Physical Therapy Professional Liability Claim Report 

5th EDITION
The American Physical Therapy Association (APTA) is dedicated to improving the lives of individuals and communities through the provision of high quality physical therapy. This commitment includes advancing best practices, reducing risk, and protecting the health, safety, and well being of everyone who places their trust in physical therapy practitioners. APTA remains focused on strengthening our influence on healthcare and supporting the continued growth and impact of the profession.
In pursuit of our vision, mission, and strategic goals, APTA is pleased to collaborate with CNA and HPSO in using data driven insights to guide our decisions and shape strategies that promote the safe, effective, and efficient delivery of physical therapist services. As part of this effort, APTA has contributed expertise to the CNA and HPSO Physical Therapy Professional Liability Claim Report, 5th Edition.
APTA is dedicated to engaging and empowering physical therapy practitioners to be influential leaders in the healthcare sector, strong advocates for the profession, and a unified force for advancing the human experience. We value HPSO’s thought leadership as an APTA Strategic Business Partner and believe this report will be a valuable resource to help physical therapy providers enhance their risk management practices.
Justin Moore, PT, DPT
CEO, American Physical Therapy Association
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Key Findings of the Physical Therapy Professional Liability Claim Report

The average total incurred for professional liability (PL) claims has increased 20.3 percent, to $162,174 in the 2026 dataset from $134,761 in the 2020 dataset.
Physical therapy practices (PT practices) experienced a 15.4 percent higher average total incurred than individually insured physical therapists (PTs), physical therapist assistants (PTAs), and PT students ($170,418 versus $147,655).

Physical Therapy Closed Claims Overview

Introduction

In collaboration with Healthcare Providers Service Organization (HPSO), CNA continues to be one of the nation’s leading providers of professional liability (PL) insurance coverage for physical therapy practitioners. In 2006, CNA and HPSO published the first report analyzing PL closed claims on behalf of insured physical therapy practitioners. As part of our joint mission to educate insureds and the healthcare industry at large regarding risk-related issues, we are pleased to present our fifth physical therapy closed claim report entitled, “Physical Therapy Professional Liability Claim Report: 5th Edition.” This report is designed to help physical therapy practitioners strengthen their practice and minimize PL exposures by identifying loss patterns and emerging trends.

Dataset and Methodology

The 2026 dataset consists of closed claims or matters that meet the following criteria:
  • Involved physical therapists (PTs) or physical therapist assistants (PTAs), whether insured individually or through a physical therapy practice (PT practice), or other healthcare practitioners providing services as an employee of an insured PT practice.
  • Closed between January 1, 2020, and December 31, 2025.
In addition to the above, this report will include the following categories of claims:
  • Professional liability claims resulting in indemnity payments of $10,000 or more.
  • Professional liability claims without an indemnity payment but with incurred expenses of at least $1.
  • Licensure Defense Expenses that incurred at least $1 in expense.

Limitations and Considerations

  • Indemnity and expense payments include only monies paid by CNA on behalf of its insureds.
    • The data reflects the “per claim” policy limits, which are typically $1,000,000 for CNA primary PL insurance.
    • Other possible sources of payment, such as payments by co-defendants in response to the claim, are not considered.
  • All incurred costs and expense amounts are attributed to the year the claim closed, regardless of when the claim was first reported or when the alleged injury occurred.
  • Due to the uniqueness of each individual claim, the average total incurred amounts displayed within this report may not necessarily be indicative of the severity attributed to any single claim.
  • This report also provides select findings from the CNA/HPSO 2016 and 2020 physical therapy closed claim datasets, each of which reflects five years of data, for comparative purposes. Because some elements of the inclusion criteria may differ across datasets from previous CNA/HPSO physical therapy claim analyses and in claim reports from other organizations, readers should exercise caution when making comparisons with other reviews.

Terms

For the purposes of this report only, please refer to the following terms and explanations.

2016 dataset

A reference to an earlier CNA report, entitled “Physical Therapy Professional Liability Exposure: 2016 Claim Report Update,” which included data from 2010-2014.

2020 dataset

A reference to the prior CNA report, entitled “Physical Therapy Professional Liability Exposure Claim Report: 4th Edition,” which included data from 2015-2019.

