Directory · North Carolina · Medical malpractice

Who writes medical malpractice in North Carolina

Ranked by direct premium written in 2025 from the North Carolina market share report (every company, not a top-N list).

122 companies wrote medical malpractice in North Carolina in 2025, $215.8M in direct premium. Medical Mutual Insurance Company of North Carolina led with 21.2%; the top five hold 50%.

By Sam Alishahi, independent insurance broker · All lines in North Carolina

Top 10 · NAIC table: 11.1, 11.2 - Medical Professional Liability

The insurer groups that write the most medical malpractice in North Carolina

Top 10 insurer groups by direct premium written in 2025, from the NAIC's Market Share Reports for Property/Casualty Groups and Companies by State. A group is the parent and its insurance companies together; share is the group's part of the state total for the line; loss ratio is losses incurred over premium earned.

#	Insurer group	Premium written	Share	Loss ratio	Member companies here
1	Curi Holdings Group	$50.2M	23.25%	24%	Medical Mutual Insurance Company of North Carolina, MMIC Insurance, Inc., Medical Security Insurance Company, UMIA Insurance, Inc.
2	Mag Mutual Insurance Group	$41.3M	19.12%	70%	MAG Mutual Insurance Company, Professional Security Insurance Company, MD Advantage Insurance Company of New Jersey
3	Berkshire Hathaway Group	$25.2M	11.69%	67%	GEICO General Insurance Company, GEICO Texas County Mutual Insurance Company, GEICO County Mutual Insurance Company, Government Employees Insurance Company
4	Cna Insurance Group	$15.1M	6.99%	24%	Continental Casualty Company, Continental Insurance Company, (The), American Casualty Company of Reading, Pennsylvania, National Fire Insurance Company of Hartford
5	Doctors Co. Group	$10.4M	4.84%	42%	Doctors' Company (The), An Interinsurance Exchange, The Doctor's Management, TDC Specialty Insurance Company, TDC National Assurance Company, Doctors Company Risk Retention Group, A Reciprocal Exchange, The
6	Liberty Mutual Group	$7.8M	3.60%	137%	Safeco Insurance Company of America, Liberty Insurance Underwriters, Inc., Liberty Mutual Fire Insurance Company, Liberty County Mutual Insurance Company
7	Proassurance Corporation Group	$7.7M	3.56%	—	NORCAL Insurance Company, ProAssurance Indemnity Company, Inc., ProAssurance Insurance Company of America, Allied Eastern Indemnity Company
8	Chubb Ltd Group	$5.1M	2.38%	15%	Federal Insurance Company, Ace American Insurance Company, Ace Property and Casualty Insurance Company, Chubb Lloyd's Insurance Company of Texas
9	Coverys Group	$4.7M	2.19%	290%	Preferred Professional Insurance Company, ProSelect Insurance Company, Coverys Specialty Insurance Company, Coverys Risk Retention Group, Inc.
10	Arch Insurance Group	$4.3M	2.01%	37%	Arch Insurance (UK) Limited, Arch Mortgage Insurance Company, Arch Indemnity Insurance Company, Arch Specialty Insurance Company

