“Nuclear Verdicts” in Medical Malpractice Cases Are Not the Problem. So what is?

In recent years, the insurance defense industry has fixated on so-called “nuclear verdicts,” jury awards in medical malpractice cases that exceed $10 million. These verdicts have been portrayed as excessive, irrational, and harmful to the healthcare system. The latest industry reports, such as those from TransRe and WTW, lament the rising size of medical malpractice awards while conveniently omitting the human cost of medical negligence and the role insurance companies play in driving these outcomes.

This article continues a prior discussion on medical malpractice claims. It aims to counter the misleading claims made by the insurance industry, expose the flawed logic behind their statistics, and bring the focus back to where it belongs: the injured patients and grieving families whose lives have been irreparably altered by preventable medical errors.

The Real Story Behind Large Jury Verdicts

Insurance industry rhetoric paints large jury verdicts as the result of runaway juries acting emotionally rather than rationally. Outrageously, one article even goes so far as to suggest it is improper to “focus on the personal toll of medical errors” and “framing healthcare providers as negligent.” In reality, these so-called “nuclear verdicts” result from cases where the negligence is particularly egregious and the harm suffered is devastating. Consider the facts of cases often publicized as exhibiting “nuclear verdicts”:

• A newborn left permanently brain-damaged due to the failure to appreciate signs of fetal distress and perform a timely C-section. This child will never be able to care for himself or live on his own, and his parents were deprived of the joys of parenthood.
• A young mother who died because a hospital ignored clear signs of sepsis, resulting in little kids who will never know their mother and a husband who lost the love of his life.
• A patient left quadriplegic after a surgical error that could have been prevented with proper protocol. He can no longer care for himself. He lost all liberties and freedoms we take for granted.

These are not minor injuries. These are life-altering, catastrophic harms that leave families struggling to cover medical expenses, long-term care, lost wages, and the emotional devastation of a preventable tragedy.

The Misleading Use of Statistics

The insurance industry argues that the average size of the largest 50 medical malpractice verdicts has doubled recently, increasing from $27 million in 2019 to $56 million in 2024. However, this statistic is presented without context. Here’s what they leave out:

1. Inflation and Rising Medical Costs: Medical care, long-term rehabilitation, and home care have skyrocketed. A verdict that may have seemed large in 2010 would be insufficient today to cover a lifetime of care for a severely disabled patient.
2. Cases Were Delayed Due to COVID-19: Courts were shut down during 2020 and 2021, creating a backlog of high-value cases. The recent increase in large verdicts reflects the resumption of these cases, not a fundamental shift in jury behavior. However, I will permit the possibility that watching over a million Americans die a slow and traumatic death from Covid might have caused some people to value life a little more.
3. Selective Data Presentation: The industry focuses on the largest verdicts while ignoring the vast majority of cases that settle for much lower amounts. The average medical malpractice payout is around $400,000. Payout statistics do not include defense verdicts and dismissals. As reported in Forbes, over 80% of all medical malpractice lawsuits end with no payout.

Sadly, the other data that is left out is that only a small fraction of medical errors lead to claims, a smaller percentage of those cases ever go to trial, and of those, an infinitesimally small percentage result in “nuclear verdicts.”

Insurance Companies and Egotistical Healthcare Providers Drive Large Verdicts 

Ironically, insurance companies and healthcare providers, who view themselves as infallible, contribute to the very verdicts they decry. By refusing to settle clear cases of malpractice, they force injury victims to take their cases to trial, where juries—presented with overwhelming evidence of negligence—often respond with large damage awards. The same insurers then turn around and use these verdicts as a scare tactic to push for tort reform, arguing for caps on damages that would protect negligent healthcare providers at the expense of injury victims.

