Staying ahead in today’s insurance marketplace requires sharp insights and the right tools. The 2026 State of the Markets at a Glance deliver insights into key industry trends, emerging risks, and actionable intelligence to help you navigate the marketplace with confidence. Whether you’re assessing market shifts, identifying new opportunities, or fine-tuning your strategy, our latest insights ensure you stay informed and prepared for what is ahead.
GENERAL OUTLOOK
The healthcare liability market in 2026 remains defined less by a traditional hard or soft cycle and more by severity-driven risk, long-tail uncertainty, and structural capacity constraints. Industry benchmarks and carrier financial data indicate that while claim frequency has remained relatively stable across many healthcare segments, loss severity, defense costs, and time-to-resolution continue to rise. These trends are placing sustained pressure on both primary and excess layers, reinforcing underwriting discipline and limiting meaningful rate relief.
A key dynamic shaping the current environment is market bifurcation. Healthcare organizations with favorable loss experience, disciplined governance, strong risk management, and exposure in supportive venues can still achieve competitive outcomes, including stable pricing and more flexible terms. In contrast, risks operating in adverse venues, offering higher-acuity services, or maintaining complex organizational structures are encountering firmer pricing, higher self-insured retentions (SIRs), reduced limits, and fragmented capacity. This bifurcation is increasingly granular, emerging not only by class of business, but by county, court jurisdiction, and service line, making broad-based pricing assumptions less reliable.
Legal system volatility continues to be a central driver of market behavior. Statute-of-limitations expansions, revival statutes, and evolving judicial interpretations have altered expected loss development patterns and reinforced carrier conservatism. As a result, certain healthcare risks are migrating from the admitted market into the excess and surplus (E&S) space at an accelerated pace, often faster than underwriting and claims infrastructure can scale to meet demand.
Reinsurance dynamics further amplify these pressures. Reinsurers remain highly focused on tail risk, influencing attachment points, limit deployment, trigger structures, and overall coverage breadth. This has translated into smaller carrier line sizes, fewer occurrence-based options for long-tail exposures, and heightened scrutiny of excess layers, particularly for severity-exposed classes and adverse venues.
Compounding market challenges are the financial constraints facing healthcare providers themselves. Many systems continue to operate with thin margins, limited liquidity, and restricted access to capital. As revenues fail to keep pace with rising excess pricing, insureds are increasingly seeking relief through higher SIRs or reduced limits. While these strategies are within an insured’s discretion, brokers play a critical role in helping clients understand the trade-offs, particularly how short-term premium relief may increase long-term volatility and balance sheet risk.
The 2026 healthcare liability marketplace remains mixed and highly segmented. Competitive conditions persist for well-performing risks, while severity-exposed classes, adverse venues, and excess layers are expected to remain firm, with continued emphasis on program structure, retention strategy, and thoughtful deployment of capacity.
LIFE SCIENCES
The life sciences segment of the healthcare market in 2026 remains relatively stable, with pricing generally flat to modestly increasing. Product and professional liability premiums are typically ranging from flat to approximately 10%, with well-managed organizations often achieving flat to low single-digit increases. Broader healthcare commercial and casualty markets are also showing signs of stabilization, with some lines experiencing slight rate reductions that extend to life sciences-related exposures.
Capacity remains strong, supported by continued new entrants across specialty, digital health, and life sciences markets, which is driving competition and helping keep pricing in check. Underwriting appetite is increasingly nuanced and differentiated based on an organization’s role within the product development, manufacturing, and distribution chain. Contract manufacturers continue to see favorable underwriting support, while compounding pharmacies are facing heightened scrutiny as underwriters assess growing counterparty and aggregation risks. The continued expansion of telehealth and connected health technologies has also increased appetite for digital health risks, with carriers introducing more tailored coverage forms to address evolving exposures.