Medical malpractice · North Carolina

The companies

#	Company	NAIC	Home state	Status here	Premium	Share
1	Medical Mutual Insurance Company of North Carolina	32522	NC	Admitted (licensed)	$45.7M	21.16%
2	MAG Mutual Insurance Company	42617	GA	Admitted (licensed)	$22.8M	10.55%
3	Professional Security Insurance Company	11811	AZ	Surplus lines (eligible)	$18.5M	8.56%
4	Medical Protective Company (The)	11843	IN	Admitted (licensed)	$13.0M	6.02%
5	American Casualty Company of Reading, Pennsylvania	20427	PA	Admitted (licensed)	$7.9M	3.68%
6	Columbia Casualty Company	31127	IL	Surplus lines (eligible)	$7.1M	3.28%
7	Doctors' Company (The), An Interinsurance Exchange, The Doctor's Management	34495	CA	Admitted (licensed)	$6.9M	3.18%
8	NATIONAL FIRE \u0026 MARINE INSURANCE COMPANY\	20079	NE	Surplus lines (eligible)	$6.0M	2.77%
9	ProAssurance Specialty Insurance Company	17400	VT	Surplus lines (eligible)	$5.7M	2.63%
10	Ironshore Specialty Insurance Company	25445	AZ	Surplus lines (eligible)	$5.4M	2.52%
11	Medical Security Insurance Company	33090	NC	Admitted (licensed)	$4.4M	2.05%
12	Arch Specialty Insurance Company	21199	MO	Surplus lines (eligible)	$4.3M	2.01%
13	Coverys Specialty Insurance Company	15686	NJ	Surplus lines (eligible)	$4.1M	1.92%
14	Illinois Union Insurance Company	27960	IL	Surplus lines (eligible)	$3.9M	1.81%
15	Health Care Industry Liability Reciprocal Insurance Company, A Risk Retention Group	11832	DC	Writes (premium reported)	$2.9M	1.34%
16	General Star Indemnity Company	37362	DE	Surplus lines (eligible)	$2.6M	1.21%
17	Admiral Insurance Company	24856	DE	Surplus lines (eligible)	$2.6M	1.21%
18	Bridgeway Insurance Company ( Formerly American Modern Surplus Lines Insurance Company	12489	DE	Surplus lines (eligible)	$2.2M	1.03%
19	Liberty Insurance Underwriters, Inc.	19917	IL	Admitted (licensed)	$2.2M	1.01%
20	TDC Specialty Insurance Company	34487	DC	Surplus lines (eligible)	$2.1M	1.00%
21	OMS National Insurance Company	44121	IL	Writes (premium reported)	$1.9M	0.88%
22	QBE Specialty Insurance Company	11515	ND	Surplus lines (eligible)	$1.9M	0.87%
23	Eastern Dentists Insurance Company (A Dental Society Risk Rention Group)	10115	VT	Writes (premium reported)	$1.9M	0.87%
24	Evanston Insurance Company	35378	IL	Surplus lines (eligible)	$1.6M	0.73%
25	Vantage Risk Specialty Insurance Company	16275	DE	Surplus lines (eligible)	$1.5M	0.72%
26	Risk Underwriters Group, LLC, a Risk Retention Group	17635	VT	Writes (premium reported)	$1.5M	0.69%
27	Cincinnati Insurance Company (The)	10677	OH	Admitted (licensed)	$1.5M	0.68%
28	Doctors Company Risk Retention Group, A Reciprocal Exchange, The	14347	DC	Writes (premium reported)	$1.4M	0.67%
29	\|Landmark American Insurance Company	33138	NH	Surplus lines (eligible)	$1.4M	0.67%
30	Ophthalmic Mutual Insurance Company (A Risk Retention Group)	44105	VT	Writes (premium reported)	$1.4M	0.66%
31	Kinsale Insurance Company	38920	AR	Surplus lines (eligible)	$1.4M	0.66%
32	Pharmacists Mutual Insurance Company	13714	IA	Admitted (licensed)	$1.3M	0.60%
33	StarStone Specialty Insurance Company	44776	DE	Surplus lines (eligible)	$1.2M	0.58%
34	NCMIC Insurance Company	15865	IA	Admitted (licensed)	$1.2M	0.56%
35	Caring Communities, a Reciprocal Risk Retention Group	12373	DC	Writes (premium reported)	$1.2M	0.55%
36	Ace American Insurance Company	22667	PA	Admitted (licensed)	$1.1M	0.52%
37	Fortress Assurance Corporation	10801	IL	Admitted (licensed)	$1.1M	0.52%
38	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	19445	PA	Admitted (licensed)	$1.1M	0.52%
39	Health Care Indemnity Incorporated	35904	CO	Surplus lines (eligible)	$1.0M	0.48%
40	Berkshire Hathaway Specialty Insurance Company	22276	NE	Admitted (licensed)	$935,384	0.43%
41	Fair American Insurance and Reinsurance Company	35157	NY	Admitted (licensed)	$912,422	0.42%
42	Allied World Assurance Company (U.S.) Inc.	22730	NH	Admitted (licensed)	$888,811	0.41%
43	Allied World Surplus Lines Insurance Company	24319	AR	Surplus lines (eligible)	$828,619	0.38%
44	Applied Medico-Legal Solutions Risk Retention Group, Inc.	11598	AZ	Writes (premium reported)	$802,976	0.37%
45	Preferred Physicians Medical Risk Retention Group, a Mutual Insurance Company	44083	MO	Writes (premium reported)	$782,116	0.36%
46	Clinician Assurance Inc., a Risk Retention Group	16851	VT	Writes (premium reported)	$769,599	0.36%
47	Lexington Insurance Company	19437	DE	Surplus lines (eligible)	$620,807	0.29%
48	ProAssurance Insurance Company of America	14460	IL	Admitted (licensed)	$538,874	0.25%
49	ProSelect Insurance Company	10638	NE	Admitted (licensed)	$529,084	0.25%
50	Beazley Excess and Surplus Insurance, Inc. (C)	17520	CT	Surplus lines (eligible)	$518,701	0.24%
51	National Guardian Risk Retention Group, Inc.	36072	HI	Writes (premium reported)	$476,554	0.22%
52	MS Transverse Specialty Insurance Company	41807	TX	Surplus lines (eligible)	$474,870	0.22%
53	\|Texas Insurance Company	16543	TX	Surplus lines (eligible)	$447,954	0.21%
54	COPIC, a Risk Retention Group	14906	DC	Writes (premium reported)	$430,444	0.20%
55	Homesite Insurance Company of Florida	11156	IL	Surplus lines (eligible)	$430,081	0.20%
56	Physicians Insurance Risk Retention Group, Inc.	15738	VT	Writes (premium reported)	$429,610	0.20%
57	Endurance American Specialty Insurance Company	41718	DE	Surplus lines (eligible)	$428,776	0.20%
58	Integris Assurance Company	13793	FL	Admitted (licensed)	$422,442	0.20%
59	NORCAL Insurance Company	33200	CA	Admitted (licensed)	$422,356	0.20%
60	MSIG Specialty Insurance USA Inc.	34886	NY	Surplus lines (eligible)	$398,526	0.18%
61	Capitol Specialty Insurance Corporation	10328	WI	Surplus lines (eligible)	$354,456	0.16%
