Paper 42: Malpractice insurance coverage for major team physicians: a survey study

Objectives: Team physicians caring for professional athletes face heightened medicolegal and financial risks from malpractice litigation which is exacerbated by increasing injury frequency, rising compensation values, and high-profile verdicts exceeding tens of millions of dollars. Prior analyses estimate that malpractice coverage of at least $52.6 million is required to protect 95% of NFL player contracts, yet it remains unclear whether team physicians' policies align with this risk. Despite several notable lawsuits, little is known regarding coverage structures, decision-making authority, or the knowledge base of physicians navigating this landscape. This study aimed to (1) characterize malpractice insurance coverage among professional team physicians across U.S. sports leagues, (2) assess practice models, policy structures, and limitations, and (3) evaluate physician knowledge, resources, and perceptions influencing coverage decisions. We hypothesized that wide variability exists in malpractice coverage depending on practice type, location, and league affiliation, and that coverage values often fail to meet the potential medicolegal financial exposure faced by physicians.
Methods: We conducted a cross-sectional survey of team physicians practicing in professional sports across the United States. The instrument was developed at a single academic institution with input from fellowship-trained sports medicine and foot & ankle surgeons combining multiple-choice and open-ended questions. Initial distribution targeted 200 physicians in the NFL and NBA between July 26, 2024, and March 7, 2025 (initial response rate 21.5%). Following revisions for clarity, the survey was redistributed to the full membership of the American Medical Society for Sports Medicine (AMSSM), with data collection concluding June 18, 2025. Respondents provided data on demographic/practice characteristics, malpractice coverage type and amount, policy structures, legal requirements, claims history, and influencing factors. Descriptive statistics were calculated for quantitative responses; qualitative data were standardized using systematic coding by trained research staff.
Results: A total of 74 respondents completed the survey. The majority (64.9%) were affiliated with the NFL, followed by MLB (27.0%), NHL (12.2%), MLS (9.5%), and NBA (8.1%), with 14.9% covering multiple leagues. Geographically, 39.2% practiced in the South, 23.0% Midwest, 21.6% West Coast, and 16.2% Northeast. Regarding practice models, 39.1% were academic, 33.8% private practice, 16.2% hybrid, and 10.8% hospital-employed.Most physicians (54.0%) reported carrying their own malpractice insurance and only 1.4% were covered directly by a professional team. Coverage values ranged from $500,000 to $28.5 million, with averages of $8.63 million for NFL physicians, $6.75 million for MLB, and $3.16 million for NHL. Only 9.5% of physicians had a direct role in setting policy terms. Fifteen percent reported riders specific to sports medicine. Three respondents (4.1%) reported sports-organization contribution to premiums, and 9.5% reported policy limitations on athlete care. Only 6.8% reported insurer requirements for additional qualifications.Three physicians (4.0%) had been subject to malpractice claims as a team physician. Thirty-six percent reported that their malpractice insurance did not clearly guarantee full representation in team-related litigation, and 25.7% received no legal guidance when selecting policies. Only 35.1% reported access to educational or risk management resources. Policy review was most often annual (44.6%); however, 9.5% had never reviewed their policy. Notably, 14.9% reported modifying coverage in response to high-profile lawsuits such as Maragos v. Bradley/Rothman Orthopaedics and Cox v. Lorich/HSS.
Conclusions: This study demonstrates that U.S. professional team physicians face substantial malpractice coverage deficits relative to the potential financial exposure of lawsuits involving elite athletes. Coverage values averaged $8.63 million for NFL physicians, $6.75 million for MLB, and $3.16 million for NHL, which fall dramatically short of projected coverage needs of $52.6 million (NFL), $108.1 million (MLB), and $64.1 million (NHL), yielding deficits up to $101.35 million. Despite heightened risk, the majority of physicians carry policies far below required thresholds, lack decision-making authority in coverage selection, and report limited access to legal or educational resources. Courts and insurers largely fail to recognize sports medicine as a distinct specialty which can compound physician vulnerability. Together, these systemic deficiencies threaten the sustainability of sports medicine practice and may discourage physicians from covering professional athletes. Mitigation strategies must include enhanced institutional support and improved physician access to legal and risk management guidance. Without these steps, team physicians will remain exposed to outsized medicolegal risk.