Our inaugural Singapore Malpractice Claims report

Time to put the “surging malpractice claims” myth to bed once and for all.

Last month, Insurance Asia invited me to a discussion on malpractice insurance premiums, specifically looking at the impact of the recent surge in claims against doctors. 

I probably killed the mood a little by arguing that Howden had seen no evidence of a surge. The volume of claims had certainly increased a little over the last twelve months, but not to the point where it would impact premiums. This was hardly the type of response that makes for an interesting interview, but it was the truth. Not long afterwards, a doctor who was considering joining Howden asked me what our annual premium increases were likely to be. When I replied that we have not increased our premiums since 2017, he was skeptical and asked how that was possible given the rapidly rising malpractice claims environment. 

The problem, of course, is that nobody publishes statistics on malpractice claims in Singapore. Nobody expects details of specific cases to be publicized, for obvious reasons, but even reports showing broad trends or specialty-wide experience are non-existent.  

At Howden, we believe that doctors deserve the opportunity to understand the likelihood of facing a claim. So we’ve put together our very first Malpractice Claims Report, based on all claims notified to us over the past twelve months.

Large claims

Howden defines a large claim as one that exceeds S$500,000 in expected total payments. For the year to September 2024, we received only one such claim, involving an allegation that a radiologist failed to detect early signs of cancer. The estimate for this claim is currently set at $1.3 million.

A single large claim is not grounds for increasing premiums. Malpractice insurance pricing models assume that large claims will occur occasionally. It is only when such claims occur more frequently than expected that insurers will begin to revise their premiums.

For other specialties, all 2024 notifications have payment estimates of $50,000 or less. These are the “working losses” that we expect to receive every year. 

Obstetricians had a 12.5% chance of being the subject of a claim in 2024.

Working claims against obstetricians typically involve minor post-delivery complications, and we received several such notifications during 2024. We also received one notification that involved a coroner’s case. There was no allegation of negligence against the obstetrician, and no adverse findings by the coroner, but legal costs for representation nevertheless exceeded $20,000. 

Neurosurgeons had a 15% chance of being the subject of a claim in 2024.

Until recently it was relatively unusual for neurosurgeons to report working claims at all. Due to the nature of the specialty, malpractice claims against neurosurgeons usually relate to significant disability following surgery and are therefore in the medium to high range. However, in 2024 we have seen an increasing number of complaints related to treatment costs across all specialties, including neurosurgery. 

Orthopaedic surgeons had a 17% chance of being the subject of a claim in 2024.

Working claims for orthopaedic surgeons usually relate to patient expectations. With many orthopaedic procedures there is a relatively wide range of outcomes. Modern day patients have very high expectations and will sometimes pursue complaints after successful surgery, commonly alleging loss of function, and ongoing pain and suffering. Such claims are usually defensible, but some doctors will prefer that we offer small settlement amounts to resolve such matters quickly.

Aesthetic surgeons had a 50% chance of being the subject of a claim in 2024.

Aesthetic surgery has always carried a high risk of patient complaints and claims. Working claims often relate to the costs associated with revising a procedure to achieve a more desirable outcome. The subjective nature of such complaints makes them difficult to manage, and small settlements are often proposed to minimize potential for escalation.

ENT surgeons had a 12% chance of being the subject of a claim in 2024.

Like orthopaedics, ENT surgery can have variable outcomes and working losses are often related to patient expectations. Certain sinus surgeries also have an aesthetic element and bring a claims profile that resembles aesthetic surgeons.

Anaesthetists had an 8% chance of being the subject of a claim in 2024.

While anaesthetics is rated as a medium-risk specialty, this is largely due to the exposure to larger claims involving patient deaths. Working claims are relatively uncommon but can arise where there are localized reactions to injections or lingering effects of anaesthesia following surgery. 

Cardiologists had an 20% chance of being the subject of a claim in 2024.

Failure to diagnose a heart condition is by far the most common allegation brought against cardiologists, and we received several such notifications during 2024. In addition, claims relating to poor outcomes following complex angioplasty procedures were received. Claims of this nature are defensible, but inevitably there will be legal expenses incurred in resolving them.

Radiologists had a 7% chance of being the subject of a claim in 2024.

As noted above, our largest claim for 2024 was an allegation that a radiologist failed to diagnose cancer from a scan. Like cardiologists, failure to diagnose is the most common allegation brought against radiologists, with cancer-related claims being the most severe. However, as the incidence of such claims is low, radiologists are considered a moderate-risk specialty.

Respiratory Specialists had a 10% chance of being the subject of a claim in 2024.

The continuing impact of Covid has created a higher exposure to claims in this specialty. The most common claims made during 2024 alleged negligence where Covid patients, often elderly and with other medical conditions, were unresponsive to treatment. Claims involving such seriously ill patients are defensible and usually resolve once a coroner’s investigation report is handed down.

General Practitioners had a 6% chance of being the subject of a claim in 2024.

As expected, general practitioners faced the lowest likelihood of a claim in 2024. The diversity of primary care means that it was not possible to identify any trends in the type of claims, although there was some increase in the incidence of complaints regarding worker health assessments. 

Of course, a single report like this is unable to identify trends. However, when we produce our second report in September 2025 we will present comparisons with the figures above. At that point it will become clearer whether the reports of escalating malpractice claims are fact or fiction.