The Death Discount — Why a Fatal Medical Error Settles for Less Than a Survivable One: 263,622 NPDB Malpractice Payments, 2005–2025

Analysis of 263,622 medical-malpractice payments reported to the U.S. National Practitioner Data Bank between 2005 and 2025, grouped by NPDB's severity-of-outcome scale. Finding: the median payment when a patient DIED is $235,000 (n=73,178). When a patient survived with quadriplegia or brain damage it is $575,000 (n=11,565) — 2.45× higher. Ranked by median, death is FOURTH of ten severity levels; quadriplegia/brain damage, major permanent injury and significant permanent injury all settle higher. Robustness: brain-damage cases skew toward infants and death cases toward ages 50–70, so the comparison is stratified by patient age. The gap holds in all 12 age bands tested, from 1.80× to 3.22× — it is not a composition artefact. The discount is narrowing over time: 3.54× in 2005, 1.59× in 2025. Mechanism: a wrongful-death claim belongs to the survivors and compensates their losses (support, services, companionship). The decedent's own pain and suffering is generally not recoverable there; where it survives it belongs to a separate survival action, which several states restrict or bar. A catastrophically injured patient who lives recovers a lifetime of future medical care, lost earning capacity AND their own pain and suffering. Window: 2005–2025, because NPDB did not publish the severity-of-outcome field before 2004 (all 250,672 rows from 1990–2003 are blank; 2004 is 12% incomplete). Unit of analysis is one payment per practitioner; the combined total_payment field is deliberately NOT summed, to avoid double-counting multi-practitioner settlements. All headline figures are medians — the distribution is strongly right-skewed. This is not a claim that the legal system values life cheaply in principle, nor a causal estimate of any single statute. It reports what payers paid, by recorded severity. Analysis: Settlement Insight Research.