Orthopedic surgeons in Texas are part of a high-exposure group of surgical specialties. Neurosurgery and obstetrics typically carry the very highest malpractice risk, but orthopedics is consistently close behind, especially for subspecialties involving spine, trauma, and high implant volumes.
Texas tort reform lowered the overall number of lawsuits, yet orthopedic claims remain among the most severe and expensive to defend. The Texas Department of Insurance (TDI) closed-claim reports which were published through 2015, showed that only about 29% of malpractice claims statewide ended in a payment. However, when orthopedic claims were paid, the indemnity amounts often exceeded the statewide average of $317,447, with several reaching into the millions.
Since Texas ended closed-claim reporting, ongoing data is best reviewed through the National Practitioner Data Bank (NPDB) Data Analysis Tool. National studies, such as the New England Journal of Medicine’s specialty risk analysis confirm that orthopedic surgery remains one of the specialties most likely to face a malpractice claim during a career.
Premiums reflect these realities. A surgeon practicing spine and trauma in Houston is underwritten very differently than a hand surgeon in Lubbock. Subspecialty mix, call responsibilities, and where you practice remain the key factors that carriers weigh when pricing coverage.
This guide provides orthopedic surgeons with a 2025-focused overview of the Texas market: premiums, underwriting considerations, state law, high-risk procedures, and what to expect during the quoting process.
Orthopedic surgery in Texas combines high patient demand with procedures that often carry life-altering consequences. From complex spine fusions in Houston trauma centers to joint replacements in Austin or fracture repairs in Lubbock, every case involves risk. Even with tort reform reducing overall lawsuit frequency, orthopedic claims that proceed can be among the costliest in the state, with indemnities frequently exceeding Texas’s average payout.
Malpractice insurance isn’t just about satisfying hospital credentialing or ASC requirements - it’s about protecting your career, practice, and personal assets from high-severity claims tied to surgical outcomes. Whether you’re hospital-employed or running a private group, adequate coverage is essential in a state where economic damages remain uncapped under Texas Civil Practice & Remedies Code Chapter 74.
The malpractice market for orthopedic surgeons in Texas remains low in frequency but high in severity. Post-tort reform, fewer claims are filed, yet those that go forward often involve catastrophic injury or costly complications.
Resources such as the AAOS Diagnosis and Prevention of Periprosthetic Joint Infections (2019) guideline are increasingly referenced by carriers and risk management review in evaluating infection prevention practices. (AAOS PJI guideline PDF)
Carriers in Texas put less weight on how many orthopedic claims are filed and far more on the severity of those claims. Surgeons who provide detailed procedure logs, show strong infection-control protocols, and maintain clean loss-run narratives often receive more favorable terms. Metro location (especially Houston, Dallas) and subspecialty mix (spine, trauma) remain primary drivers of premium variation.
From the TMLT summary of MPL Association’s closed-claim data, here’s what’s known:
When orthopedic surgeons in Texas ask about cost, the short answer is that it depends on what type of orthopedics you practice, how often you take call, and where you operate. Premiums aren’t uniform - carriers look closely at subspecialty, prior claims, and even which part of the state you practice in before quoting.
Most orthopedic surgeons carry claims-made policies, since occurrence coverage is rarely offered in Texas. For a mature claims-made policy - meaning you’ve been in practice at least five or six years and past the discounted years - annual premiums usually range between $45,000 and $80,000.
New surgeons don’t start at those numbers right away. Claims-made policies are step-rated, which means you pay discounted premiums in years one through four, then reach full maturity by year five or six.
By year five, most Texas orthopedic surgeons are paying full mature rates - and subspecialty mix determines whether that’s closer to $45,000 or $80,000.
Group practices often benefit from economies of scale, since carriers may allow surgeons to share limits. Solo practitioners must carry separate limits, which generally pushes premiums higher.
Hospital-employed surgeons are usually covered under their institution’s program, but it’s essential to confirm both the limits of liability and whether the hospital provides tail coverage if employment ends. Private practice surgeons must carry their own individual coverage.
Carriers also look closely at:
Orthopedic surgeons in Texas generally pay more than general surgeons, but usually less than OB/GYNs and neurosurgeons, the two specialties that almost always top the premium scale.
