Who writes medical malpractice in South Dakota
Ranked by direct premium written in 2025 from the South Dakota market share report (every company, not a top-N list).
31 companies wrote medical malpractice in South Dakota in 2025, $16.0M in direct premium. COPIC Insurance Company led with 69.1%; the top five hold 91%.
By Sam Alishahi, independent insurance broker · All lines in South Dakota
The companies
| # | Company | NAIC | Home state | Status here | Premium | Share |
|---|---|---|---|---|---|---|
| 1 | COPIC Insurance Company | 11860 | CO | Admitted (licensed) | $11.0M | 69.08% |
| 2 | MMIC Insurance, Inc. | 16942 | MN | Admitted (licensed) | $1.7M | 10.78% |
| 3 | Medical Protective Company (The) | 11843 | IN | Admitted (licensed) | $700,075 | 4.38% |
| 4 | American Casualty Company of Reading, Pennsylvania | 20427 | PA | Admitted (licensed) | $661,232 | 4.14% |
| 5 | National Union Fire Insurance Company of Pittsburgh, Pennsylvania | 19445 | PA | Admitted (licensed) | $351,019 | 2.20% |
| 6 | NCMIC Insurance Company | 15865 | IA | Admitted (licensed) | $341,390 | 2.14% |
| 7 | Pharmacists Mutual Insurance Company | 13714 | IA | Admitted (licensed) | $258,124 | 1.62% |
| 8 | Liberty Insurance Underwriters, Inc. | 19917 | IL | Admitted (licensed) | $205,505 | 1.29% |
| 9 | Doctors' Company (The), An Interinsurance Exchange, The Doctor's Management | 34495 | CA | Admitted (licensed) | $153,772 | 0.96% |
| 10 | Cincinnati Insurance Company (The) | 10677 | OH | Admitted (licensed) | $90,306 | 0.57% |
| 11 | MAG Mutual Insurance Company | 42617 | GA | Admitted (licensed) | $79,482 | 0.50% |
| 12 | Aspen American Insurance Company | 43460 | TX | Admitted (licensed) | $63,173 | 0.40% |
| 13 | Ace American Insurance Company | 22667 | PA | Admitted (licensed) | $62,343 | 0.39% |
| 14 | Berkshire Hathaway Specialty Insurance Company | 22276 | NE | Admitted (licensed) | $48,616 | 0.30% |
| 15 | Professional Solutions Insurance Company | 11127 | IA | Admitted (licensed) | $41,474 | 0.26% |
| 16 | Great Divide Insurance Company | 25224 | ND | Admitted (licensed) | $28,625 | 0.18% |
| 17 | ProAssurance Insurance Company of America | 14460 | IL | Admitted (licensed) | $21,069 | 0.13% |
| 18 | Continental Casualty Company | 20443 | IL | Admitted (licensed) | $18,688 | 0.12% |
| 19 | Allied World Assurance Company (U.S.) Inc. | 22730 | NH | Admitted (licensed) | $15,939 | 0.10% |
| 20 | Fortress Assurance Corporation | 10801 | IL | Admitted (licensed) | $15,503 | 0.10% |
| 21 | State Farm Fire and Casualty Company | 25143 | IL | Admitted (licensed) | $15,118 | 0.09% |
| 22 | ProSelect Insurance Company | 10638 | NE | Admitted (licensed) | $13,634 | 0.09% |
| 23 | Cincinnati Indemnity Company (The) | 23280 | OH | Admitted (licensed) | $7,388 | 0.05% |
| 24 | ProAssurance Indemnity Company, Inc. | 33391 | AL | Admitted (licensed) | $6,436 | 0.04% |
| 25 | Fair American Insurance and Reinsurance Company | 35157 | NY | Admitted (licensed) | $5,751 | 0.04% |
| 26 | Cincinnati Casualty Company (The) | 28665 | OH | Admitted (licensed) | $4,256 | 0.03% |
| 27 | Hartford Fire Insurance Company | 19682 | CT | Admitted (licensed) | $3,773 | 0.02% |
| 28 | American Home Assurance Company | 19380 | NY | Admitted (licensed) | $2,178 | 0.01% |
| 29 | Beazley Insurance Company, Inc. | 37540 | CT | Admitted (licensed) | $357 | 0.00% |
| 30 | Greystone Insurance Company | 10019 | CT | Admitted (licensed) | $224 | 0.00% |
| 31 | Philadelphia Indemnity Insurance Company | 18058 | PA | Admitted (licensed) | $1 | 0.00% |
Method and source
Source: the South Dakota insurance regulator company list, read 2026-10-18. SD publishes no licensing roster. This is the SD Division of Insurance market share report set for 2025 (NAIC i-site, CodeList Basis: Licensed): every licensed company that reported SD direct premium on its 2025 annual statement, so licensed companies with no SD premium are absent. type = statement type of the total report(s) the company appears in (Property & Casualty / Life / Health / Title; Life covers both the Life & Annuity and the Life A&H totals). lines = SD per-line reports in which the company wrote direct premium > 0, named as the report headers name them (P&C lines plus the A&H lines filed on P&C/Life statements). Farm mutuals sheet (no NAIC codes) and the 'all statement types' aggregates skipped. No surplus lines eligibility list is published by SD (surplus lines filings go through the SLIP+ clearinghouse). 1 company(ies) found only in a per-line report, not in any total, left out: 38920 Kinsale Ins Co (Aircraft - All Perils). "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.
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