ProAssurance business insurance

Overview

ProAssurance is a Birmingham, Alabama, specialty insurer best known for medical malpractice. Since June 26, 2026, it has been a wholly owned subsidiary of The Doctors Company, the physician-owned malpractice insurer based in Napa, California, which bought it for $25.00 a share in cash, about $1.3 billion. ProAssurance's stock was delisted from the NYSE at closing. For now the company keeps its name, website, products and contacts while TDC decides how to combine the two groups.

The ProAssurance group was ranked No. 81 among U.S. business insurers by 2025 commercial lines direct premiums written, with $927.0 million, based on NAIC market share data. It ranks fifth nationally in medical professional liability, which made up $655.9 million of that total. Workers' compensation added $230.4 million and products liability $40.7 million. Because the NAIC figures predate the closing, ProAssurance still appears as its own group; the combined TDC organization reports more than $2.5 billion of direct written premium.

The group includes several brands a buyer may know separately:

• ProAssurance MPL, including NORCAL, for physicians, groups, hospitals, senior care and medical facilities.
• PICA Group, for podiatrists, chiropractors and other specialized professionals.
• Preferred Physicians Medical (PPM), a risk retention group.
• Medmarc, for medical technology and life sciences companies.
• Eastern Alliance Insurance Group, a workers' comp carrier writing in 33 states.

Most business comes through appointed agents and brokers.

History

Alabama physicians formed Mutual Assurance in 1976 to fill a gap in malpractice coverage; Birmingham Medical News credits Derrill Crowe, MD, as founder. In 1991 Mutual Assurance became the first physician-founded company to demutualize and list publicly, on NASDAQ. It moved to the NYSE in 1997 as Medical Assurance, Inc., and merged with Professionals Group in 2001 to form ProAssurance Corporation.

Growth came by acquisition, including two sponsored demutualizations of doctor-owned insurers (PICA and NORCAL):

• 2005: NCRIC Group
• 2006: Physicians Insurance Company of Wisconsin
• 2009: Podiatry Insurance Company of America (PICA)
• 2013: Medmarc Insurance Group, the products liability insurer the medical technology industry created in 1979
• 2014: Eastern Insurance Holdings of Lancaster, Pennsylvania, which brought in workers' comp, plus a majority capital position in Syndicate 1729 at Lloyd's
• 2021: NORCAL Group, closed May 5, 2021, a large California-based malpractice writer

The Doctors Company deal. TDC and ProAssurance announced the agreement on March 19, 2025. The $25.00 price was about 60% above ProAssurance's closing price the day before. Ned Rand was ProAssurance's president and CEO when it was announced. AM Best said the same day that ProAssurance's ratings were unchanged by the announcement. Shareholders approved the deal in June 2025. The companies first expected to close in the first half of 2026, and after state regulatory approvals TDC completed the purchase on June 26, 2026. At announcement, AM Best's 2023 data ranked TDC second and ProAssurance fourth in U.S. medical professional liability, with nearly 16% of the market between them. Trade press now describes the combination as the second-largest U.S. malpractice writer behind MedPro Group, part of Berkshire Hathaway.

Business insurance products

Medical professional liability. Coverage for physicians and medical groups, hospitals and health systems, senior care and long-term care facilities, miscellaneous medical facilities and allied health professionals. Options run from first-dollar policies to risk-sharing programs, captives and alternative risk transfer for multistate and national providers. Most physicians buy claims-made coverage, and ProAssurance sells tail coverage for those who leave a policy. Specialty business written by ProAssurance Specialty can move at renewal, on the broker's request, to TDC Specialty, TDC's E&S arm. ProAssurance says it is a top-five malpractice carrier nationally, top three in 11 jurisdictions including Alabama, California and Wisconsin, and top 10 in 37 states. It has more than 23,000 malpractice policies.

Medical products and life sciences. Medmarc writes products liability for makers and distributors of medical technology, clinical trials coverage for clinical-stage companies, and errors and omissions for medical technology and pharmaceutical activities. Medmarc now sits within TDC Specialty's life sciences offering.