Key risk and claims drivers continue to influence underwriting decisions. Social inflation, nuclear verdicts, and litigation funding remain primary concerns, contributing to increased claim frequency and severity across the healthcare and life sciences landscape. GLP-1 receptor agonists remain a particular focus for underwriters, especially in terms of aggregate limit deployment and exposure management. In addition, cybersecurity, clinical trial operations, and telehealth-related professional liability exposures continue to grow, reflecting the evolving and increasingly complex risk profile of the life sciences sector.
LONG-TERM CARE + SENIOR LIVING
Senior living and long-term care facilities remain a critical component of the U.S. healthcare system as the population continues to age rapidly. By 2050, more than 82 million Americans are expected to be over age 65, nearly double the 2020 figure, driving sustained demand for skilled nursing, assisted living, memory care, home health, and wellnessfocused housing models. While demographic demand remains strong in 2026, the sector continues to face heightened regulatory scrutiny, operational pressure, and insurance market volatility.
Much of what defined the senior living insurance market in 2025 remains applicable in 2026. Rate expectations are generally flat to up 15%, driven by loss experience, venue exposure, and changes in risk profile. Social inflation and the continued threat of nuclear verdicts remain primary pricing drivers, particularly in plaintiff-friendly jurisdictions. Carrier recalibration is ongoing as insurers reassess appetite, tighten underwriting guidelines, and reduce deployed capacity. While new market entrants have added competition, concerns remain around long-term sustainability, claims handling expertise, and restrictive policy language.
A growing challenge for the sector is the pace of mergers and acquisitions, largely driven by private equity and REIT activity. Frequent ownership changes, often three to four times for the same facility within a five-year to ten-year period, have made it increasingly difficult to obtain complete underwriting data. Underwriters typically require at least five years, and in some cases 10 years of historical loss information per facility, along with quality metrics, CMS survey results, and detailed information on the acquiring entity, including operational experience and post-acquisition plans. In many cases, acquirers have limited prior senior living experience or lack a clearly defined operating strategy. These data gaps materially impact underwriting confidence and can limit access to the most competitive terms.
Most senior living placements continue to reside in the E&S market, where flexibility allows for tailored solutions, though capacity remains inconsistent. Primary per-claim limits typically range from $1M to $5M, with excess capacity commonly available between $5M and $15M. However, many carriers are reducing participation from $10M to $5M per layer. Common coverage constraints include abuse and molestation sublimits, class action exclusions, and communicable disease exclusions, reinforcing the importance of careful policy review and early renewal planning.
Retention strategy remains a growing concern. During and immediately following COVID-19, many carriers exited the space or imposed significant rate increases, prompting insureds to assume materially higher deductibles or retentions to manage premium costs. While these higher attachments initially generated savings, the long-tail nature of senior living claims means those losses are now reaching settlement. As a result, many operators are experiencing unexpected cash flow strain when funding large retained losses. This dynamic has also introduced increased credit risk for carriers, as some insureds are unable or unwilling to satisfy higher deductible obligations, an issue expected to remain a concern throughout 2026.
Operational challenges continue to pressure the sector. Labor shortages persist, particularly for skilled nursing facilities competing with hospitals on wages and benefits, while declining reimbursement rates further strain margins. Medical cost inflation continues to elevate claim severity, especially in assisted living and memory care, where allegations related to falls, elopements, medication errors, and inadequate supervision remain prevalent. Ownership structure also plays a role in underwriting outcomes, with private equity-backed facilities facing heightened scrutiny unless they can demonstrate strong governance, consistent staffing, and a patient-centered care model.
In response, underwriters in 2026 are increasingly focused on demonstrated execution rather than stated intent. Facilities that can evidence proactive risk management, such as documented fall prevention programs, staff training protocols, and quality-of-care initiatives, are better positioned in the marketplace. Early engagement in the renewal process, ideally 90 to 120 days in advance, allows time to address data gaps, develop a thoughtful marketing strategy, and present a transparent, comprehensive submission.