(graph)
The Takeaway: Malpractice premiums for orthopedic surgeons in Texas mature quickly. Subspecialty, trauma call, surgical setting, and where you practice are the biggest drivers of cost, with most surgeons paying between $45,000 and $80,000 once fully rated.
Texas has one of the most surgeon-friendly liability environments in the country, but “friendly” doesn’t mean risk-free. Tort reform took a lot of heat out of the system in 2003, yet orthopedic cases still hit hard when they do go forward.
The headline everyone remembers is the cap on noneconomic damages. Under CPRC §74.301 pain and suffering awards are capped at $250,000 per physician, with another $250,000 allowed for each facility involved - maxing out at $750,000 if multiple hospitals or clinics are named.
But here’s the catch: economic damages aren’t capped. If a patient loses their livelihood after a spine fusion gone wrong or needs lifetime care after a trauma case, the verdict can climb into the millions. Orthopedic surgeons feel that exposure more than many other specialties because your outcomes directly affect function and long-term earning power. Wrongful death cases fall under CPRC §74.303 and those can be equally costly when dependents are involved.
For most malpractice suits, plaintiffs have two years from the date of the alleged negligence to file. There are limited discovery-rule exceptions, but Texas courts don’t hand those out lightly. With minors, claims can be filed until the child’s 14th birthday. And after 10 years, the statute of repose shuts the door completely - no claim can be filed, no matter what.
Texas also makes plaintiffs show their cards early. Within 120 days of filing, they have to submit an expert report from a physician saying your care fell below standard. If they don’t, the case gets tossed. That rule cut down on the frivolous lawsuits, but the flip side is this: when a case does survive, it’s usually well-prepared and harder to fight off.
Even with caps in place, juries aren’t all the same. A spine case in Houston or Dallas will be viewed differently than one tried in Lubbock or Amarillo. San Antonio and Austin sit somewhere in the middle. Rural counties may see fewer lawsuits, but when one does land, the damages can be just as high.
The big picture is this: tort reform gave surgeons in Texas some breathing room, but it didn’t eliminate the risk. Orthopedic claims remain high-severity because they involve mobility, independence, and income. That’s why carriers continue to price your policies at the upper end, even in a state with caps.
The Takeaway: Texas law limits pain-and-suffering payouts, but it doesn’t shield you from the biggest risk - uncapped economic damages. For orthopedic surgeons, that’s where the dollars stack up.
Not all orthopedic cases are treated the same by carriers - or by juries. Some procedures almost guarantee more underwriting scrutiny because history shows they’re where the biggest claims come from. The Texas Department of Insurance (TDI) closed-claim data, alongside National Practitioner Data Bank reports, consistently put orthopedics in the top five for severity nationwide.
Spinal procedures drive some of the highest indemnity payouts for orthopedic surgeons in Texas.
The Takeaway: In Texas, carriers track risk by subspecialty, not just by “orthopedic surgery” as a whole. Spine and trauma remain the most scrutinized, while joint, hand, and sports still carry meaningful exposure.
For most orthopedic surgeons in Texas, malpractice coverage starts with a claims-made policy. That’s the standard structure here, and for good reason - it keeps annual premiums more affordable upfront. The trade-off, of course, is that when you leave a job or change carriers, you’ll need some way to protect your prior work. That’s where tail or nose coverage comes into play.
Occurrence coverage is technically the simpler option - it covers you for care delivered during the policy year, no matter when a lawsuit is filed. But for orthopedics, occurrence policies are almost never available in Texas. The severity of spine and trauma claims just makes them too risky for carriers to offer.
Tail insurance is the safety net that follows you after a claims-made policy ends. The cost usually runs about two to two-and-a-half times your annual premium, which can feel like a punch when you’re leaving a practice. Some groups or hospitals agree to pay for it at retirement, but that’s not something to assume - it needs to be spelled out in your contract.
The other option is nose coverage. If you’re switching carriers, your new company may agree to backdate coverage so you don’t have to buy tail from the old one. That’s cleaner, but it depends on your history and whether the new carrier wants the risk.
Hospitals and surgery centers in Texas almost always require $1 million per claim and $3 million per year. That’s the baseline. Trauma centers or large referral contracts may push higher. For spine surgeons or those with heavy implant work, carriers themselves may insist on stronger limits.
