Medical Malpractice Compensation Tables: A Comprehensive Guide To Calculating Damages

Compensation for medical malpractice is calculated using tables that take into account factors such as permanent and temporary disability, the patient's age and moral damage.

Since 2025, the National Unified Table (TUN) has been introduced to harmonise compensation across the country, although local tables such as those of Milan remain a valid reference.

The assessment of biological damage (physical harm) is the starting point. Tables are used to correlate the percentage of disability with the patient's age, and the amount can be personalised based on the circumstances.

What the medical malpractice compensation tables are

Compensation tables for medical malpractice are tools used by courts to calculate the amount of financial compensation owed to individuals who have suffered harm due to medical negligence.

These tables quantify non-pecuniary damage (also known as biological damage), which includes injury to physical and psychological integrity, moral suffering and other consequences.

The criteria on which they are based include the patient's age, the severity of the injury (expressed as a percentage of permanent disability), the degree of subjective suffering (moral damage) and temporary disability.

These tables help standardise compensation criteria and ensure greater fairness among patients.

The tables in use

The main reference in Italy is the Milan Tables, although specific tables also exist for cases involving minor injuries (micro-permanent disabilities).

Historically, the Milan Court Tables have been the most widely used and nationally recognised reference for calculating non-pecuniary damage.

The Gelli-Bianco Law (Law 24/2017) provides for the introduction of a National Unified Table for major injuries (permanent disability above 9 percent) and a specific table for minor injuries.

The tables for micro-permanent disabilities are provided at national level by the Private Insurance Code (Articles 138 and 139) and apply to injuries resulting in a disability between 0 and 9 percent.

The aim is to definitively overcome inconsistencies between different local tables (such as those of Milan and Rome) and establish an official, nationwide system.

When compensation for medical malpractice is due

A patient is entitled to compensation for medical malpractice when a health injury is caused by wrongful conduct (negligence, lack of skill or imprudence) by a doctor or healthcare facility, provided that the causal link between the error and the harm suffered is proven.

Liability may lie with the individual practitioner or with the healthcare facility itself.

The right to compensation arises in cases of:

• Diagnostic error: incorrect or delayed diagnosis that worsens the patient's chances of recovery.
• Surgical or therapeutic error: improperly performed procedures or inadequate treatments.
• Lack of information: treatments performed without the patient's informed consent.
• Hospital-acquired infections: infections contracted due to poor hygiene or negligence by the facility.
• Lack of monitoring: omission of checks considered essential.

Intent, negligence and liability

Intent and negligence affect medical liability because they determine whether the patient's damage resulted from a medical error and the degree of responsibility involved.

Negligence (carelessness, imprudence, lack of skill) is an unintentional error, whereas intent implies the deliberate wish to cause harm, or acceptance of the risk that it will occur.

Depending on the level of negligence or the presence of intent, the consequences may be civil (damages) and criminal (imprisonment or other penalties).

The main difference lies in intentionality: negligence is unintentional, intent is voluntary and aimed at causing harm. In both cases, a causal link must exist between the doctor's conduct and the damage suffered by the patient.

Negligence

• Definition: unintentional error caused by negligence (failing to do what should be done), imprudence (doing something that should not be done) or lack of skill (insufficient competence).
• Consequences:
  • Civil: entails the obligation to compensate both pecuniary damage (medical expenses, loss of income) and non-pecuniary damage (pain and suffering).
  • Criminal: punishable under criminal law. The type of penalty depends on the severity of the error and the compliance with general guidelines.
• Requirements for liability: it is necessary to prove negligent conduct, damage and the causal link between the two.
• Importance of the causal link:
  In civil cases, the evaluation requires that the damage is "more likely than not" the consequence of the error.

In criminal cases, the standard of proof is "beyond reasonable doubt".

In situations involving special technical difficulty, medical liability is limited to cases of intent or gross negligence (Article 2236 of the Civil Code).
In such cases, slight negligence may not lead to legal consequences.

Intent

• Definition: the deliberate intention to cause harm to the patient.
• Consequences: in both civil and criminal proceedings, intent significantly increases the doctor's liability and results in severe penalties.
• Requirements: in cases of indirect intent, it must be shown that the doctor foresaw the possibility of causing harm but acted nonetheless, accepting the risk for personal reasons (for instance, financial gain or recognition).

Such scenarios are extremely rare in the medical field, since healthcare professions are inherently oriented toward patient care.

