How to Navigate Nuclear and Thermonuclear Verdicts in Senior Care Liability Cases
“Nuclear verdicts in senior care are rarely about a single mistake — they are built over time as small operational gaps, documentation inconsistencies, and missed opportunities stack into a powerful jury narrative.”
What Are Nuclear and Thermonuclear Verdicts?
A nuclear verdict is a jury award exceeding $10 million, where damages far surpass what would traditionally be expected based on economic loss. According to a 2024 study by the U.S. Chamber of Commerce Institute of Legal Reform (IRL), more than 1,200 nuclear verdicts were recorded nationwide between 2013 and 2022, with a median award of approximately $21 million and an average award of $89 million.
What’s more, their data suggests the trend is accelerating, identifying 129 nuclear verdicts in 2023, with nearly 44% exceeding $20 million and at least 23 verdicts surpassing $100 million, a level referred to as thermonuclear. Medical liability cases accounted for nearly 30% of nuclear verdicts in 2023, up from roughly 20% during the prior decade, highlighting increased severity in healthcare-related litigation.
Nuclear and thermonuclear verdicts fuel social inflation, defined by the National Association of Insurance Commissioners (NAIC) as the rising cost of liability claims above general economic inflation due to a variety of factors including shifting cultural attitudes towards corporations, aggressive plaintiff attorney strategies, the influence of social media, and third-party litigation funding. This, in turn, creates an environment primed for more nuclear and thermonuclear verdicts.
Nuclear verdict exposure is also shaped by geography. California, Florida, New York, and Texas collectively generate approximately half of all nuclear verdicts in the United States, despite representing only about one-third of the national population. When adjusted for population, Florida presents the highest per-capita risk, followed by New York, Washington, Georgia, and California.
As nuclear and thermonuclear verdicts continue to rise in frequency and size, long-term care providers face an increasingly complex liability environment where understanding the scope of nuclear verdicts and how to navigate and prevent them is essential.
Recent Examples of Nuclear Verdicts in Senior Care
High-severity verdicts in senior care rarely hinge on a single mistake. Instead, they tend to arise when care failures, documentation gaps, staffing issues, or oversight breakdowns accumulate into a narrative of preventable harm. The following recent nuclear (and near nuclear) cases across the senior care continuum illustrate how these exposures can escalate into multi-million-dollar verdicts and settlements.
Skilled Nursing Facility, California | $15 Million Wrongful Death Verdict (2026)
In Vallejo, California, a jury ordered a skilled nursing facility to pay $15 million following the death of a 96-year-old resident. Trial testimony focused on alleged failures to provide appropriate care, monitor the resident’s condition, and respond to known risks.
Nursing Home, Illinois | $12.2 Million Verdict (2025)
A Cook County jury awarded $12.2 million to the family of a 79-year-old nursing home resident whose care allegedly led to pressure injuries, infections, and death. The jury found that the facility failed to provide adequate monitoring and timely intervention as the resident’s condition worsened. The exposure centered on preventable clinical deterioration and documentation gaps, which jurors viewed as evidence of substandard care.
Nursing Home, Arkansas | $6.6 Million Verdict (2025)
A Camden County jury awarded $6.6 million to the family of a nursing home resident who suffered from severe dehydration, malnutrition, and pressure injuries prior to death. According to trial evidence, the resident experienced prolonged neglect, including inadequate monitoring and failure to meet basic care needs.
Long-Term Care Provider, Tennessee | $7 Million Verdict (2024)
A Tennessee jury awarded approximately $7 million, including punitive damages, after finding that a long-term care provider engaged in fraudulent conduct related to resident care and billing practices. The jury specifically found intentional misrepresentation, elevating the case beyond negligence.
Assisted Living, California | $32 Million Verdict (2023)
A California jury awarded more than $32 million to an assisted living resident who suffered repeated falls, injuries, and complications over time. Evidence showed the resident experienced 20 or more falls, inadequate supervision, and unsafe evacuation and transport during a wildfire event.
Recognizing the trending accelerators that lead to nuclear and thermonuclear verdicts in senior care is the first step for providers to prevent themselves from becoming the next nuclear case.
Common Nuclear Verdict Accelerators Across Long-Term Care Settings
Social inflation, supply and labor inflation, aggressive plaintiff attorney tactics, and the increasing cost of long-term care for patients’ families are all external factors creating a more friendly environment for nuclear verdicts in long-term care. An analysis of the recent nuclear verdicts in senior care settings also highlights several internal facility factors that increase nuclear verdicts, especially when stacked together.
Preventability Narratives: Plaintiffs emphasize missed opportunities, ignored warning signs, and delays in intervention.
Documentation Inconsistencies: Care plans, progress notes, and incident reports that fail to tell a clear, unified story undermine senior care operator credibility.
