Key Takeaways
- NHS Resolution received 15,236 new clinical negligence claims in 2025/26, up 5.6% on the previous year, with total payments reaching £3.24bn, an increase of 4.8%.
- A record 84% of claims were kept out of formal processes.
- Rising claims don’t mean every healthcare business should automatically face higher premiums – medical malpractice risk depends on the individual business.
- Generative AI is lowering the barrier to complaints and claims, while AI-supported diagnostic and transcription tools are introducing new risk from the provider side.
- Insurer appetite for the same risk varies significantly, so how a business presents itself to the market matters.
- Premium ultimately comes down to exposure, insurer appetite, how well the risk is understood, and the quality of the broker representing it.
What do the latest NHS Resolution figures show?
NHS Resolution’s latest annual report gives a pretty stark indication of the claims environment facing healthcare. In 2025/26, it received 15,236 new clinical negligence claims, up 5.6% from the previous year, while total payments across its clinical schemes reached £3.24bn, an increase of 4.8%. Interestingly, a record 84% of claims were kept out of formal processes, so while claims numbers and costs continue to rise, there is clearly more to the picture than the headline figures alone.
Do NHS figures apply directly to commercial medical malpractice insurance?
These are NHS figures and the dynamics of the commercial medical malpractice market are different, but they still provide an important backdrop. The cost of clinical risk is increasing and that will inevitably form part of insurers’ thinking. The question is whether that should automatically translate into higher premiums for every healthcare business. We don’t think it is that simple.
Why medical malpractice risk isn’t a commodity
Medical malpractice is not a commodity and two healthcare businesses with similar turnover, working in a similar area, can present very different risks. Specialty and procedures are obviously part of the picture, but so are a number of other factors:
- The treatments being provided
- The patient profile
- Where the work is taking place
- Who is delivering it and under what arrangements
- Claims history
- Consent processes
- Record keeping
- Clinical governance
- The structure of the business
- What happens when something does go wrong
Even the claims history itself needs some context. A business that has had previous claims but can show strong governance, what it learned and what it changed as a result may be a very different risk to one with no claims but weaker controls or exposures that have never really been examined.
How is generative AI changing the claims environment?
The claims environment is changing as well. Generative AI has made medical and legal terminology much more accessible and somebody can now research an issue, understand the language around it and produce a detailed complaint or letter in a matter of minutes. Our own claims team is seeing more examples of complaints where AI appears to have played a part in how they have been researched or drafted, sometimes producing lengthy and highly legalistic correspondence at a very early stage. That does not mean every AI-assisted complaint becomes a clinical negligence claim, and there is nothing wrong with patients being better informed, but the barrier to questioning an outcome, making a complaint or exploring whether something might have gone wrong is undoubtedly lower than it once was.
How is AI changing risk from the provider side?
AI is changing the risk from the other direction too. Healthcare businesses are increasingly using AI-supported diagnostic tools, transcription systems and other technology, which brings its own questions around governance, responsibility and liability. For insurers, all of this now sits alongside the more traditional drivers of medical malpractice claims and makes understanding the individual risk even more important.
Why do insurers view the same risk so differently?
One of the less visible parts of the medmal market is just how differently insurers can view the same risk. Appetite changes. One insurer may be very comfortable with a particular procedure, specialty or business model, while another may have had a poor claims experience in that area and take a much more cautious view. Equally, an insurer may be prepared to look at something more complex if it understands how the business operates and has confidence in the governance and controls behind it.
Why presentation to the market matters
This is where presentation to the market really matters. A proposal form and a turnover figure rarely tell the full story of a healthcare business. A good presentation should explain what the business actually does, where the exposures are, how those exposures are managed and, if there have been claims or incidents, what happened and what has changed as a result. Done properly, it gives an underwriter the information to price the actual risk rather than make assumptions about it.
What’s driving the wider claims environment?
There is no escaping the wider claims environment. Claims frequency, the severity of losses, legal costs and medical inflation all feed into the economics of medical malpractice insurance. But that does not mean every risk should receive the same increase, or that the first price offered is necessarily the right one.
What actually determines your premium?
Premium ultimately comes down to the exposure, an insurer’s appetite for that exposure and how well the risk is understood. That is also why the choice of broker matters. Access to the right markets is part of it, but relationships with those markets are important too. A broker who understands the business, knows which insurers genuinely have an appetite for it and knows how best to present the risk is in a much stronger position to create competition and challenge a price where it does not reflect the individual risk.
The Bottom Line
The headline is that clinical negligence claims are rising. For anyone buying medical malpractice insurance, the more important question is whether the insurer – and the broker representing the risk to them – really understands what they are being asked to insure.
Frequently Asked Questions
How many clinical negligence claims did NHS Resolution receive in 2025/26?
NHS Resolution received 15,236 new clinical negligence claims in 2025/26, a rise of 5.6% on the previous year.
How much did NHS Resolution pay out in clinical negligence claims in 2025/26?
Total payments across its clinical schemes reached £3.24bn, an increase of 4.8% on the previous year.
What proportion of NHS clinical negligence claims are resolved without going to formal process?
A record 84% of claims were kept out of formal processes in 2025/26.
Does a rise in NHS clinical negligence claims mean medical malpractice premiums should rise for every healthcare business?
Not automatically. While the rising cost of clinical risk will factor into insurers’ thinking, medical malpractice is not a commodity, and two similar-looking healthcare businesses can present very different risks depending on specialty, patient profile, governance, consent processes and claims history.
What factors influence a healthcare business’s medical malpractice risk?
Key factors include the specialty and procedures performed, treatments provided, patient profile, location of work, who delivers care and under what arrangements, claims history, consent processes, record keeping, clinical governance, and business structure.
How is AI affecting medical malpractice claims?
Generative AI is lowering the barrier to making complaints by making medical and legal terminology more accessible, sometimes producing detailed, legalistic correspondence early on. At the same time, AI-supported diagnostic and transcription tools used by healthcare providers are introducing new questions around governance, responsibility and liability.
What ultimately determines a medical malpractice insurance premium?
Premium comes down to the exposure itself, an insurer’s appetite for that exposure, and how well the risk is understood, supported by a broker who can present the business accurately and negotiate effectively with insurers who have genuine appetite for it.