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John J. Hare

Member, Executive Committee

Chair, Appellate Advocacy & Post-Trial Practice

JJHare@mdwcg.com

Portrait of John J. Hare

The Quarterly Dose

Highlights in Pennsylvania Medical Malpractice Law: Expansion of Liability, Nuclear Verdicts, and Emerging Litigation Trends

The Quarterly Dose – August 2026

August 26, 2026

by John J. Hare and Holli K. Archer

Pennsylvania’s medical malpractice landscape has undergone significant changes. In the last two years, courts, litigants, insurers, and health care providers have faced a dramatic rise in nuclear verdicts, evolving juror attitudes, aggressive plaintiff advertising, third-party litigation funding, and increasingly complex procedural challenges. These developments have not only reshaped medical malpractice litigation, but have also intensified concerns about health care access, insurance costs, and Pennsylvania’s legal climate.

The Expansion of Liability and the Rise of Nuclear Verdicts

One of the most significant trends in medical malpractice litigation is the expansion of liability and the rise of so-called “nuclear verdicts” (generally speaking, personal injury verdicts in excess of $10 million). Nationally, 2025 set the all-time record with 140 nuclear verdicts, including 30 thermonuclear verdicts (above $100 million) and five verdicts exceeding $1 billion. This continued a steady upward trend from 108 nuclear verdicts in 2024 and 91 in 2023.

Pennsylvania has exceeded the national trend. From June 2021 to May 2026, the Commonwealth had 42 nuclear verdicts, with 29 occurring in Philadelphia alone. Medical malpractice cases account for 17 of those 42 verdicts. Philadelphia remains the epicenter of large medical malpractice awards, producing 11 of the state’s 17 medical malpractice nuclear verdictss. Other excessive malpractice verdicts have occurred in York, Beaver, Chester, Delaware, and Luzerne counties.

Although appellate courts have occasionally reduced excessive awards, the overall trend is concerning. Only five of Pennsylvania’s 42 nuclear verdicts have been reversed or reduced. In medical malpractice cases, notable examples include:

  • Newlin v. Vita Healthcare Group – $19 million verdict overturned.
  • Dawson v. Bayada Home Health Care – $14 million verdict remitted to $8 million.

What Is Driving Large Verdicts?

Legal analysts increasingly point to the COVID-19 pandemic as a catalyst for changing juror perspectives and expanded liability. The pandemic created what many describe as twin sensitivities: a heightened concern for safety and risk prevention, and increased skepticism toward corporations and institutions. These attitudes align closely with the plaintiff-oriented “reptile” litigation strategy, which aims to generate juror anger by framing a corporate defendant’s alleged actions as a threat to community safety.

Another factor frequently cited in discussions about large verdicts is a growing skepticism toward institutions and large organizations. In many cases, jurors may view corporations, hospitals, insurers, and other well-resourced entities as being in a better position to prevent harm and protect the public. As a result, they may hold these organizations to particularly high (and in many cases unrealistic) standards of conduct and accountability.

The Impact of Changing Jury Demographics

Demographic changes are also influencing litigation outcomes. Millennials represent the largest cohort and may comprise up to 40% of many jury pools. Studies suggest they are the most likely to award large verdicts as they are highly safety-conscious due to experiences such as 9/11, school shootings, and COVID-19, and generally less trusting of large institutions, corporations, and established systems.

Equally important is the emergence of what jury consultants describe as “vulnerable jurors” – individuals who have recently experienced significant financial, medical, or personal hardship. The economic and health-related disruptions of the pandemic have expanded this segment of the population.

Notably, political affiliation has become a less reliable predictor of defense-oriented verdicts. Jurors at both political extremes may be receptive to plaintiffs’ arguments, particularly when they perceive corporate defendants as part of a powerful establishment.

Lawyer Advertising and the Litigation Economy

Philadelphia has become one of the most heavily advertised legal markets in the country. According to the 2025-2026 Judicial Hellholes report, plaintiffs’ firms reportedly spent $76.6 million on more than 634,000 advertisements in the region. Billboard, television, radio, and digital marketing campaigns have become nearly unavoidable throughout the metropolitan area.

Critics argue that extensive advertising creates a self-reinforcing cycle by:

  • Encouraging potential plaintiffs to pursue claims.
  • Increasing settlement demands.
  • Raising expectations regarding verdict values.
  • Expanding public awareness of litigation opportunities.

Consequences for Insurance and Health Care

The rise in nuclear verdicts has had substantial financial consequences. As verdict severity rises, liability insurance becomes both more expensive and more difficult to obtain. Insurers increasingly report reduced capacity, higher premiums, and more restrictive underwriting practices. For health care providers already facing workforce shortages, reimbursement pressures and rising operational costs, increased malpractice exposure creates additional strain. The result may ultimately affect patient access to care, particularly in underserved or rural communities.

The Legal Marketplace: Workforce Challenges

Although the number of lawyers increased dramatically throughout the 20th century, growth has slowed considerably since 2000. Am Law 200 firms have experienced a net loss of litigators in recent years, and trends suggest that demand for experienced trial attorneys may increasingly outpace supply, particularly in high-exposure litigation areas such as medical malpractice defense.