2026 dataset

A reference to this CNA report, entitled “Physical Therapy Professional Liability Claim Report: 5th Edition,” which includes data from 2020-2025.

Distribution

Refers to a specific group of closed claims with categories expressed as a percentage of the total.

Expense payment

Monies paid for the investigation, management or defense of a claim, including, but not limited to, expert witness expenses, attorney fees, court costs, and record duplication expenditures.

Total paid indemnity

Monies paid on behalf of an insured in the settlement or judgment of a claim.

Total incurred 

The sum of total paid indemnity and expense payments.

Average total incurred

The cost of total paid indemnity and expense payments, divided by the total number of claims with payment.

General Data Analysis for Physical Therapy Professionals

There were 497 PL claims with indemnity payments above $10,000 representing 53.4 percent of the 2026 dataset with an average total incurred of $162,174 (Figure 1). These claims represent the most severe physical therapy PL exposures and are the primary focus of the detailed analyses presented in Part 1 through Part 3. These sections examine potential risks and associated liability exposures encountered by PT practices, individual PTs, and PTAs, providing the reader with strategies to recognize and mitigate the identified exposures.
Licensure Defense Expenses comprised 24.6 percent of the 2026 dataset with 229 matters and incurred an average expense of $7,369. These matters reflect regulatory and disciplinary issues that differ fundamentally from civil liability claims but nonetheless result in significant financial and professional consequences. Part 4 of this report examines the allegations in licensure defense expenses and the potential outcomes experienced by PTs or PTAs.
Although this report does not discuss these claims in depth, it is important to note that PL claims that resolved without an indemnity payment may still generate defense costs. Claims that resolved without an indemnity payment represent the smallest share of the 2026 dataset at 22.0 percent of total claims and have an average expense payment of $18,092. Expenditures can include attorney fees, expert witness fees, and costs involved in the investigation of the claim. As with all claims, expense amounts can vary widely based on the unique facts and circumstances of each matter.
A PL claim may be resolved without an indemnity payment for various reasons, including:
  • The claim was successfully defended on behalf of the insured, resulting in a favorable jury verdict.
  • The claim was withdrawn by the plaintiff during the investigation or discovery process.
  • The claim was dismissed by the court prior to trial in favor of the insured defendant.
The length of time between when an incident occurs and closure of a claim or lawsuit varies depending on multiple factors including, but not limited to, the applicable statute of limitations, court calendars, and the complexity of the matter. As indicated in Figure 1, PL claims without indemnity payments may take an average of 3.5 years to close. This protracted timeframe underscores the importance of comprehensive and accurate documentation to preserve relevant patient information
Figure 2 compares the average total incurred from the 2016, 2020, and 2026 claim datasets of all physical therapy closed claims with paid indemnity greater than or equal to $10,000. In the 2020 dataset, the average total incurred ($134,761) increased 12.4 percent as compared to the 2016 dataset ($119,893). The upward trend continued in the 2026 dataset, with the average total incurred amount rising to $162,174, an increase of 20.3 percent compared to the 2020 dataset.
While the increase in claim severity is influenced by many factors and largely depends on specific facts and circumstances of each case, broader industry trends, such as social and tort inflation, also play a meaningful role in driving increases in severity. Social inflation occurs when the overall rate of increasing claim severity exceeds general economic inflation. This may be driven by political, legal, and cultural factors that influence societal attitudes towards litigation, jury awards, and claim settlement values. In recent years, exceptionally high jury verdicts, often disproportionate to the underlying facts of the case or alleged injuries, have become more common. These outcomes are frequently driven by an emotional appeal to juror sympathy, heightened societal distrust, and inflated punitive damages.

1

Claims by Coverage Category

 

Distribution

Distri-
bution

Average Total Incurred
Average Years to Close

Professional liability, indemnity

(≥ $10,000) and expense

53.4%
$162,174
3.1 yrs
Licensure defense expenses (≥ $1)
24.6%
$7,369
2.6 yrs
Professional liability, expense only (≥ $1)
22.0%
$18,092
3.5 yrs

2

Comparison of Average Total Incurred
Closed Claims with Paid Indemnity of ≥ $10,000
2016
$119,893
2020
$134,761
2026
$162,174

The average total incurred for professional liability (PL) claims has increased 20.3 percent, to $162,174 in the 2026 dataset from $134,761 in the 2020 dataset.