Overall, the senior living market in 2026 is defined by strong demographic demand alongside persistent volatility. Coverage remains available, but underwriting discipline is high, capacity is constrained, and scrutiny around ownership structure, retention strategy, and operational controls continues to intensify. Successful outcomes will depend on proactive planning, transparent data, and close collaboration with experienced wholesale partners.
MISCELLANEOUS MEDICAL
On the facilities side, the overall story remains consistent with prior years: capacity is plentiful, and although the pace of new entrants has slowed, there is still no shortage of options. As a result, we are not seeing meaningful firming in pricing.
A familiar cycle continues to play out. At renewal, many carriers seek rate increases to ensure their books remain healthy and can absorb losses. However, these same carriers often maintain aggressive new business goals, resulting in a noticeable disparity between renewal pricing and new business quotes. It is not uncommon to see a carrier request additional rate on an existing account while simultaneously offering significantly lower pricing to attract new opportunities.
Given the competitive landscape, especially on standard new business, there is considerable ability to find viable alternatives. When a carrier is overly aggressive on renewal, replacement options are often available, and frequently at more favorable terms. This dynamic is most pronounced within miscellaneous medical facilities, where competition remains high and new online platforms continue to enter the market. We expect this trend toward digital distribution and streamlined underwriting to continue.
While many segments remain competitive, challenges persist within behavioral health and social services, where exposure to sexual abuse and molestation (SAM) claims is higher. In these classes, markets are showing increased rate pressure, more conservative underwriting, adjustments to retroactive dates on SAM sublimits, and overall firmer market conditions. By contrast, areas such as ambulatory surgery centers continue to enjoy a broad competitive field. Although SAM exposure exists, there is substantially more appetite and capacity compared to higher-risk behavioral health and social service operations.
PHYSICIANS
In 2026, physician professional liability is undergoing a structural reset centered on limit adequacy. While claim frequency remains manageable for many lower-acuity specialties, severity trends, venue expansion, and verdict inflation have materially eroded the protection historically provided by standard primary limits. Benchmark data and loss experience increasingly show large verdicts and settlements penetrating excess layers, particularly for high-acuity specialties and in plaintiff-friendly jurisdictions.
Several core themes are shaping the physician marketplace. Demand for higher total limits continues to rise as extended defense timelines, broader theories of damages, and more aggressive plaintiff strategies increase the probability of excess loss involvement. As a result, physician excess placements are growing, with primary limits alone increasingly viewed as insufficient in many venues. Market conditions remain sharply segmented by specialty and jurisdiction: clean risks in favorable venues retain access to competitive terms, while adverse venues drive firmer pricing, higher retentions, and greater structural complexity. Excess markets are also placing heightened emphasis on primary carrier quality, with claims handling capability, defense strategy, and historical performance playing a larger role in capacity decisions.
Venue pressure remains a defining challenge. In addition to long-standing difficult jurisdictions such as New Mexico, Cook County, and parts of Pennsylvania, new tough venues are emerging, most notably metro Atlanta, along with several other developing plaintiff-friendly regions. These trends are fueled by nuclear verdicts and expanded venue shopping capabilities in certain states, elevating both severity and volatility. The most challenging specialties remain consistent with prior years, with neurosurgery, obstetrics, orthopedics (including spine), and pediatrics continuing to face higher frequency, elevated severity, and constrained market appetite.
Technology adoption is increasingly influencing physician underwriting. AI-assisted diagnostics, clinical decisionsupport tools, and telehealth are prompting new questions around standard of care, appropriate reliance, and governance. While direct AI-driven malpractice claims remain limited today, underwriters increasingly view these tools as potential severity multipliers over time, particularly where controls, documentation, and oversight are insufficient.
Market access varies meaningfully by practice size and structure. Some classes previously difficult to place in the admitted market, such as telemedicine, have become more accessible; however, E&S remains the preferred or required avenue for many risks due to multi-jurisdictional exposure and coverage complexity. Larger physician groups (typically 15 or more physicians) often benefit from creative program structures available in the E&S market, while small to mid-sized practices (approximately 2–15 physicians) continue to be primarily served by admitted carriers, with E&S options remaining strong for more complex exposures.