There are a few details buried in policies that orthopedic surgeons should actually read.
Texas has a mix of admitted carriers and excess & surplus (E&S) markets. The right fit depends on your subspecialty, claims history, and whether you’re entering, switching, or leaving practice. Admitted carriers write most of the business, but surgeons with high-risk procedures, prior claims, or gaps in coverage may need an E&S option.
Sorting through these carriers isn’t something most surgeons want to do themselves - applications are long, underwriting questions are detailed, and each company has a different appetite. That’s where working with a broker matters: we know which carriers are open to spine-heavy practices, which are cautious with trauma call, and which are better suited for general orthopedic surgeons.
The Takeaway: For most orthopedic surgeons in Texas, a claims-made policy with $1M/$3M limits is the baseline. The real questions are how your tail will be handled, whether your carrier is comfortable with your subspecialty, and what’s hiding in the endorsements. Those details matter more than the logo on the front of the policy.
In Texas, the career stage you’re in shapes not only your premium but also the type of protection you need. Carriers look closely at transitions, since they often change your risk profile and can leave gaps if not managed carefully.
Orthopedic surgeons starting out in Texas almost always begin with a step-rated claims-made policy. Premiums are discounted for the first four to five years, then reach full maturity by year six. Hospitals and surgery centers will expect proof of coverage at $1M/$3M, and carriers will establish your retroactive date with your first policy. Guarding that retro date is essential - lose it, and your prior years of practice in Texas are no longer covered.
Many hospital contracts in Texas leave tail coverage to the surgeon when employment ends. Some larger systems may cover it at retirement, but that’s not guaranteed and should be spelled out in your contract. Moving into private practice means you’ll need your own individual coverage and to navigate the application process directly with carriers.
Group practices in Texas often negotiate shared limits, which can help reduce costs. But carriers also evaluate the group’s claims history. A clean record benefits everyone, while a prior indemnity payment can push premiums up across the board. Some groups in Houston, Dallas, and San Antonio have seen rate impacts tied to just a handful of large claims.
If you shift into spine or trauma work, carriers in Texas re-underwrite you with fresh eyes. Spine and trauma exposure are closely scrutinized here, especially in metro trauma centers. Expect premiums to climb if your implant volumes or trauma call schedule increase. It’s better to disclose subspecialty changes proactively than to surprise the carrier at renewal.
Texas does not have a Patient Compensation Fund, so orthopedic surgeons rely entirely on their malpractice policy to protect them after practice ends. Many carriers offer free retirement tail coverage if you meet certain conditions (such as being with the same carrier for a set number of years and fully retiring from practice). If you don’t qualify, tail typically costs 200–250% of your annual premium.
Securing malpractice coverage in Texas doesn’t have to be complicated or time-consuming. In fact, to begin the process, at DrsCoverage we usually can start getting initial indications using a recent application - one completed within the past year for a renewal or prior carrier submission. With that in hand, we can approach carriers directly and secure initial indications on your behalf.
By working through DrsCoverage, you avoid repeating the same application process with multiple carriers or worrying about missing information. We streamline submissions, communicate directly with underwriters, and make sure your practice is presented accurately so you see the most competitive terms available.
Carriers don’t just differ on price. The policy details can significantly affect your protection:
These are distinctions that rarely show up in the premium but matter greatly when a claim is filed. DrsCoverage reviews these side by side so orthopedic surgeons can make decisions based on the full picture, not just the lowest number.
Starting early - ideally 60–90 days before renewal - allows time for carriers to review your file and issue firm quotes. Loss runs from prior carriers are often the biggest delay, and DrsCoverage manages those requests for you. The earlier your application is submitted, the stronger your position with underwriters.
The Takeaway: With one recent application, DrsCoverage can begin securing quotes from leading carriers writing orthopedic surgeons in Texas. Our role as insurance broker is to manage the details, present your practice properly, and provide a clear comparison of both cost and coverage.
Schedule a consultation with a licensed medical malpractice insurance broker. You can also request a quote to get started or email us with any questions. If you have a recent carrier application (such as last year’s), it may help us provide initial indications faster. A DrsCoverage broker is available to assist you at any stage.
(3).svg)