Elements considered in calculating compensation

Compensation for medical malpractice in Italy is primarily divided into pecuniary damage and non-pecuniary damage.

Non-pecuniary damage includes biological damage and moral damage (and, in many cases, existential damage, often assessed together).

A medico-legal expert report is essential to objectively quantify biological damage and determine the percentage of disability.

Pecuniary damage

Pecuniary damage refers to the actual financial losses suffered by the injured party and is divided into:

• Emerging damage: includes direct, documented expenses incurred because of the harmful event.
  This category covers medical expenses (consultations, tests, medication, surgeries), care assistance and travel required for treatment.
• Loss of earnings: refers to the loss of future income resulting from temporary or permanent inability to work or generate income.
  Quantification is usually based on the victim's income and on the percentage of disability affecting work capacity.
• Future assistance: may fall under either emerging damage or loss of earnings, depending on the case.
  It may include costs for ongoing personal assistance (such as caregivers or nurses) required due to the injuries suffered.
• Loss of assets: calculated based on the proven loss of personal or family assets.

Biological damage

Biological damage represents the temporary or permanent impairment of a person's physical and psychological integrity, verified through medico-legal assessment, regardless of its impact on earning capacity.

There are two types of impairment:

• Temporary disability: refers to the period during which the injured person is unable to perform daily activities.
  Compensation is awarded for each day of disability, which may be absolute (total incapacity) or partial (reduced capacity).
• Permanent disability: expressed as a percentage, representing the severity of the injury and the extent of permanent impairment of health.
  This percentage is used, alongside the victim's age and the specific compensation tables, to calculate the monetary value of the damage.

Moral damage

Moral damage consists of subjective suffering and emotional distress (anguish, anxiety, pain) caused by the harmful event.

It is distinct from biological damage but is compensated together with it as part of non-pecuniary damage.

Compensation is generally determined through a personalisation of the base value of biological damage, taking into account the specifics of the case.

Importance of the medico-legal assessment

The medico-legal assessment is the key piece of evidence in compensation proceedings.

It is usually carried out once the patient's clinical condition has stabilised to allow for an accurate evaluation of permanent damage.

The medico-legal expert objectively assesses the injuries suffered and the causal link between the event and the damage.

They determine the extent of impairment and establish the percentage of permanent disability based on standard medico-legal criteria and specific tables.

This percentage is the essential basis for calculating biological damage, as it provides an objective and impartial foundation for the compensation request, safeguarding the rights of the injured party.

Medical malpractice compensation tables and the National Unified table

Italy is currently transitioning from local compensation tables (such as those used in Milan and Rome) to the National Unified Table (TUN).

The legislator's intention is to ensure uniformity and fairness in awarding compensation for biological damage throughout the country.

Until now, compensation for non-pecuniary damage has been based on different criteria adopted by various courts.

Over time, the Milan Tables have become the prevailing reference point, though not the only one.

This situation has led to:

• Disparity in treatment: for identical injuries, compensation may vary significantly depending on the territorial jurisdiction (for example, between Milan and Rome).
• Legal uncertainty: the absence of a single national standard makes case outcomes less predictable.

Compensation tables for medical malpractice are based on criteria including the victim's age, degree of permanent disability (PD), and moral damage.
The final calculation is not always automatic, as the court may consider additional circumstances.

The National Unified Table (TUN)

The National Unified Table (TUN) for compensating biological damage resulting from major injuries is mandatory for accidents occurring from 5 March 2025 (the date on which the relevant decree came into force).

Details on applicability:

• For injuries occurring from 5 March 2025, the TUN applies exclusively and nationwide to the compensation of non-pecuniary damage (biological and moral) in cases of significant injuries (permanent disability above 9 percent).
• For injuries occurring before that date, Courts generally continue applying previously established jurisprudential criteria, particularly the Milan Court Tables, which the Court of Cassation recognised as the national reference for ensuring uniformity of treatment.
• For minor injuries (up to 9 percent disability), a specific ministerial table set out in Article 139 of the Private Insurance Code applies, separate from the TUN for major injuries.

How the compensation tables work

• Permanent Disability (PD) and Biological Damage: biological damage is calculated based on age and disability percentage.
  For instance, compensation for a 90 percent disability is significantly higher for a 20-year-old than for an 80-year-old.
• Moral damage: Tables also account for moral damage, calculated through fixed percentage increases or predefined ranges.

Comparative examples using the TUN

Important: the comparative table provides indicative figures.