Emerging and evolving exposures require increased diligence, as they are not always clearly captured in standard applications. Telemedicine expansion, GLP-1 medication prescribing, and ketamine therapy, now supported by broader carrier participation, must be identified early to avoid coverage gaps, particularly in admitted placements.
Overall appetite for physician risk remains stable but narrow and highly specialty-dependent. Many groups face a limited pool of viable carriers, reinforcing the importance of broad market access and deep underwriting relationships. Excess pricing continues to rise regardless of primary rate movement, and retail agents should proactively prepare insureds for this trend during renewal discussions.
Locum tenens providers face a particularly challenging outlook. After significant growth during the COVID-19 period and subsequent staffing shortages, the segment is now contracting as utilization normalizes and older claims mature. Many locums groups are experiencing rising premiums, declining revenues, and more difficult renewal negotiations. Importantly, lower revenue does not automatically translate to lower premium; in some cases, especially within locum tenens, deteriorating loss experience can drive higher costs, a dynamic that may also affect larger physician groups over time.
The physician outlook is competitive for low-acuity, clean risks in favorable venues, while conditions are firming for high-acuity specialties, adverse venues, and physician excess layers, with venue-driven severity remaining the primary pressure point.
HUMAN SERVICES
In many states, statutory notice requirements continue to give carriers broad flexibility to modify policy forms at renewal, which can result in meaningful changes to terms, conditions, or sublimits from one policy period to the next. Retail agents should remain vigilant and communicate proactively with clients to set expectations around potential coverage shifts, particularly as carriers recalibrate underwriting guidelines and reduce deployed capacity.
Within the broader human services sector, behavioral health and social services remain among the most challenging classes to place. Elevated exposure to sexual abuse and molestation (SAM) claims continues to drive cautious carrier behavior, including increased rate pressure, tighter underwriting, and reduced appetite. Insureds in these segments generally face firmer market conditions than other healthcare or human services classes, with some carriers adjusting retroactive dates on SAM sublimits or narrowing coverage triggers. These dynamics reinforce the importance of early renewal engagement and comprehensive submission materials to minimize disruption and improve placement outcomes.
Market conditions continue to vary by organization size. Smaller organizations remain challenged by limited E&S market selection, often due to insufficient pricing for the risk or an inability to meet minimum premium requirements, though some direct-market options remain available in the near term. Middle to large-sized organizations already positioned in the E&S market are generally experiencing minimal rate increases and, in some cases, modest rate decreases driven by increased competition. Compared to last year, more carriers have entered the space, often through opportunistic strategies that deploy lower capacity at higher pricing.
Pricing volatility has moderated since the sharp increases seen last year, but structural pressures persist. Organizations remaining in the admitted market increasingly face reduced primary capacity, requiring excess placements to fill gaps. This trend is expected to continue as admitted carriers further restrict limits and, in many cases, remove abuse coverage altogether. Auto liability has also become a significant driver of non-renewals, contributing to the continued erosion of traditionally packaged programs.
Foster care and adoption services remain a primary driver of non-renewals within the sector. The severity of incurred claims activity, combined with evolving legislation such as New York’s Child Victim Act, which expands statute of limitations exposure, has materially reduced carrier appetite. As a result, finding replacement capacity for these risks remains difficult, reinforcing the need for early planning, transparent submissions, and realistic expectations around pricing and structure.
CORRECTIONAL CARE
The marketplace for correctional care in 2026 remains largely unchanged from 2025. Capacity continues to be extremely limited, with only a small number of carriers willing to consider risks with meaningful correctional exposure. Accounts with more than 50% correctional care exposure have very few market options, while those with 15% exposure or less may see slightly more availability, though underwriting remains cautious. Whether the insured is an individual provider or a small group, carriers require a high level of detailed information before they are willing to quote.