Looking Ahead

Pennsylvania’s medical malpractice environment is undergoing a profound transformation. Rising nuclear verdicts, evolving juror attitudes, aggressive advertising, and procedural complexities are reshaping the risk landscape for health care providers, insurers, and defense counsel. As courts, legislators, and industry stakeholders consider potential reforms, medical malpractice practitioners must remain vigilant. Success increasingly depends not only on the merits of a case, but also on understanding changing jury behavior, preserving appellate issues, and navigating a legal environment that continues to expand the boundaries of liability.

Firm Highlights

Thought Leadership

Commonwealth Court Reaffirms the Constitutionality of Act 111's IRE Provisions

In this case, the claimant sustained a work injury of January 6, 1994, which was acknowledged by Notice of Compensation Payable (NCP). After the claimant’s receipt of 104 weeks of temporary total disability benefits, the employer filed a Request for an Impairment Rating Examination (IRE). The IRE was performed in May 2023 and the IRE physician found that the claimant had a 5% whole person impairment, under the AMA Guides. The employer filed a Petition based on the IRE results, and the Petition was granted by the WCJ. During litigation, the claimant argued that the IRE provisions of Act 111 (Section 306(a.3) of the Act) were not applicable to her injury, since it predated June 24, 1996, the date Act 57 went into effect, and that the IRE provisions were unconstitutional. The Workers’ Compensation Judge (WCJ)) granted the Petition and the Board affirmed. On appeal to the Commonwealth Court, the claimant argued that Act 111 violated the nondelegation doctrine and that its retroactive application to the claimant’s injury was unconstitutional. The court rejected the arguments on the basis that they had already found the same arguments without merit in multiple, prior cases. The court also addressed an argument made by the claimant that Act 111 was procedurally defective under the Pennsylvania Constitution because it was only considered on two days in each House after having undergone amendments and reassignments. The court noted that the Pennsylvania Constitution requires every bill to be considered on three different days in each House. The claimant maintained that, according to the legislative history, the bill did not receive three separate days of consideration from each House when it was assigned a new bill number. The court pointed out, however, that the bill number, H.B. 1840 remained constant and was considered on three occasions by the House. Further, the court concluded that minor amendments to the bill were germane to its original subject, which was to modify the Act’s IRE process, in accordance with Protz II.

Defense Victory Obtained in Workers’ Compensation Case

Result

Defense Victory Obtained in Workers’ Compensation Case

business meeting photo

Result

Summary Judgment Obtained in Insurance Coverage Case

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News

Marshall Dennehey Announces 2027 New Jersey Super Lawyers And Rising Stars

Bret E. Dubbert Joins Marshall Dennehey’s Orlando Office as Special Counsel in the Casualty Department

News

Bret E. Dubbert Joins Marshall Dennehey’s Orlando Office as Special Counsel in the Casualty Department

Marshall Dennehey Named a Standout in Litigation by BTI Consulting Group

News

Marshall Dennehey Named a Standout in Litigation by BTI Consulting Group

Complete Victory Obtained in a Workers’ Compensation Matter

Result

Complete Victory Obtained in a Workers’ Compensation Matter

Event

CLM 2026 Focus Conference

Allison joins three insurance industry leaders to discuss how cyber coverage disputes, the growing impact of social inflation on bodily injury claim valuation, and the use of artificial intelligence are reshaping the bad faith landscape. The panel will examine emerging sources of extra-contractual exposure, including evolving cyber insurance coverage issues and the challenges of accurately valuing bodily injury claims. Practical approaches to claim evaluation using AI, along with defense strategies designed to help prevent or successfully defend against bad faith litigation, will also be addressed. 

Thought Leadership

WCJ Improperly Refused to Conduct C&R Hearing and Erroneously Required Settlement of All Pending Petitions

In this case, the claimant sustained injuries in the course and scope of her employment as a registered nurse. The employer acknowledged the injury by a Notice of Compensation Payable (NCP).  Subsequently, a Workers’ Compensation Judge (WCJ) expanded the description of injury. The employer then filed a Termination Petition, alleging the claimant was fully recovered from the injuries. Providers filed Utilization Review (UR) Petitions, challenging UR determinations finding their chiropractic treatment to be not reasonable and necessary. A settlement of the claim was eventually reached, and the employer filed a Petition to Seek Approval of a Compromise and Release (C&R) Agreement. The C&R outlined that the agreement fully resolved all future workers’ compensation claims except for the termination and UR Petitions. Briefs were filed and one day later, the WCJ issued an Interlocutory Order which stated if instructions were not followed regarding filing of a C&R, a settlement hearing date would not be given. The employer complied with the order, and filed the C&R. Subsequently, the WCJ notified the parties that the C&R must resolve all issues in the petitions, or would not be entertained. A settlement hearing was never held, and the WCJ then issued a decision, granting the Termination Petition and dismissing the UR Petitions. The WCJ also said that the Petition for Approval of a C&R was dismissed without prejudice, as the issues in the Termination and UR Petitions went to a decision. The claimant appealed to the Workers’ Compensation Appeal Board (Board). The Board granted the claimant’s appeal, finding that the WCJ violated the requirement of Section 449 that an expedited hearing be held when a Petition for Approval of a C&R is filed.  The Board further held that it was legally incorrect for the WCJ to insist that the C&R resolve all issues raised by the pending Petitions. The Board remanded the case to a new WCJ, and Employer appealed to the Commonwealth Court. The court affirmed the Board and held that the WCJ erred, as a matter of law, by refusing to hold an expedited hearing within 30 days, once the Petition for Approval of a C&R was filed.  The court noted that the language of Section 449(b) is mandatory, and a settlement hearing is not discretionary or dependent on a party’s separate request for a stay, or whether the record has been closed. The court further rejected Employer’s argument that the case should not be remanded to a new WCJ for a new decision on the termination and and UR Petitions, as the Board passed no judgment on whether the C&R Agreement resolved the termination and UR Petitions, and left it for the WCJ to decide in connection with the Petition for Approval of a C&R.

