History

California’s Medical Injury Compensation Reform Act (MICRA) was enacted in 1975 in response to skyrocketing judgments, drastic increases in malpractice insurance premiums, and diminishing access to health care. That year, two malpractice insurance companies made major announcements: one notified 2,000 Southern California physicians that their insurance would not be renewed, and the other notified 4,000 Northern California physicians that their premiums would increase by 380 percent.

These companies had determined that the California medical malpractice insurance market had become too risky and unstable for financially sound underwriting. The number of claims had increased by 200 percent in a 10-year period, and the dollar amounts awarded in judgments or settlements had increased 1,000 percent in 10 years.

MICRA’s Major Provisions

  • A cap of $250,000 on noneconomic damages (i.e., pain, suffering, loss of consortium)
  • Disclosure to the jury of collateral sources of payment (other sources of health insurance payments for the same injury)
  • Limits on attorney fees
  • Periodic payments for future damages
  • A requirement that plaintiffs give a 90-day warning of an impending claim to the provider so that the provider has a chance to settle the claim out of court
  • A strengthened physician discipline system

Proven Benefits

Lower premiums—At the time MICRA was enacted, California’s malpractice insurance rates were among the highest in the nation; today, California rates are among the lowest. More health care professionals now carry liability insurance because coverage is available, and the premium rates are affordable.

Improved access to care—MICRA strikes a balance, encouraging the availability of health care while also providing for compensation to injured patients. Self-insured public institutions provide health care to hundreds of thousands of patients who do not have health insurance. By containing costs, MICRA maintains the availability of funds to serve those who could not otherwise afford health care, while injured patients are fairly compensated.

Earlier and more equitable settlements—Fewer malpractice cases go to trial now than in the era before MICRA. MICRA’s provisions promote earlier and more equitable settlements. Fewer frivolous lawsuits now go to trial (although many meritless actions are still filed).

Preserving MICRA

If the MICRA cap is lifted, all sectors of health care will be affected. The bulk of the increase would be borne by physicians in high-risk specialties such as ob/gyn and surgery and by self-insured hospitals. Premium rates would increase significantly for physicians in all specialties. In addition, increased limits of coverage could be needed, which would also increase premium rates substantially. Safety net providers, including hospitals, community clinics, and rural facilities, would pay higher liability costs, leaving less money for programs serving those in need. Read more about why MICRA works .

 

A Model for National Reform

MICRA is the model for reforms enacted in Colorado, Florida, Indiana, Montana, Texas, and Virginia, and for legislation proposed before many other state legislatures. It is also recognized as a model for federal reforms and in legislation put before Congress.

 

What You Can Do

Lend your voice to the fight for effective medical liability reform by contacting your state and federal representatives and asking them to preserve and support MICRA-like reforms. Take every opportunity to spread the word through the media and your patients, friends, and professional colleagues. Your contribution to The Doctors Company’s federal and state political action committees (DOCPACs) helps us advocate for and defend medical liability reforms.

 

More Information About MICRA

Our Chairman and CEO, Richard E. Anderson, MD, FACP, has been honored as a thought leader on medical malpractice insurance and jurisprudence. You can view his recent in-depth presentations on MICRA in the Knowledge Center. We have also provided links to organizations across the country that are advocating for medical-legal reforms.



Visit the Chairman’s Library. Get insights directly from one of the nation’s preeminent authorities on the medical liability industry and political reform initiatives.


Learn more about The Doctors Company and the birth of the mission we relentlessly pursue.