile |
| 7 | Indiana | 8.03 | $328,278 | 127 | -21.9% | Favorable |
| 8 | West Virginia | 7.27 | $440,372 | 37 | -18.2% | Favorable |
| 9 | Kentucky | 7.15 | $428,979 | 82 | +57.9% | Hostile |
| 10 | Oklahoma | 6.14 | $560,920 | 53 | -59.6% | Hostile |
| 11 | Alaska | 5.94 | $1,096,591 | 11 | -7.6% | Favorable |
| 12 | Montana | 5.88 | $272,574 | 17 | +42.2% | Favorable |
| 13 | Kansas | 5.82 | $294,378 | 45 | -2.3% | Hostile |
| 14 | Delaware | 5.76 | $509,844 | 16 | +43.6% | Hostile |
| 15 | Mississippi | 5.07 | $289,911 | 31 | +62.2% | Mixed |
| 16 | Nevada | 5.02 | $445,810 | 34 | +4.5% | Mixed |
| 17 | Missouri | 4.98 | $472,033 | 92 | +16.9% | Mixed |
| 18 | Georgia | 4.97 | $883,990 | 130 | -4.5% | Hostile |
| 19 | Hawaii | 4.78 | $622,288 | 20 | -0.9% | Weak |
| 20 | Illinois | 4.40 | $731,155 | 171 | +35.7% | Hostile |
| 21 | Idaho | 4.36 | $912,188 | 16 | +33.5% | Mixed |
| 22 | Utah | 4.33 | $420,714 | 35 | +28.9% | Mixed |
| 23 | Wyoming | 4.21 | $366,000 | 5 | +18.0% | Hostile |
| 24 | California | 4.09 | $353,171 | 477 | +0.5% | Mixed |
| 25 | Michigan | 3.93 | $290,144 | 130 | +14.9% | Mixed |
| 26 | Alabama | 3.85 | $618,370 | 46 | +95.9% | Hostile |
| 27 | Connecticut | 3.66 | $728,800 | 50 | +75.0% | Hostile |
| 28 | Maryland | 3.53 | $436,330 | 78 | -5.1% | Weak |
| 29 | Nebraska | 3.51 | $654,342 | 19 | +60.0% | Favorable |
| 30 | South Carolina | 3.46 | $474,462 | 46 | -22.4% | Mixed |
| 31 | Oregon | 3.27 | $494,881 | 42 | +4.9% | Hostile |
| 32 | Arkansas | 3.07 | $323,523 | 22 | -10.3% | Hostile |
| 33 | Washington | 3.06 | $872,330 | 66 | +15.9% | Hostile |
| 34 | Texas | 3.02 | $268,280 | 218 | -26.4% | Favorable |
| 35 | Massachusetts | 2.84 | $730,286 | 90 | +73.1% | Mixed |
| 36 | Arizona | 2.78 | $504,712 | 52 | -38.6% | Hostile |
| 37 | South Dakota | 2.65 | $281,167 | 6 | -36.1% | Mixed |
| 38 | New Hampshire | 2.50 | $856,818 | 11 | -29.6% | Hostile |
| 39 | Virginia | 2.06 | $539,566 | 49 | +8.0% | Favorable |
| 40 | Ohio | 1.91 | $444,931 | 72 | -14.8% | Mixed |
| 41 | Iowa | 1.91 | $533,482 | 14 | -31.6% | Weak |
| 42 | Tennessee | 1.73 | $558,438 | 32 | -34.5% | Weak |
| 43 | Colorado | 1.64 | $468,879 | 29 | +19.2% | Mixed |
| 44 | Wisconsin | 1.61 | $1,356,296 | 27 | -3.1% | Mixed |
| 45 | Rhode Island | 1.58 | $703,571 | 7 | -38.7% | Hostile |
| 46 | District of Columbia | 1.38 | $812,071 | 7 | +54.6% | Hostile |
| 47 | North Carolina | 1.11 | $430,492 | 32 | -44.5% | Weak |
| 48 | Minnesota | 0.87 | $425,984 | 16 | -28.1% | Hostile |
| 49 | North Dakota | 0.52 | $32,500 | 1 | -68.2% | Mixed |
| 50 | Vermont | 0.39 | $145,000 | 1 | -69.4% | Hostile |
| 51 | Maine | 0.23 | $135,000 | 1 | -92.6% | Hostile |
Where these numbers come from
Payments come from the NPDB Public Use Data File, which records every medical malpractice payment made on behalf of a physician after a written claim or judgment. Reports are counted by the state the physician worked in and the year the report was filed. NPDB re-cuts the file quarterly and revises past years, so these numbers can shift slightly between updates. 2026 covers only 3 months so far. Selecting it scales those months to a full-year estimate so the shape is comparable, and marks the result “est.” — but a single quarter is a small sample for one state, so treat individual states in that year with more caution than the national picture.
Physician counts — the denominator under every rate on this page — come from HRSA’s Area Health Resources Files, counting non-federal patient-care M.D.s and D.O.s, and originating with the AMA and AOA physician masterfiles. The most recent year actually measured is 2023. That data is published about two years behind, so 2024, 2025 and 2026 use the 2023 count carried forward. Rates for those years are therefore approximate, and will move when a newer release lands.
Colors are scaled within the selected year, not across all years. Every year uses the full color range, so a state can change color purely because it was re-ranked against the other states — without its own rate changing at all. Compare states within a year freely; compare a state against itself over time using the numbers rather than the colors.
Damages caps come from a hand-curated scorecard, version v0.3, as of 2026-06-07. It does not change with the year slider.
What this is not. Not a measure of medical quality, not a prediction of any individual’s risk of being sued, and not legal or actuarial advice. Payment data reflects historical payouts after a written claim or judgment, which is a narrower thing than “malpractice happened here.” The damages-cap scorecard is a research tool — verify any row with counsel before relying on it.