History and Advocacy

In 1979, TMLT was created by physician members of the Texas Medical Association to establish a source of affordable and stable malpractice insurance in Texas. Today, led by a Board of Governors whose members are all physicians, TMLT sets the standard for coverage and service that is unmatched in Texas and in our industry.

The history of TMLT is a story of vision, creativity, dedication, and courage. The idea of forming a self-insurance trust led by physicians sprang from a handful of physicians and a young Austin attorney in the mid-1970s. They wanted to create their own company that would provide the kind of service and support Texas physicians deserved.

Success began almost immediately. These same physician leaders recruited the right insurance professionals to lead the new company. Working together, the physician governing boards and staff of TMLT have taken the company from a fledgling start up of a handful of employees and a few hundred policyholders, to the leading writer of medical liability insurance in the state of Texas today.

With more than 20,000 policyholders in its care, TMLT is the largest and most respected medical liability insurance provider in Texas. 

TMLT has a long-standing record of advocating for physicians and the medical community. As a physician-governed organization, we recognize the impact legislation and regulation has on your practice. With our advocacy efforts, our goal is to protect tort reform, reduce red tape, and mitigate the burden of regulatory compliance.

Liability reform
In the late 1990s, the number of medical liability claims filed against Texas physicians was increasing at an alarming rate. Though the vast majority of these claims were non-meritorious, defending them was costly, as was the drain on the time and resources of the physicians involved.

Disproportionately high jury verdicts and rising legal costs led many insurers to withdraw from Texas, and some went out of business altogether. The crisis forced the few remaining malpractice insurers to raise rates.

With declining reimbursements already taking a bite out of their incomes, rising premiums placed another difficult burden on Texas physicians. Many retired early, stopped taking high-risk patients, or moved out of the state. The result was restricted access to health care driven by an out-of-control legal system.

TMLT was one of founding members of the Texas Alliance for Patient Access (TAPA), which grew into a statewide coalition of more than 200 physicians, hospitals, nursing homes, and physician liability carriers. TAPA researched, helped draft, and successfully lobbied for the passage of Texas’ landmark medical liability reforms in 2003. TMLT was engaged throughout the tort reform process, continuing the effort it had been working on since 1993.

During the 2003 legislative session, TAPA provided witnesses to testify before the House Civil Practices Committee and the Senate State Affairs Committee. TMLT supported the testimony with data that demonstrated the negative impact that out-of-control, non-meritorious litigation was having on patient access to health care.    

After an intense campaign that included physicians marching on courthouses in Corpus Christi and the Rio Grande Valley, House Bill 4 passed. TAPA and its supporters achieved the “ten gallon tort reform” often touted nationwide as the gold standard for others seeking to pass similar legislation.  

The cornerstone of the reforms — the $250,000 cap on noneconomic damages for physicians and a maximum of $750,000 including hospitals and institutions —substantially reduced lawsuits and liability costs without limiting the rights of plaintiffs to collect economic damages for meritorious claims. Other provisions of the bill included expert witness reforms, heightened protections for emergency care, periodic payment of future medical expenses, and limiting economic damages to those actually paid or incurred.

To ensure the legality of the caps, Texas voters passed Proposition 12, a constitutional amendment giving the Texas Legislature the authority to set damage caps in health care liability lawsuits.

TMLT was the first carrier to reduce rates following the passage of Proposition 12. A steady stream of rate reductions followed that initial 12 percent reduction in 2004. In addition, we enhanced our coverage to include cyber liability and employment practices liability insurance. All of this was made possible by the passage of historic reforms.

On May 16, 2005, Texas was removed from the American Medical Association's (AMA) list of states in medical liability crisis. The AMA cited the medical liability reforms of 2003 as the reason for the improved conditions in Texas.

Access to care
Patients in Texas are benefiting from tort reform. Since May 2003, based on information from the Texas Medical Board, Texas has added 9,273 more physicians than can be accounted for by population growth.The Association of Medical Colleges data shows that Texas ranks second in the country in physician growth between 2008 and 2014. New physician licenses went from 2,513 in the year 2003 to 4,295 in 2015.

"Tort reform as enacted appears to be working as envisioned by the Texas Legislature. Physicians with no malpractice history are flocking to Texas because it provides a more encouraging environment for the practice of medicine," said former Texas Medical Board Executive Director Donald Patrick, MD.

Advocacy continues
TMLT’s physician advocacy has not stopped with the passage of tort reform. Given the resounding success of medical liability reform, it is essential that we maintain these reforms. TMLT works closely with TAPA and other groups to keep our reforms intact. Read more about the benefits of medical liability reform and TAPA’s ongoing activities at TAPA website.

TMLT’s Governmental Relations Department is engaged in other activities as well. Along with industry partners and associations, we develop strategies to manage health care related legislation and to help relieve the burden of over-regulation. We meet with legislators and regulators to discuss issues that affect physicians. Both separately, and as a member of TAPA, TMLT files amicus (friend of the court) briefs on key cases that will interpret the letter and intent of the Texas Medical Liability Act as amended by HB 4. TMLT stands in partnership with you in the effort to further improve health care for all Texans.