Actual compensation may vary depending on the specific circumstances and the court's decisions.

Timeframes for compensation in medical malpractice cases

Timeframes vary significantly, ranging from six months to several years, depending on whether the matter is resolved amicably or through litigation.

If litigation is avoided, a settlement may be reached within six months.
If judicial proceedings are necessary, the timeframe may extend to two to five years or more.

In cases without settlement, pre-litigation technical consultancy (ATP) may conclude within one year, whereas standard civil proceedings may last three to five years.

Two main paths are available: out-of-court settlement and judicial proceedings.

Out-of-Court settlement

If the healthcare facility or insurer accepts the claim without dispute, a settlement and payment can be achieved within six months, sometimes within 90 to 180 days.

Judicial proceedings

Pre-litigation technical consultancy (ATP): this stage involves an independent medical assessment to evaluate liability, ideally concluding within six months from the filing of the petition.
In practice, due to delays, the overall duration may reach 18 to 24 months.

Ordinary civil proceedings: if no settlement is reached and ATP does not resolve the case, a civil action is initiated.
The average duration ranges from three to five years.

Statute of limitations

It is essential to act within the statute of limitations, which varies depending on the party being sued:

• 10 years for healthcare facilities (contractual liability).
• 5 years for doctors or other healthcare professionals (non-contractual liability).

The limitation period runs from the moment the damage becomes objectively identifiable and the patient becomes aware of it.

Critical issues and future prospects of compensation tables

The Italian system for compensating medical malpractice presents several critical issues and is currently undergoing a transition toward the application of the National Unified Table (TUN), which represents the main future development in the field.

Main critical issues of the current system:

1. Inconsistent compensation awards: the absence of a nationwide table for significant injuries has led to disparities in the amounts awarded to patients depending on the competent court (the Milan Tables were often used as a reference but without a general legal obligation).
2. Complex and lengthy proceedings: obtaining compensation for medical malpractice is often a long and complex process requiring extensive medico-legal assessments and sometimes resulting in prolonged legal disputes.
3. Medico-legal interpretation challenges: application of damage assessment criteria, even within existing tables, involves discretion and debate among specialists, as highlighted in Supreme Court decisions on specific forms of damage (such as pre-death damage).
4. Financial burden on healthcare facilities and insurers: uncertainty and the potentially high amounts of compensation contribute to making insurance policies costly for healthcare facilities and professionals, with repercussions throughout the sector.

Future prospects for compensation tables

The main future development is the implementation and widespread application of the National Unified Table (TUN) for compensation of biological and non-pecuniary damage, established under the Gelli-Bianco Law (Law 24/2017).

Harmonisation and standardisation: the primary goal of the TUN is to ensure fairness and uniformity nationwide in the assessment and compensation of damages, reducing differences between courts.

Simplification and faster procedures: a standardised compensation system is intended to facilitate quicker, out-of-court settlements, minimising the need for litigation.

Application to serious injuries: the TUN will apply specifically to significant injuries (greater than 9 percent permanent disability), while minor injuries will continue to follow existing tables (Private Insurance Code).

Personalisation of damage: although the tables introduce standardised "average" values, they still allow for adjustments based on specific circumstances to ensure full compensation for the harm suffered.

The effectiveness of the National Unified Table will depend on its actual application and interpretation by judges and medico-legal experts.

Legal assistance in medical malpractice compensation cases

Legal assistance in medical malpractice claims relies on two pillars: technical evaluation of medical conduct and building a legal case.

The objective, once it is assessed whether the specific case has grounds to proceed, is to claim and obtain compensation for the harm suffered.

The process may take place out of court (settlement attempt) or in court (civil action).

What to do:

1. Gather documentation:
2. Medical records, reports, diagnostic tests and any other relevant medical documentation.
3. Photographic evidence, if applicable.
4. Case assessment with experts:
5. Medico-legal expert: essential to perform the medico-legal assessment and establish the causal link between the medical error and the damage.
6. Initiate legal action:
7. Out-of-court phase: an attempt is made to reach an agreement with the healthcare facility or insurer. This phase may be resolved quickly (in as little as six months) if an agreement is reached.
8. Judicial phase: if no agreement is reached, a civil lawsuit is initiated. Timeframes may extend to five years.

Damage assessment includes medical, pharmaceutical and rehabilitation expenses, as well as loss of income.
Non-pecuniary damages include physical, moral and psychological harm, extending also to family members in cases involving death or permanent disability.