How This Strategy Backfires

Insurance companies often engage in aggressive claims-denial strategies, delaying or refusing fair settlements even in cases where liability is clear. Their goal is to deter claims and minimize payouts. Similarly, healthcare providers, possibly fearing employment ramifications for their negligent conduct, refuse to admit to their mistakes and, in some cases, prevent their insurance company from negotiating fair settlements. However, this strategy frequently backfires in spectacular ways:

1. Juries Punish Bad Faith Tactics – When jurors learn that an insurer had multiple opportunities to settle a case for a reasonable amount but instead forced a severely injured patient into prolonged litigation, they become more inclined to award punitive damages. Similarly, when negligence is fairly obvious from the facts, or the provider’s conduct defies expectations, jurors get frustrated by being forced out of their lives to parent the negligent healthcare provider. This transforms what could have been a $5 million settlement into a $50 million verdict.
2. Higher Litigation Costs – Prolonged legal battles drive up costs for both sides. By dragging out cases, insurers pay massive legal fees, expert witness costs, and administrative expenses, all of which contribute to the ultimate price tag. Some defense lawyers make anywhere from $500 to $1,000 an hour, with their support staff billing in large amounts, which disincentivized early care resolution.
3. Public Perception and Reputational Damage – Insurance companies complain about “runaway juries,” but the truth is that their own refusal to act reasonably creates the very verdicts they denounce. The health care industry also rolls the dice that either a judge or jury will absolve them of liability even when it is not deserved. Jurors, aware of these tactics, react by sending a clear message: companies and negligent healthcare providers that gamble with people’s lives will be held accountable.
4. Encouraging More Litigation — If insurance companies gained a reputation for settling meritorious claims fairly, plaintiffs would have less incentive to pursue costly, time-consuming litigation. Instead, their hardline stance forces more cases into court, increasing the likelihood of large verdicts.

“Healthcare has become a big business, and the corporatization of medicine now puts companies on the stand and not your local community hospital or your family doctor that you have known since birth,” Bill Burns, vice president of research for the Medical Professional Liability Association, told Medspace. Why is that important? Because Mr. Burns knows that, in the past, jurors never wanted to punish their local, small-town doctor — often ignoring that he had at least $1 million in liability insurance to make up for his mistakes. Today, jurors are aware that hedge funds and profit-driven corporations dominate the healthcare industry — focusing on profits over patient safety.

The Human Cost of Preventable Medical Errors

What’s often missing from industry reports is the perspective of the victims. Behind every large verdict is a person who has suffered immense harm. When a jury awards tens of millions of dollars, it’s not out of sympathy alone — it’s often because the evidence proves that the victim needs that money for basic survival.

This is supported by examples of recent high-profile cases:

1. A $261 million verdict against Johns Hopkins All Children’s Hospital in Florida in December 2023. The hospital intentionally imprisoned and separated a 10-year-old girl from her family for three months, forcing her to endure untreated pain and related issues, by claiming her family committed medical abuse. The girl’s mother killed herself because she was the focus of the hospital’s claims and thought it might be the only way to get her daughter back home with her family.
2. A $412 million verdict in New Mexico for a case involving botched penile injections and misdiagnosis. The compensatory award was around $37 million, reflecting the catastrophic injuries suffered; this joined the ranks of nuclear verdicts because the jury punished the defendants, through punitive damages, for running a multi-million dollar fraudulent scheme conning men into unnecessary and dangerous medical treatment.
3. A $183 million verdict upheld in Philadelphia for a birth injury case due to a delayed C-section. The jury awarded $10 million for past pain and suffering, $70 million for future pain and suffering, $1.7 million for lost earnings, and $101 million for future medical costs.

The Realities of a Typical Jury Verdict for a Medical Negligence Case

Again, we typically only hear about the large verdicts. Sensationalized to create anger and fear. The groups who pump out tort reform propaganda rarely ever tell you about the typical cases. The insurance defense industry never talks about the medical malpractice cases they win, either by technicality or jury verdict, despite the healthcare provider’s obvious negligence. You also rarely every hear about the typical outcomes.

Juries are given wide latitude in determining their verdict. Many courts do not allow the jury to identify how much it awards for each element of damages (e.g., past medical, future medical, past pain and suffering, future pain and suffering, wage loss, etc.). Many times, juries come up with nice round numbers because of human nature. Those numbers are often determined by factors outside the evidence presented in the trial.