Excess coverage is still difficult to obtain, and where it is available, carriers maintain strict underwriting guidelines. Insureds should expect significant exclusions or limitations, particularly around abuse and other high-severity exposures, which remain common in this class. Overall, there are no material improvements anticipated for 2026. The market remains firm, capacity is scarce, and higher information requirements continue to be the norm. Early engagement and thorough preparation are essential to navigating this segment successfully.
CYBER + TECHNOLOGY
Cyber and technology-driven liability have become increasingly inseparable from healthcare professional liability in 2026. Operational disruptions, data integrity failures, and system outages are no longer evaluated solely as cyber events; instead, they are assessed through a patient safety and professional liability lens, particularly where clinical operations, decision-making, or continuity of care are impacted. As healthcare delivery grows more technologydependent, underwriting focus has expanded beyond traditional cyber controls to include governance frameworks, operational resilience, and escalation protocols.
Artificial intelligence adoption continues to accelerate across both clinical and operational functions. To date, most observed claims activity has arisen from governance and control failures rather than the underlying technology itself. However, underwriters are increasingly evaluating how organizations oversee and validate AI tools, maintain appropriate human-in-the-loop controls, and ensure documentation, auditability, and decision transparency. Alignment between clinical use cases and formal organizational policy has become a key underwriting consideration, particularly as AI-supported decision-making expands into higher-acuity settings.
Telehealth remains a stable but closely scrutinized exposure. Underwriting emphasis continues to center on licensure compliance, documentation standards, prescribing practices, escalation pathways, and demonstrable parity with in-person standards of care. Multi-jurisdictional delivery models and evolving regulatory expectations reinforce the need for disciplined governance and consistent clinical protocols.
Overall, cyber and technology risk differentiation is increasingly driven by the maturity of governance structures, the degree of operational and clinical dependency on technology, and how deeply digital tools are integrated into patient care workflows. The cyber and technology outlook is stable to firm, with outcomes highly differentiated by governance maturity, operational resilience, and alignment between technology use and clinical risk management.
HOSPITALS + HEALTH SYSTEMS
Hospital professional liability remains one of the most capacity-constrained and execution-intensive segments of the healthcare liability market in 2026. Severity escalation, prolonged claim development, and venue-driven volatility continue to exert significant pressure on excess layers, shaping both underwriting appetite and program structure.
Hospitals are increasingly encountering higher attachment points and retentions, reduced per-carrier limit deployment, and more fragmented program towers that require a greater number of participating markets. These structural shifts have lengthened placement timelines and increased execution risk, particularly for large systems, complex organizations, and those operating in challenging jurisdictions.
Venue risk has emerged as a dominant underwriting variable. Legislative and procedural changes have produced outsized verdicts in jurisdictions previously considered moderate, increasing uncertainty around ultimate loss outcomes and reinforcing conservative underwriting postures. As a result, pricing, capacity, and structure are increasingly influenced by venue exposure at a granular level rather than broad class-based assumptions.
Claims handling quality has become a critical differentiator in hospital placements. Excess carriers are placing heightened emphasis on the capabilities of primary insurers, recognizing that early claims strategy, defense posture, and settlement discipline materially impact ultimate severity. Towers are demonstrably more difficult to complete when excess markets lack confidence in the underlying claims infrastructure, regardless of an insured’s historical loss experience.
Financial pressure further complicates the hospital risk profile. Even systems reporting operating profits often do so on thin margins, limiting their capacity to absorb large retained losses. This dynamic is driving more strategic discussions around retention levels, excess attachment optimization, and total cost of risk, shifting the focus beyond premium alone.
Operational complexity adds another layer of underwriting scrutiny. Workforce shortages, evolving service line mixes, and rapid technology adoption, particularly within large systems and academic medical centers, continue to influence underwriting outcomes and capacity deployment.
Firming conditions are expected to persist, particularly for large health systems, complex service lines, adverse venues, and higher excess layers, with severity and execution risk remaining the primary market constraints.
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