62	James River Insurance Company	12203	OH	Surplus lines (eligible)	$351,861	0.16%
63	PracticeProtection Casualty Company	12843	FL	Admitted (licensed)	$346,630	0.16%
64	Aspen Specialty Insurance Company	10717	ND	Surplus lines (eligible)	$334,359	0.15%
65	Lone Star Alliance, Inc., a Risk Retention Group	15211	DC	Writes (premium reported)	$315,529	0.15%
66	Allied Professionals Insurance Company, A Risk Retention Group, Inc.	11710	AZ	Writes (premium reported)	$290,321	0.13%
67	Great Divide Insurance Company	25224	ND	Admitted (licensed)	$277,725	0.13%
68	Hamilton Select Insurance, Inc.	17178	DE	Surplus lines (eligible)	$259,640	0.12%
69	Aspen American Insurance Company	43460	TX	Admitted (licensed)	$236,051	0.11%
70	AXIS Surplus Insurance Company	26620	IL	Surplus lines (eligible)	$206,736	0.10%
71	ProAssurance Indemnity Company, Inc.	33391	AL	Admitted (licensed)	$206,502	0.10%
72	Community Blood Centers' Exchange, Risk Retention Group	13893	IN	Writes (premium reported)	$185,023	0.09%
73	Houston Specialty Insurance Company	12936	TX	Surplus lines (eligible)	$184,471	0.09%
74	California Healthcare Insurance Company, a Risk Retention Group	44504	HI	Writes (premium reported)	$180,710	0.08%
75	\|Hudson Excess Insurance Company	14484	DE	Surplus lines (eligible)	$165,115	0.08%
76	Green Hills Insurance Company, A Risk Retention Group	11941	VT	Writes (premium reported)	$152,878	0.07%
77	Liberty Surplus Insurance Corporation	10725	NH	Surplus lines (eligible)	$144,987	0.07%
78	Richmond National Insurance Company	17103	NH	Surplus lines (eligible)	$142,634	0.07%
79	Cincinnati Casualty Company (The)	28665	OH	Admitted (licensed)	$132,975	0.06%
80	American Association of Orthodontists Insurance Company (a RRG)	10232	AZ	Writes (premium reported)	$121,172	0.06%
81	Hartford Fire Insurance Company	19682	CT	Admitted (licensed)	$111,090	0.05%
82	\|Trisura Specialty Insurance Company	16188	OK	Surplus lines (eligible)	$109,166	0.05%
83	Healthcare Professional Long Term Care Risk Retention Group, Inc.	16957	AL	Writes (premium reported)	$95,928	0.04%
84	Future Care Risk Retention Group, Inc.	16661	AL	Writes (premium reported)	$93,705	0.04%
85	Chubb Custom Insurance Company	38989	NJ	Surplus lines (eligible)	$83,858	0.04%
86	Spirit Mountain Insurance Company Risk Retention Group, Inc.	10754	AL	Writes (premium reported)	$83,022	0.04%
87	Beazley Insurance Company, Inc.	37540	CT	Admitted (licensed)	$79,326	0.04%
88	Ascot Specialty Insurance Company	45055	RI	Surplus lines (eligible)	$73,521	0.03%
89	Doctors Professional Liability Risk Retention Group, Inc.	15893	NC	Admitted (licensed)	$73,232	0.03%
90	Indigo Risk Retention Group Inc.	17484	SC	Writes (premium reported)	$67,119	0.03%
91	MMIC Risk Retention Group, Inc.	14062	DC	Writes (premium reported)	$57,918	0.03%
92	Professional Solutions Insurance Company	11127	IA	Admitted (licensed)	$55,356	0.03%
93	American Home Assurance Company	19380	NY	Admitted (licensed)	$53,803	0.02%
94	Affiliates Insurance Reciprocal, a Risk Retention Group	13677	VT	Writes (premium reported)	$52,784	0.02%
95	Great American Fidelity Insurance Company	41858	OH	Surplus lines (eligible)	$47,231	0.02%
96	Preferred Professional Insurance Company	36234	NE	Admitted (licensed)	$46,483	0.02%
97	Continental Casualty Company	20443	IL	Admitted (licensed)	$41,336	0.02%
98	Cincinnati Indemnity Company (The)	23280	OH	Admitted (licensed)	$39,488	0.02%
99	United Specialty Insurance Company	12537	TX	Surplus lines (eligible)	$37,778	0.02%
100	ISMIE Mutual Insurance Company	32921	IL	Admitted (licensed)	$32,909	0.02%
101	Western World Insurance Company, Inc.	13196	NH	Surplus lines (eligible)	$31,647	0.01%
102	State Volunteer Mutual Insurance Company	33049	TN	Admitted (licensed)	$30,831	0.01%
103	ProAssurance American Mutual, A Risk Retention Group	15647	DC	Writes (premium reported)	$27,605	0.01%
104	Positive Physicians Insurance Company	11863	PA	Admitted (licensed)	$20,199	0.01%
105	ISMIE Indemnity Company	11084	IL	Surplus lines (eligible)	$20,000	0.01%
106	State Farm Fire and Casualty Company	25143	IL	Admitted (licensed)	$18,723	0.01%
107	Continental Insurance Company, (The)	35289	PA	Admitted (licensed)	$16,516	0.01%
108	Cincinnati Specialty Underwriters Insurance Company (The)	13037	DE	Surplus lines (eligible)	$16,184	0.01%
109	CAMPMED CASUALTY \u0026 INDEMNITY COMPANY, INC.	12260	NH	Admitted (licensed)	$12,924	0.01%
110	Dellwood Specialty Insurance Company	17332	AZ	Surplus lines (eligible)	$11,137	0.01%
111	Academic Medical Professionals Insurance RRG, LLC	12934	VT	Writes (premium reported)	$10,917	0.01%
112	Practiceprotection Insurance Company (A Rrg)	16189	AL	Writes (premium reported)	$10,625	0.00%
113	NORCAL Specialty Insurance Company	35114	TX	Surplus lines (eligible)	$9,845	0.00%
114	Healthcare Professional Risk Retention Group, Inc.	16383	NC	Admitted (licensed)	$8,875	0.00%
115	Lammico Risk Retention Group, Inc.	14444	DC	Writes (premium reported)	$7,953	0.00%
116	Franklin Casualty Insurance Company, A Risk Retention Group	10842	VT	Writes (premium reported)	$7,000	0.00%
117	Berkley Assurance Company	39462	IA	Surplus lines (eligible)	$6,279	0.00%
118	AIX Specialty Insurance Company	12833	DE	Surplus lines (eligible)	$4,256	0.00%
119	Church Mutual Insurance Company, S. I.	18767	WI	Admitted (licensed)	$1,004	0.00%
120	NCMIC Risk Retention Group, Inc.	14130	VT	Writes (premium reported)	$852	0.00%
121	Emergency Capital Management, a Risk Retention Group, LLC	14163	VT	Writes (premium reported)	$623	0.00%
122	Philadelphia Indemnity Insurance Company	18058	PA	Admitted (licensed)	$1	0.00%