If we look at the average case involving a 30-year-old woman, with two small children, who is paralyzed from the waist down, we would see that her economic losses as a result of her injury include:

• $8 to $20 million for lifetime medical care and rehabilitation, past and future, including in-home nursing, specialized treatments, and necessary medical equipment.
• $5 million for lost earnings, presuming she can no longer work or must work at a reduced capacity.
• $1 million for lost household services, reflecting the value of all the things a young mother does to raise her kids, care for her home, and ensure the safety of her loved ones.

These are not arbitrary figures. They reflect the actual financial losses that a medical malpractice victim can suffer. At a minimum, $14 million in financial losses. If the negligent healthcare provider is not paying for the damage they caused, then who will? Most likely YOU. You, me, and every taxpayer will be forced to bear the burden of negligent healthcare providers — and that does not seem right.

The above amounts do not include the human losses experienced by the mother having to live with the indignity of wearing a diaper, losing her freedom to come and go as she pleases, losing the ability to freely interact in a world that is not made for wheelchair-bound people, losing the ability to do the things with her kids as she used to, and all the other components that go with the loss of enjoyment of life. Gone are her freedoms, hopes, and aspirations. Pile on top the fact that her loved ones will be forced to become caregivers.

Cases like this demonstrate the severe consequences of medical errors that lead to life-altering injuries or death. As is apparent from just a few examples, the cost of 24-hour-per-day future medical care is immense. Missing from the calculations is that the injury victims must pay the lawyer for their time and effort (i.e., usually 40% of the total recovery), they must cover costs expended to litigate their case (i.e., medical malpractice cases can cost anywhere from $150,000 to $750,000 depending on the complexity of issues), many injury victims are forced to take out loans to cover their living expenses and healthcare needs, and then they have to pay back their health insurance company for injury-related care (i.e., this can exceed $1 million). The injury victim will need at least a $25 million verdict just to break even with financial losses.

Even when the attorney reduces their fee, since most good ones will, the injury victim is never adequately compensated for the harms and losses they suffered.

Conclusion: Reframing the Narrative

Juries don’t issue large verdicts arbitrarily. They do so when the evidence of harm is overwhelming, the negligence is clear, and the need for compensation is undeniable. The real crisis is not “nuclear verdicts,” but the preventable medical errors that devastate families and force them to seek justice in the first place.

Rather than blaming juries for holding negligent doctors and hospitals accountable, we should ask why these tragic errors happen in the first place. The focus should be on preventing medical mistakes, improving patient safety, and ensuring that those harmed receive full and fair compensation. The focus should not be on protecting the profits of insurance companies.

Full and fair compensation is the only way to provide justice for injury victims. If insurance companies and health care providers want to avoid large jury verdicts, then they need to eliminate preventable medical errors. Here are some high-level suggestions:

• Encourage critical thinking,
• Avoid understaffing,
• Avoid needless distractions,
• Implement and enforce patient safety protocols, and
• Own up to mistakes.

If you or a loved one is the victim of medical negligence and suffered life-altering catastrophic injuries or lost a loved one, then you need an experienced medical malpractice lawyer to help you get justice and the compensation you deserve.

About the Author

Joseph D'Aguanno

Guided by the belief that being a highly skilled specialist in a narrow field is better than being ordinary in everything, Joseph “JD” D’Aguanno leads Arizona’s best personal injury law firm in Phoenix, AZ. Having extensive cross-training in pre-litigation negotiations and trial lawyer skills, with decades of experience, JD strives to provide clients with the most valuable legal services a personal injury lawyer can provide. Under his direction, Gage Mathers Law Group is an award-winning personal injury law firm providing aggressive representation to victims of a car accident, medical malpractice, dog bite, motorcycle accident, and other injurious events. Gage Mathers is trusted by thousands of lawyers and clients throughout the country because of their reputation for getting clients the maximum compensation they deserve.

Years of experience: Over 24 years
Bar number: 020421
Location: Phoenix, AZ
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