Part 1: Physical Therapy Practice Professional Liability Exposures and Data Analysis

The highest proportion of closed claims arose from PT practices, which accounted for 63.8 percent of all closed claims, compared to 36.2 percent for those individually insured, as reflected in Figure 3.
Physical therapy practice PL policies generally provide coverage for the corporate entity, owners, and employees acting within the scope of their duties, which may include PTs, PTAs, athletic trainers, occupational therapists, and other professional staff. In contrast, individual PT coverage is limited to the named insured and does not extend to others.
Physical therapy practice owners are vicariously liable for the negligent acts or omissions of their employees and supervisees. Vicarious liability reflects the exposure a PT practice owner assumes for patient care delivered by others on behalf of the practice. In addition, PT practice owners have direct liability (under corporate negligence theories) related to the inherent responsibilities of ownership, including hiring, credentialing, onboarding, supervision, and policy development and enforcement. These ownership-related duties create independent exposure for the practice and owner, significantly expanding liability beyond the owner’s direct patient care.

Analysis of Closed Claims by Insurance Type

Figure 3 compares claim distribution and severity by insurance type, distinguishing between claims insured under a PT practice policy and those insured under individual PL policies for PTs, PTAs, or PT students.
  • Figure 3 highlights that PT practices experienced a 15.4 percent higher average total incurred than individually insured PTs/PTAs/PT students ($170,418 compared to $147,655). As discussed above, vicarious liability plays a role in the higher severity of claims asserted against PT practices.

3

Distribution and Average Total Incurred by Insurance Type

Closed Claims with Paid Indemnity of ≥ $10,000
Distribution
Average Total Incurred
PT practice (PTs, PTAs, and other healthcare professionals)
63.8%
$170,418
Individually insured
36.2%
$147,655
PTs
32.2%
$151,504
PTAs
3.6%
$117,477
PT students
0.4%
$111,320
Overall
100.0%
$162,174

Physical therapy practices (PT practices) experienced a 15.4 percent higher average total incurred than individually insured physical therapists (PTs), physical therapist assistants (PTAs), and PT students ($170,418 versus $147,655).

Analysis of Allegations for PT Practices

Physical therapy practices had a higher proportion of claims alleging failure to monitor compared to individually insured practitioners (23.3 percent versus 15.0 percent) and experienced a 42.7 percent higher average total incurred for these claims ($249,817 versus $175,082), as represented in Figures 4 and 5.
  • These claims cited failures by PT practice owners to provide appropriate supervision, training, and/or onboarding for employed staff. Of the 23.3 percent of failure to monitor claims involving a PT practice,18.9 percent involved allegations that the PT practice provided inadequate supervision of a PTA/PT student and had an average total incurred of $355,666, highlighting that supervision failures drive both frequency and severity for PT practices.
  • Additional claims often involved allegations that patients were inadequately monitored during treatment, resulting in the PT practice owners being held vicariously liable for the actions of a PT, PTA, or other healthcare professional.
Equipment-related claims resulted in a 36.9 percent higher average severity for PT practices compared to individually insured PTs ($187,020 for PT practices versus $136,574 for individually insured PTs).
  • This increased severity is consistent with the broader responsibilities assumed by PT practices for equipment selection, maintenance, inspection, and safety oversight.
The example below illustrates PL exposures that a PT practice owner may experience:

4

Distribution by Top Allegation Class and Insurance Type
Closed Claims with Paid Indemnity of ≥ $10,000
Failure to monitor
23.3%
15.0%
Improper performance of manual therapy
19.6%
30.6%
Improper use of a biophysical agent
14.2%
14.4%
Equipment-related
12.9%
8.3%
Improper management over the course of treatment
11.4%
9.4%
PT Practice
Individually Insured

5

Average Total Incurred by Allegation Class and Insurance Type
Closed Claims with Paid Indemnity of ≥ $10,000
Failure to monitor
$249,817
$175,082
Equipment-related
$187,020
$136,574
Improper performance of manual therapy
$171,264
$171,326
Improper management over the course of treatment
$150,434
$198,457
Improper use of a biophysical agent
$94,380
$76,793
PT Practice
Individually Insured

Equipment-related claims resulted in a 36.9 percent higher average severity for PT practices compared to individually insured PTs.

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