Staffing and Acuity Misalignment: Even appropriate staffing levels may be criticized if skill mix does not match resident needs.
Family Communication Breakdowns: Lack of communication with residents’ families, failing to share troubling patient details with them, and poorly documented conversations often create anger from families and become emotional focal points at trial.
Regulatory or Survey History: Past deficiencies (related or not) are frequently used to suggest a pattern of disregard by the long-term care provider.
Corporate Ownership Optics: Complex ownership or management structures can be framed as profit-driven decision-making.
Delayed or Defensive Post-Incident Response: Inconsistent internal narratives following an event often deepen nuclear verdict exposure.
Senior care providers can reduce all of these nuclear verdict-fueling factors by practicing proactive risk management.
Reducing Nuclear Verdict Exposure: A Proactive Risk Management Approach
The current risk landscape demands a new level of preparedness for senior care providers. The question is not if providers will face litigation; it’s when.
From a broad perspective, proactive risk management focuses on:
Operational alignment that matches resident acuity with services in real time.
Documentation discipline that evolves with the resident and reflects actual care delivery.
Clear, proactive family communication that sets and reinforces expectations.
Integrated incident response that prioritizes accuracy, transparency, and learning.
With this in mind, senior care providers can follow best practices to proactively prevent claims, reduce claims severity, increase staff preparedness, successfully manage resident/family expectations, and adopt smart technology to enhance operations.
Claims Prevention
The most effective risk management strategy for providers is to prevent claims from happening in the first place. In 2025, the top claims Future Care RRG saw from insureds were wrongful death, falls, pressure ulcers, and negligence. Other high-cost clinical failures trending across the senior care continuum in 2026 include skin and wound related injuries, medication mismanagement, mishandling behavioral health challenges, elopement, infections and environmental hazards, and uncoordinated care transitions.
Senior care providers should identify their top claims allegations and establish targeted risk management procedures to address those issues. Senior care providers can take advantage of the risk management programs offered by their liability insurance providers, such as risk management assessments, specialized training, and custom risk management support.
Reduce Claims Severity
Long-term care providers can reduce claims severity by reporting claims and communicating with their insurers immediately, so claims teams can initiate early intervention strategies. This proactive approach can help identify root causes before claims escalate, avoid providers from being blindsided in litigation, and provide a quick turnaround opportunity for providers to implement improvements in safety and quality of care.
Documentation and communication can also play a large role in reducing claims severity. Families expect real-time updates and meaningful participation in care decisions. Objective, consistent documentation supported by digital communication platforms builds defensibility and reduces misunderstandings that escalate into complaints or litigation.
Staff Stability and Preparedness
Staffing remains the single most influential predictor of safety, satisfaction, and litigation exposure. Instability drives falls, medication errors, resident conflict, and inconsistent care delivery. As acuity rises, the demand for trained CNAs, LPNs, dementia specialists, and behavior-trained staff accelerates. Operators must refine recruitment pipelines, strengthen competency validation, implement staff retention strategies, and adopt digital task-checking tools to ensure reliability across shifts.
Healthcare recruitment platform, Hireology, recommends relying less on staffing agencies and instead building stronger internal referral and candidate networks. They advise responding to applications within 24 hours and highlighting growth opportunities, flexibility, and strong leadership to attract and retain top talent in today’s competitive market. Once hired, automating onboarding and training ensures a consistent new-hire experience. Personalizing these processes helps increase retention and align staff with community values.
Resident Experience, Family Satisfaction & Community Reputation
Nuclear and thermonuclear verdicts are usually fueled by emotion and distrust of corporations. Lawsuits are often not the result of exceptionally poor care, but the result of families who become angry when they experience unmet expectations in service or care levels. Therefore, from a risk management perspective, it is vitally important that the quality of care that facilities promise when residents are admitted is the level of care that residents receive. Family communication that consistently meets set expectations (especially during moments of crisis) is a powerful tool to build trust and show families that safety is a top priority.
Especially when faced with understaffing, facilities need to make an honest assessment of their current staffing capabilities and only take on patients who are a realistic match. Adverse events like falls or allegations of abuse and neglect occur when facilities admit individuals with care needs beyond what the facility can provide.
Positive online reviews and fostering good relationships with their communities can help facilities develop a public perception of corporate responsibility, safety, and care. These facilities are less likely to be painted as a bad actor in litigation.
Smart Technology Solutions
Adopting smart technology solutions built to aid in risk management can help further enhance senior care defensibility and operations.
Wicked Technologies produces smart incontinence pads that notify caregivers in real-time of moisture events along with predictive analysis, wound prevention automation, and compliance dashboards.
Helpany’s radar-based motion monitoring solution improves fall prevention and care services within senior communities while assisting with transparent family communication, documentation support, and safety alerts. Another fall management solution, Kamicare, uses ai-equipped devices to help senior living communities detect and respond to falls faster while improving care-plan workflow management, shift handoff, and resident monitoring.
