Who writes medical malpractice in Texas
Ranked by direct premium written in 2025 from the Texas Department of Insurance market share report (every company, not a top-N list).
44 companies wrote medical malpractice in Texas in 2025, $231.7M in direct premium. Medical Protective Company (The) led with 25.4%; the top five hold 67%.
By Sam Alishahi, independent insurance broker · All lines in Texas
The companies
| # | Company | NAIC | Home state | Status here | Premium | Share |
|---|---|---|---|---|---|---|
| 1 | Medical Protective Company (The) | 11843 | IN | Admitted (licensed) | $58.9M | 25.43% |
| 2 | Doctors' Company (The), An Interinsurance Exchange, The Doctor's Management | 34495 | CA | Admitted (licensed) | $45.2M | 19.53% |
| 3 | American Casualty Company of Reading, Pennsylvania | 20427 | PA | Admitted (licensed) | $20.2M | 8.73% |
| 4 | ProAssurance Indemnity Company, Inc. | 33391 | AL | Admitted (licensed) | $15.4M | 6.67% |
| 5 | Health Care Indemnity Incorporated | 35904 | CO | Admitted (licensed) | $14.9M | 6.42% |
| 6 | NORCAL Insurance Company | 33200 | CA | Admitted (licensed) | $12.3M | 5.29% |
| 7 | Texas Medical Insurance Company | 10393 | TX | Admitted (licensed) | $8.0M | 3.44% |
| 8 | Fortress Assurance Corporation | 10801 | IL | Admitted (licensed) | $7.1M | 3.08% |
| 9 | NCMIC Insurance Company | 15865 | IA | Admitted (licensed) | $5.1M | 2.21% |
| 10 | Liberty Insurance Underwriters, Inc. | 19917 | IL | Admitted (licensed) | $5.0M | 2.14% |
| 11 | ProSelect Insurance Company | 10638 | NE | Admitted (licensed) | $4.3M | 1.84% |
| 12 | Texas Hospital Insurance Exchange | 32514 | TX | Admitted (licensed) | $4.2M | 1.82% |
| 13 | ProAssurance Insurance Company of America | 14460 | IL | Admitted (licensed) | $3.9M | 1.68% |
| 14 | MAG Mutual Insurance Company | 42617 | GA | Admitted (licensed) | $3.8M | 1.65% |
| 15 | Berkshire Hathaway Specialty Insurance Company | 22276 | NE | Admitted (licensed) | $3.8M | 1.64% |
| 16 | Pharmacists Mutual Insurance Company | 13714 | IA | Admitted (licensed) | $3.4M | 1.48% |
| 17 | Ace American Insurance Company | 22667 | PA | Admitted (licensed) | $1.8M | 0.78% |
| 18 | Allied World Assurance Company (U.S.) Inc. | 22730 | NH | Admitted (licensed) | $1.6M | 0.71% |
| 19 | Fair American Insurance and Reinsurance Company | 35157 | NY | Admitted (licensed) | $1.4M | 0.59% |
| 20 | Medical Mutual Insurance Company of North Carolina | 32522 | NC | Admitted (licensed) | $1.3M | 0.57% |
| 21 | Aspen American Insurance Company | 43460 | TX | Admitted (licensed) | $1.2M | 0.50% |
| 22 | Great Divide Insurance Company | 25224 | ND | Admitted (licensed) | $1.2M | 0.50% |
| 23 | ISMIE Mutual Insurance Company | 32921 | IL | Admitted (licensed) | $1.1M | 0.49% |
| 24 | Integris Assurance Company | 13793 | FL | Admitted (licensed) | $947,760 | 0.41% |
| 25 | Positive Physicians Insurance Company | 11863 | PA | Admitted (licensed) | $729,215 | 0.31% |
| 26 | National Union Fire Insurance Company of Pittsburgh, Pennsylvania | 19445 | PA | Admitted (licensed) | $695,862 | 0.30% |
| 27 | Continental Casualty Company | 20443 | IL | Admitted (licensed) | $593,148 | 0.26% |
| 28 | CAMPMED CASUALTY \u0026 INDEMNITY COMPANY, INC. | 12260 | NH | Admitted (licensed) | $563,121 | 0.24% |
| 29 | Professional Solutions Insurance Company | 11127 | IA | Admitted (licensed) | $410,598 | 0.18% |
| 30 | Hartford Fire Insurance Company | 19682 | CT | Admitted (licensed) | $375,993 | 0.16% |
| 31 | Texas Medical Liability Insurance Underwriting Association | 32697 | TX | Admitted (licensed) | $375,318 | 0.16% |
| 32 | Preferred Professional Insurance Company | 36234 | NE | Admitted (licensed) | $342,684 | 0.15% |
| 33 | Beazley Insurance Company, Inc. | 37540 | CT | Admitted (licensed) | $329,523 | 0.14% |
| 34 | State Volunteer Mutual Insurance Company | 33049 | TN | Admitted (licensed) | $299,027 | 0.13% |
| 35 | American Home Assurance Company | 19380 | NY | Admitted (licensed) | $243,743 | 0.11% |
| 36 | Cincinnati Insurance Company (The) | 10677 | OH | Admitted (licensed) | $190,449 | 0.08% |
| 37 | Continental Insurance Company, (The) | 35289 | PA | Admitted (licensed) | $138,410 | 0.06% |
| 38 | PracticeProtection Casualty Company | 12843 | FL | Admitted (licensed) | $105,526 | 0.05% |
| 39 | State Farm Fire and Casualty Company | 25143 | IL | Admitted (licensed) | $65,168 | 0.03% |
| 40 | Cincinnati Indemnity Company (The) | 23280 | OH | Admitted (licensed) | $53,634 | 0.02% |
| 41 | Cincinnati Casualty Company (The) | 28665 | OH | Admitted (licensed) | $50,276 | 0.02% |
| 42 | State Farm Lloyds | 43419 | TX | Admitted (licensed) | $16,698 | 0.01% |
| 43 | Church Mutual Insurance Company, S. I. | 18767 | WI | Admitted (licensed) | $3,275 | 0.00% |
| 44 | Philadelphia Indemnity Insurance Company | 18058 | PA | Admitted (licensed) | $6 | 0.00% |
Method and source
Source: the Texas Department of Insurance company list, read 2026-10-17. "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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