States Without Damage Caps Pay 34% More in Malpractice Settlements

Name: U.S. Medical Malpractice Settlement Map by State (2000–2025)
Creator: Settlement Insight
Published: 2026-03-20
License: https://creativecommons.org/publicdomain/zero/1.0/

Interactive map of 459,552 medical malpractice payments across all 50 states. Toggle between average payouts, median settlements, total paid, and case counts.

Reviewed by Leonard Goldberg, Editor · Last updated August 15, 2026

24 states

Have Damage Caps

Avg payout: $217K

27 states

No Damage Cap

Avg payout: $292K

34% gap

Cap vs. No-Cap Difference

In average payout size

$114.4B

Total Malpractice Payouts

459,552 cases analyzed

Malpractice Payouts by State

Hover over any state to see details. Click for a full breakdown. Striped states have damage caps that limit non-economic damages.

$121K

$404K

Striped = state has a damage cap

Key Findings

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

Highest & Lowest Average Payouts

Top 5 — Highest Average

1MassachusettsNo cap

$404K

2IllinoisNo cap

$404K

3ConnecticutNo cap

$398K

4District of ColumbiaNo cap

$367K

5HawaiiNo cap

$351K

Bottom 5 — Lowest Average

47MichiganCapped

$121K

48CaliforniaCapped

$141K

49KansasCapped

$147K

50UtahCapped

$173K

51TexasCapped

$174K

How Damage Caps Affect Settlements

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.

Data Source & Methodology

This map uses the National Practitioner Data Bank (NPDB) Public Use Data File, maintained by the Health Resources and Services Administration (HRSA). Federal law requires all medical malpractice payments to be reported to the NPDB regardless of payment size.

Our dataset covers 459,552 payment records from 2000 to 2025, totaling $114.4B. Payment amounts are range-coded in the public file; we use midpoints for calculations. Damage cap classifications reflect current state law as of 2025.

The complete public data file is available at npdb.hrsa.gov.

Explore More Settlement Data

Dive deeper into state-specific data or estimate your own potential settlement value.

Damage Caps by State Full 530K-Case Study Try the Calculator

Looking for the ranked numbers behind this map?

All 50 States Ranked: Averages, Medians & the Cap Effect →

Open the Calculator for Your State

Click your state to see its specific damage caps, statutes of limitations, and median payouts applied to your case.

Primary sources

Every figure on this page traces to a dataset published by the agency below. The links go to the agency's own page — not to a summary of it.

National Practitioner Data Bank — Public Use Data File
U.S. Health Resources & Services Administration (HRSA) · 1990–2025
Every malpractice payment made on behalf of a licensed practitioner must be reported to the NPDB by federal law, which is what makes this the closest thing to a national malpractice payout census.
npdb.hrsa.gov

Source files last retrieved August 14, 2026. Agencies revise historical records; figures reflect the files as retrieved on that date.

Cite this analysis

This analysis is free to reuse with attribution. The underlying government files are linked above — cite them directly when you need the raw record rather than our aggregation.

APA

Goldberg, L. (2026). Settlement Amounts by State — a map of National Practitioner Data Bank payment reports and statutory damage caps [Analysis of public records]. Settlement Insight Research. https://settlementinsight.com/research/settlement-map

BibTeX

@misc{goldberg_2026_settlement_map,
  author       = {Goldberg, Leonard},
  title        = {{Settlement Amounts by State — a map of National Practitioner Data Bank payment reports and statutory damage caps}},
  year         = 2026,
  howpublished = {Settlement Insight Research},
  url          = {https://settlementinsight.com/research/settlement-map}
}

States Without Damage Caps Pay 34% More in Malpractice Settlements

Interactive map of 459,552 medical malpractice payments across all 50 states. Toggle between average payouts, median settlements, total paid, and case counts.

Reviewed by Leonard Goldberg, Editor · Last updated August 15, 2026

24 states

Have Damage Caps

Avg payout: $217K

27 states

No Damage Cap

Avg payout: $292K

34% gap

Cap vs. No-Cap Difference

In average payout size

$114.4B

Total Malpractice Payouts

459,552 cases analyzed

Malpractice Payouts by State

Hover over any state to see details. Click for a full breakdown. Striped states have damage caps that limit non-economic damages.

$121K

$404K

Striped = state has a damage cap

Key Findings

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

Highest & Lowest Average Payouts

Top 5 — Highest Average

1MassachusettsNo cap

$404K

2IllinoisNo cap

$404K

3ConnecticutNo cap

$398K

4District of ColumbiaNo cap

$367K

5HawaiiNo cap

$351K

Bottom 5 — Lowest Average

47MichiganCapped

$121K

48CaliforniaCapped

$141K

49KansasCapped

$147K

50UtahCapped

$173K

51TexasCapped

$174K

How Damage Caps Affect Settlements

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.

Data Source & Methodology

The complete public data file is available at npdb.hrsa.gov.

Explore More Settlement Data

Dive deeper into state-specific data or estimate your own potential settlement value.

Damage Caps by State Full 530K-Case Study Try the Calculator

Looking for the ranked numbers behind this map?

All 50 States Ranked: Averages, Medians & the Cap Effect →

Open the Calculator for Your State

Click your state to see its specific damage caps, statutes of limitations, and median payouts applied to your case.

Primary sources

Every figure on this page traces to a dataset published by the agency below. The links go to the agency's own page — not to a summary of it.

National Practitioner Data Bank — Public Use Data File
U.S. Health Resources & Services Administration (HRSA) · 1990–2025
Every malpractice payment made on behalf of a licensed practitioner must be reported to the NPDB by federal law, which is what makes this the closest thing to a national malpractice payout census.
npdb.hrsa.gov

Source files last retrieved August 14, 2026. Agencies revise historical records; figures reflect the files as retrieved on that date.

Cite this analysis

This analysis is free to reuse with attribution. The underlying government files are linked above — cite them directly when you need the raw record rather than our aggregation.

APA

BibTeX

@misc{goldberg_2026_settlement_map,
  author       = {Goldberg, Leonard},
  title        = {{Settlement Amounts by State — a map of National Practitioner Data Bank payment reports and statutory damage caps}},
  year         = 2026,
  howpublished = {Settlement Insight Research},
  url          = {https://settlementinsight.com/research/settlement-map}
}