Pharmacy and clinical audit partners can also help senior care facilities ensure medication safety and reduce avoidable harm.
Although no amount of smart technology can replace staff, it can improve facility operations and better position facilities to prevent claims from escalating and to defend them effectively when they do arise.
Future Care RRG’s Long-Term Care Provider Checklist for 2026
Last month, Future Care RRG produced a 2026 Essential Risk Playbook for members, outlining the impact of 2025 litigation trends, exposing the top 10 emerging risks of 2026, and providing a forward-thinking operational blueprint to strengthen care delivery, documentation integrity, and defensibility in 2026.
In the playbook, Future Care RRG also shared these 10 practical actions we recommend that our members and all long-term care operators implement this year to reduce risk exposure:
Strengthen staffing competencies and track reliability
Implement predictive wound care technology and real-time monitoring
Conduct monthly medication and MAR audits
Reassess admission criteria and high-acuity thresholds
Expand dementia and behavioral health training
Standardize documentation and communication practices
Perform quarterly environmental and infection control audits
Build structured care-transition workflows
Conduct biannual mock surveys and regulatory reviews
Implement digital family-engagement tools
In our work with senior care providers across the continuum navigating a growing landscape of nuclear verdicts, one theme is consistent: nuclear and thermonuclear verdicts are not random events. They are influenced by shifting cultural attitudes around providers’ responsibility and are built gradually, as operational gaps, documentation weaknesses, and communication breakdowns combine into a compelling jury narrative.
“Senior care is being judged through the lens of its worst outcomes, not its daily realities — which makes proactive risk leadership, transparency, and trust-building more critical than ever.”
Staying informed of the similarities of the nuclear and thermonuclear verdicts in your state and practicing proactive risk management that addresses high-payout factors remains an effective way to reduce high-severity liability exposure and protect both residents and organizations.
Discover a Custom Risk Management Solution.
Learn more about Future Care RRG’s approach to collaborative risk management and proactive claims strategies for senior care providers across the nation at fcrrg.com or submit a quick indication form today to see how Future Care RRG can help you safeguard your residents, empower your team, and support your mission.
This blog was written by Future Care Risk Retention Group (RRG). Future Care RRG provides Professional Liability, General Liability, Employee Benefit Liability, and supplemental coverages for senior care providers nationwide.
Sources
The Federation of Defense & Corporate Counsel. “Chamber perspectives on civil justice and litigation trends.” Presented at the Claims and Litigation Management Alliance Conference, 2024. https://www.thefederation.org/docs/Events/2024/CCS/CLE/11-Chamber.pdf
National Association of Insurance Commissioners. “Social inflation.” https://content.naic.org/insurance-topics/social-inflation
Reddick Law Firm. “Camden jury awards $6.6M verdict to family of nursing home victim.” Feb. 2025. https://reddicklawfirm.com/blog/2025/02/camden-jury-awards-6-6m-verdict-to-family-of-nursing-home-victim/
Abraham, Watkins, Nichols, Agosto, Aziz & Stogner. “$32M verdict for elder care resident after neglect at assisted living facility.” Nov. 2023. https://abrahamwatkins.com/blog/2023/11/32m-verdict-for-elder-care-resident-after-neglect-at-assisted-living-facility/
Wells, Chris. “Chicago family awarded verdict in nursing home death case.” Fox 32 Chicago. https://www.fox32chicago.com/news/chicago-family-verdict-nursing-home-death-case
Vallejo Sun. “Jury orders Vallejo care facility to pay $15M in lawsuit over 96-year-old woman’s death.” https://www.vallejosun.com/jury-orders-vallejo-care-facility-to-pay-15m-in-lawsuit-over-96-year-old-womans-death/
JD Supra. “Findings of fraud fuel $7 million verdict.” https://www.jdsupra.com/legalnews/findings-of-fraud-fuel-7-million-3528216/
Future Care Risk Retention Group. “The cost of vacancy: How staffing gaps are reshaping long-term care.” https://static1.squarespace.com/static/67c8d020880290420ba4ce37/t/68f9555ee052005fc960f565/1761170782915/The+Cost+of+Vacancy+Hireology.pdf
McKnight’s Senior Living. “Understaffing is driving force behind lawsuits against senior living communities, legal experts say.” https://www.mcknightsseniorliving.com/news/understaffing-is-driving-force-behind-lawsuits-against-senior-living-communities-legal-experts-say/
Future Care Risk Retention Group. “The 2026 survival guide: the essential risk playbook for long-term care operators.”
CRC Group. “Senior living marketplace risks rise as demand surges.” https://www.crcgroup.com/Tools-Intel/Specialty-Tools-Intel/senior-living-marketplace-risks-rise-as-demand-surges