The MCARE Act & Medical Malpractice Case Outcomes
When a medical error causes serious injury or death in Pennsylvania, the process of pursuing justice often involves more than proving fault. A key player behind the scenes in many high-value medical malpractice claims is the MCARE Fund – Pennsylvania’s state-run excess coverage program for healthcare providers.
If you’re wondering how MCARE affects settlements, jury verdicts, negotiation strategy, and when money actually gets paid out, this article breaks it all down in plain English.
What Is the MCARE Act?
The Medical Care Availability and Reduction of Error (MCARE) Act, enacted in 2002, created the MCARE Fund—a state-managed excess liability fund that provides secondary medical malpractice coverage to physicians and hospitals across Pennsylvania.
While healthcare providers must carry primary insurance coverage of $500,000 per claim, the MCARE Fund provides an additional $500,000 in coverage per claim, acting as a financial backstop for large settlements or jury awards.
In simple terms: when a patient’s injury results in damages exceeding $500,000, MCARE covers the excess, up to $1 million in total.
MCARE’s Role in Medical Malpractice Settlements
When a malpractice settlement in Pennsylvania exceeds a provider’s $500,000 primary insurance limit, the MCARE Fund must be involved. This has significant implications for how settlements are negotiated, approved, and paid.
Settlements Over $500,000 Require MCARE Participation
If a settlement is proposed for more than $500,000, the excess portion must be submitted to MCARE for approval and payment. This means:
- MCARE independently evaluates the case
- Negotiations often include both the primary insurer and MCARE
- Settlements require additional documentation, including MCARE’s Full and Final Release
MCARE’s Required Release: What It Means for Plaintiffs
To finalize a settlement that includes payment from the MCARE Fund, plaintiffs must sign MCARE’s Full and Final Release. This document includes specific legal and procedural terms that plaintiffs—and their attorneys— are asked to agree to. Notably an MCARE representative will typically send an email stating:
“You will be receiving MCARE’s Full and Final Release which must be fully executed to finalize the settlement. This release includes a confidentiality provision at the request of the defendants and provides that Plaintiffs agree to satisfy any and all valid liens, including Department of Human Services liens and Medicare conditional payments that have been asserted and/or which may be asserted in the future for reimbursement of any medical benefits or other benefits provided to the Plaintiff, out of the proceeds of any settlement or award. The language in the release is approved by MCARE and is not subject to change.”
This means that once the case is settled:
- Plaintiffs must agree to keep the settlement terms confidential
- Any outstanding medical or public benefit liens must be paid out of the settlement
- The release cannot be negotiated or modified
- Court approval may be required in certain cases (e.g., minors or estates)
MCARE’s Annual Payment Schedule
Perhaps the most critical practical detail for clients and lawyers is when MCARE actually pays their money. Unlike private insurers that typically issue payment within weeks, MCARE processes payments only once per year. Here is typical payout language that MCARE sends following a settlement or verdict (current as of the time this article was published):
“MCARE makes payment on claims once per year. If the properly executed MCARE-generated release is received by MCARE on or before August 31, 2025, payment will be made on December 31, 2025, pending receipt of any necessary court approval. If MCARE does not receive the fully executed MCARE-generated and approved release by that date, monies due by MCARE shall not become payable until December 31, 2026, provided that the release is received on or before August 31, 2026.”
Translation:
- If the paperwork is completed on time, you receive MCARE’s portion by the end of the same calendar year.
- If there’s any delay, you could be waiting another full year for payment.
This makes precise timing and document management absolutely critical. Plaintiffs, lawyers, and court administrators must be proactive to avoid unnecessary delays.
MCARE’s Role in Verdicts and Trials
If a malpractice case goes to trial and the jury awards damages exceeding $500,000:
- The provider’s primary insurance pays the first $500,000
- The MCARE Fund pays the next $500,000, up to a $1 million total
- Any amount beyond $1 million may fall back on the provider, hospital system, or their excess insurer
MCARE has the right to appeal trial verdicts and will often delay payout while motions or appeals are pending. Verdicts involving future medical costs or injuries to minors may also require structured settlements or court-supervised trusts, which MCARE may help administer.
MCARE and Settlement Strategy: What Lawyers Must Consider
The MCARE Fund influences not just when money is paid, but how cases are valued and resolved. At Lupetin & Unatin, we factor MCARE into every stage of high-value litigation, including:
- Evaluating when MCARE coverage will apply
- Managing lien resolution and court approval requirements
- Coordinating timely execution of MCARE’s release
- Structuring settlements to comply with MCARE rules
- Preparing clients for realistic payout timelines
We also push hard to meet the August 31 deadline each year—because waiting an extra 12 months for funds can significantly impact injured clients and grieving families.
Final Thoughts: MCARE Is Key to Getting Paid, But Comes With Strings
The MCARE Fund plays a vital role in ensuring fair compensation in large malpractice cases in Pennsylvania. But its involvement introduces unique procedural hurdles and strict timing constraints that lawyers and clients must navigate carefully.
If you are pursuing or considering a medical malpractice lawsuit in Pennsylvania, especially one involving catastrophic injury, death, or expected damages exceeding $500,000, it’s essential to work with a law firm that understands the MCARE system inside and out.
Talk to a Pennsylvania Medical Malpractice Lawyer Experienced with MCARE
At Lupetin & Unatin, we’ve helped clients across Pennsylvania recover millions in medical malpractice settlements and verdicts—including complex cases involving MCARE funding, structured payouts, and court-approved settlements.
Call us for a free consultation
Based in Pittsburgh, serving all of Pennsylvania
Proven results in catastrophic injury and wrongful death cases