Turned down?

Last resort for medical malpractice in North Carolina

Last resort	Lines	Where	How to get in
Surplus lines and Lloyd's open market	all	all states, under each state's diligent-search rules	Through surplus lines wholesalers; commercial property and liability have no guaranteed plan, so this is their last step	Source

Method and source

Source: the North Carolina insurance regulator company list, read 2026-10-18 and the surplus lines list. NCDOI P7 Property and Casualty Experience, year ended 12/31/2025: every company that filed an NC state page (P&C annual statement). 'admitted' = rows whose 'Licensed in NC' column reads 'Licensed' (includes zero-premium licensed companies and NC self-insured workers' comp funds, which have no NAIC code and type 'Self-Insured Workers' Compensation'). 'surplus_lines' = rows reading 'Authorized Surplus Lines Writer' (US nonadmitted insurers that wrote NC surplus lines business that year; alien/Lloyd's not broken out, eligible date not given). Rows 'Not Licensed' or blank (mostly risk retention groups) are dropped. 'type' = Business Type / Company Type [/ Company Sub Type]; all rows are Property and Casualty filers (no life/health in this file). 'lines' = NAIC annual-statement lines of business the company reported in NC with direct premium written or earned > 0 that year (lines actually written, not certificate-of-authority lines). 'since' not given. Status counts in file: {'Licensed': 825, '': 73, 'Authorized Surplus Lines Writer': 193, 'Not Licensed': 39}. "Premium" is direct premium written in the state for the year shown; "share" is that company's part of the state total for the line. A company can be licensed for a line and write none of it, and a surplus lines insurer can write a line without a state license for it.

Open to use. Cite "Alishahi Insurance insurance company directory" and link here. CSV · JSON.

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