Thought Leadership

Florida Supreme Court Rules Florida Statute §627.70152 Does not Apply Retroactively

In a decision that resolves years of appellate uncertainty and confirms that insurers and insureds alike can rely on the legal framework in place when a policy is issued, the Supreme Court of Florida last week found that Florida Statute §627.70152, which involves an insured’s requirement to provide an insurer with pre-suit notice before filing a suit, cannot be applied retroactively. In Universal Property & Casualty Insurance Company v. Hughes, the Court was presented with the issue of whether the statutory pre-suit notice requirement applied retroactively and whether it would apply to a breach of contract of an insurance policy that was issued before the statute went into effect. Before the Court was an appeal from a homeowner, Ms. Hughes, who sued her insurance carrier, Universal Property & Casualty Insurance Company (Universal) for breach of contract under an insurance policy that was in effect from April 24, 2019 through April 24, 2020. During the policy period, Ms. Hughes suffered a loss and, on May 29, 2019, made a claim for water damage. The carrier investigated the loss and issued payment; Ms. Hughes disputed the payment, finding the amount insufficient for repairs. On July 1, 2021, Florida Statute §627.70152 went into effect, which required insureds to provide notice of intent to initiate litigation against the carrier prior to filing a lawsuit; if an insured filed the lawsuit without complying with §627.70152, a court must dismiss the case without prejudice. On August 4, 2021, Ms. Hughes filed her lawsuit against Universal for breach of contract. Universal moved to dismiss based on her failure to comply with §627.70152. Ms. Hughes contended the notice requirement could not be applied retroactively. The trial court disagreed and dismissed the lawsuit without prejudice, and Ms. Hughes appealed. During the appeal, the Fourth District Court of Appeal, in Cole v. Universal Property & Casualty, 363 So. 3d 1089 (Fla. 4th DCA 2023), ruled that Florida Statute §627.70152 did apply retroactively to policies issued before the effective date of §627.70152. However, the Sixth District Court agreed with Ms. Hughes and overturned the trial court’s ruling, finding the statute could not retroactively apply to policies issued prior to the statute effective date. Thereafter, the other district courts weighed in, with the Third District Court agreeing with the Fourth District Court, and the First, Second and Fifth District Courts agreeing with the Sixth District Court. In resolving the conflict amongst the district courts, the Supreme Court advised “as a general rule, ‘the statute in effect at the time an insurance contract is executed governs substantive issues arising in connection with that contract.’ Hassen v. State Farm Mut. Auto. Ins. Co., 674 So. 2d 106, 108 (Fla. 1996). The Court applied the two-step test when deciding whether a statute has retroactive application: “First, the Court must ascertain whether the Legislature intended for the statute to apply retroactively. Second, if such an intent is clearly expressed, the Court must determine whether retroactive application would violate any constitutional principles.” Menendez v. Progressive Exp. Ins. Co., 35 So. 3d 873, 877 (Fla. 2010). In analyzing the Legislature’s intent, the Court must determine whether the Legislature has manifested a clear command for retroactivity in the statutory text.  In review of the statutory text, the Court found nothing in the language of the statute to indicate that the phrase “all suits” was serving another purpose of expanding its reach to suits based on policies that both predate and postdate the enactment of the statute. Buis v. Universal Prop. & Cas. Ins. Co., 394 So. 3d 738, 741 (Fla. 2d DCA 2024). Further, the Court noted the statute has an effective date, which has long been considered to be evidence against retroactive application of a statute. The Court concluded that, on its face, no provision of §627.70152 speaks to application of the statute to insurance policies issued before the statute’s effective date and therefore, the Legislature did not clearly command retroactivity of the statute to include insurance policies issued prior to the enactment of the statute. The Court briefly reviewed Universal’s argument that the presuit notice requirement was procedural, not substantive, and therefore should be applied retroactively; however, the Court agreed with the Sixth District Court’s finding that, in its entirety, §627.70152 transformed an insured’s ability to sue an insurance company under a property insurance policy and an insurer’s obligations to respond to and pay insurance claims, thus making the requirement a substantive change. The Court thereby upheld the decision of the Sixth District and disapproved the decision of the Fourth District in Cole.