California enjoys the substantial benefits of MICRA, especially compared to physicians in other states where malpractice insurance rates can be 3–5 times what California physicians pay. Yet, large settlements and jury awards still happen, and in spite of the benefits of MICRA, some physicians have experienced large increases in their malpractice or professional liability insurance costs. The underlying reasons for such increases are highly contested, with disagreement among insurance companies, physicians groups, trial lawyers and patient advocacy organizations. Because of the complex nature of the insurance industry, physicians and other members of the medical community are uncertain as to the methods insurance companies use to determine their policy premiums.