The Death Discount

• Three survivable outcomes settle higher than death. Ranked by median payment, death comes 4th of 10. Above it sit quadriplegic, brain damage, lifelong care, major permanent injury, significant permanent injury — all outcomes where the patient lives.
• The gap is structural, not statistical. Brain-damage cases skew toward infants and death cases toward ages 50–70, so we compared them inside each age band. The gap survives in all 12 bands — 3.22× for the youngest patients, still 1.8× at its narrowest.
• The reason is what the law lets you claim. A wrongful-death claim belongs to the survivors and covers their losses — support, services, companionship. The patient’s own pain and suffering generally is not recoverable there; where it survives it belongs to a separate survival action that several states restrict. A catastrophically injured patient who lives claims a lifetime of future medical care, lost earning capacity and their own pain and suffering. The dead plaintiff stops accruing damages.
• The discount is narrowing. In 2005 the brain-damage median ran 3.54× the death median; in 2025 it was 1.59×. The death median itself climbed from $195,000 to $375,000.
• Where you die matters more than most people expect. Among the 30 states with enough volume to compare, the median death payment runs from $57,500 (PR) to $595,000 (CT) — a spread of more than 10×, driven largely by state damage caps.

Source. The National Practitioner Data Bank public-use file. Reporting a malpractice payment made on behalf of a practitioner is mandatory under 45 CFR Part 60, which makes this close to a census of paid US malpractice claims rather than a sample — 263,622 payments in the study window, $85.66B in total.

Why the window starts in 2005. NPDB did not publish the severity-of-outcome field before 2004: all 250,672 rows from 1990–2003 have it blank, and 2004 is still 12% incomplete. From 2005 there is not one gap. Running a severity analysis across the whole file would compare a coded era against an uncoded one, so the export refuses to run if any row in the window lacks a code.

Unit of analysis. One row is one payment reported for one practitioner. An incident involving several practitioners produces several reports, so payment counts exceed incident counts. We use the practitioner-attributable payment field and deliberately do not sum the combined total_payment field, which would double-count multi-practitioner settlements.

Medians, not averages. Malpractice payments are extremely right-skewed — the mean death payment ($361,804) sits well above the median ($235,000) because of a small number of very large settlements. Every headline here is a median.

What this study does not claim. Not that the legal system values life cheaply in principle, and not a causal estimate of any single statute. A settlement figure measures legally recoverable damages, not the worth of a life. State is the practitioner’s work state rather than the court’s jurisdiction — usually the same, not guaranteed.

The aggregated data is published as open CSVs under CC BY 4.0. Analysis by Settlement Insight Research.