States Without Damage Caps Pay 34% More in Malpractice Settlements

Our analysis of 459,552 medical malpractice payments from the National Practitioner Data Bank (NPDB) reveals dramatic geographic variation in settlement outcomes:

• States without damage caps pay 34% more on average — $292K versus $217K in capped states
• Massachusetts has the highest average payout at $404K, while Michigan has the lowest at $121K
• New York leads in total payouts at $19.3B across 60,715 cases
• California's MICRA cap holds its average to just $141K despite being the #2 state by case volume (53,536 cases)
• The median is always lower than the average across all states, confirming that a small number of high-value cases skew averages upward

Damage caps are state laws that limit the amount of non-economic damages (pain and suffering, emotional distress, loss of companionship) a plaintiff can receive in a medical malpractice lawsuit. Currently, 24 states have some form of damage cap, while 27 states (including DC) allow unlimited non-economic damages.

The data shows a consistent pattern: states without damage caps average 34% higher payouts ($292K vs. $217K). This gap has been widening over time — from about 46% in 2000 to nearly 50% in recent years.

California is the clearest example: with its MICRA cap in place since 1975, California's average payout ($141K) is less than half the national no-cap average despite being one of the most litigious states. The cap was raised in 2023 under AB 35, but its effect on averages will take years to appear in the data.

For individuals evaluating a potential claim, your state’s damage cap (or lack thereof) is one of the most significant factors affecting your potential settlement value.