Workers' compensation. Eastern Alliance, founded in 1997 in Lancaster, Pennsylvania, writes workers' comp in 33 states for more than 13,000 policyholders. It sells traditional policies for small businesses and for mid-size and large employers, loss-sensitive plans, and Inova, an alternative market program. Its Specialty Risk unit targets top-tier accounts in high-hazard construction, forestry and transportation classes.

Who it insures

Healthcare is the core: physicians from solo practices to large groups, hospitals, senior care operators and allied professionals such as podiatrists and chiropractors (see Medical practice insurance). Medmarc serves device makers, distributors and clinical-stage life sciences companies. Eastern Alliance's comp book runs from small businesses to large and high-hazard employers in its 33 states.

The acquisition changes the routing more than the appetite. TDC says ProAssurance's mission, products and underwriting appetite are unchanged for now, and Eastern Alliance's coverage, appetite, geographic footprint and contacts are unchanged.

How to buy

Through an agent or broker in most cases. ProAssurance works with appointed agencies and its own ProAssurance Agency, and accepts applications and submissions online and by email. After the closing:

• Brokers with ProAssurance-only authority keep submitting admitted malpractice business to ProAssurance.
• Brokers appointed with both companies choose one per submission; the two companies will not quote against each other.
• ProAssurance direct business cannot be moved by an agent-of-record or broker-of-record letter.
• At renewal, most admitted ProAssurance insureds will likely be offered a policy with The Doctors Company, though some renewing soon after the closing may stay on ProAssurance paper. A claims-made insured who renews with TDC keeps the retroactive date and does not need a tail.
• Medmarc and Eastern Alliance renewals follow their existing processes.

Read when your insurer is sold or merges: what happens to your policy for what to check when your carrier changes hands.

Claims

Report a malpractice claim or incident as soon as you know of it. That includes a lawsuit, a demand for compensation, a threat of legal action, an attorney's inquiry about a patient's care, a records request for reasons other than continuing care, a board complaint or an adverse outcome that could become a claim. Call claims intake at 877-778-2524, email the incident reporting form to [email protected], fax it to 615-324-9177 or use the Claims tab in the secure portal. ProAssurance says not to send medical records with the first report. Regional claims managers take calls outside business hours. Under a claims-made form, late notice can cost you coverage. ProAssurance reports that from 2021 to 2025, 95.5% of its closed claims were resolved without trial and 76.2% closed without an indemnity payment.

Workers' comp injuries for Eastern Alliance policyholders are reported 24/7 at 800-336-3658. Eastern also offers safety analysis, training and loss control through its N3L3 risk management services.

Financial strength and ratings

On July 9, 2025, AM Best affirmed the A (Excellent) financial strength rating of ProAssurance Group's insurance companies and their "a+" long-term issuer credit ratings, with stable outlooks. AM Best rated the group's balance sheet strength as strongest. At the announcement in March 2025, AM Best said the pending sale did not change the ratings and that it did not expect a material effect on ProAssurance's rating fundamentals. ProAssurance reported $5.4 billion of assets at June 30, 2025.

The new parent's ratings matter too. AM Best rates The Doctors Company A (Excellent), with a positive outlook since October 2025, and Fitch affirmed its A (Strong) rating in July 2026 after the closing.

Strengths and weaknesses

ProAssurance brings deep regional malpractice franchises, a med-tech niche and a comp carrier, and now the capital of the largest physician-owned malpractice insurer. The open question is how long its separate identity lasts.

• Strengths: No. 5 in U.S. medical professional liability, with top-three positions in 11 jurisdictions. AM Best A (Excellent), affirmed July 2025, and a new parent rated A by AM Best and Fitch. Defense record: 95.5% of closed claims from 2021 to 2025 resolved without trial. Specialty reach beyond doctors: med-tech products liability through Medmarc and workers' comp in 33 states through Eastern Alliance.
• Weaknesses: Ownership changed in June 2026 and the long-term structure is undecided. Many admitted malpractice insureds are expected to be offered TDC renewals, and some subsidiaries may be merged into TDC companies. Separate contacts and processes for ProAssurance, NORCAL, Medmarc and Eastern Alliance add complexity. Eastern Alliance's workers' comp sits outside TDC's core medical liability business, and TDC has said only that nothing changes for now.

How to contact ProAssurance