Physicians have been liable for medical malpractice since the eighteenth century in the United States, but malpractice claims were rare until recently. In the late 1960's the frequency of claims per physician and claim severity (size of award per paid claim) began to increase at unprecedented rates, culminating in the medical malpractice insurance "crisis" of the mid-1970's. In response to this crisis, legislatures in almost every state enacted tort reforms intended to curb the rise in claims, in addition to other changes designed to assure the availability of malpractice insurance.' Between 1975 and 1978, claim frequency per physician slowed or even decreased in many states, but since 1978, claim frequency has resumed an upward trend. The St. Paul Fire and Marine Insurance Company (The St. Paul), which has been the leading writer of malpractice insurance for many years, reports a fifty-five percent increase in claim frequency since 1980from 10.5 claims per 100 physicians in 1980 to 16.3 in 1984.2 Claim severity increased faster than the rate of inflation throughout the 1970's, and this trend appears to have continued into the 1980's. The St. Paul reports that paid claim severity increased ninety-five percent during the five year period 1979-1983, from $27,408 in 1979 to $53,482 in 1983.3 The average malpractice jury award is reported to have risen from $404,726 in 1980 to