Noneconomic Damages Caps

State Constitutional Doctrines Governing Statutory Caps on Noneconomic Damages in Personal-Injury and Medical-Malpractice Cases

The leading jury-trial invalidation comes from Georgia. Atlanta Oculoplastic Surgery, P.C. v. Nestlehutt, 286 Ga. 731 (Ga. 2010) held that "the noneconomic damages caps in OCGA § 51-13-1 violate the constitutional right to trial by jury." Because "[t]he right to a jury trial includes the right to have a jury determine the amount of . . . damages, if any, awarded to the [plaintiff]," the statute failed at the threshold: "By requiring the court to reduce a noneconomic damages award determined by a jury that exceeds the statutory limit, OCGA § 51-13-1 clearly nullifies the jury’s findings of fact regarding damages and thereby undermines the jury’s basic function." The dollar figure was immaterial — "[t]he very existence of the caps, in any amount, is violative of the right to trial by jury." Sixteen years later, Clark v. Leigh, No. S26A0349 (Ga. June 16, 2026) declined an express invitation to overrule that precedent: "We reaffirm the framework set out in Atlanta Oculoplastic Surgery, P.C. v. Nestlehutt, 286 Ga. 731 (2010), and the holding of that case: the Georgia Constitution's right to trial by jury does not permit the application of OCGA § 51-13-1(b)'s damages cap to damages for pain and suffering and loss of consortium in medical malpractice actions." The court explained that "the right to trial by jury has a substantive component and is not merely a procedural right to have juries, rather than judges, decide questions of fact that may then be rendered irrelevant by statute. A merely procedural right to a jury trial would be hollow and illusory," and it held the cap "not capable of being applied in a case like this one, where a jury's verdict includes noneconomic damages for a cause of action to which the right to trial by jury applies (the estate's medical malpractice claim for pre-death pain and suffering) — even if that verdict also includes damages for a cause of action to which the right allegedly does not attach."

Missouri reached the same conclusion and repudiated its own contrary precedent. Watts ex rel. Watts v. Lester E. Cox Medical Centers, 376 S.W.3d 633 (Mo. 2012) held that "the amount of noneconomic damages is a fact that must be determined by the jury and is subject to the protections of the article I, section 22(a) right to trial by jury," and struck the medical-malpractice cap because "[s]uch a limitation was not permitted at common law when Missouri’s constitution first was adopted in 1820 and, therefore, violates the right to trial by jury guaranteed by article I, section 22(a) of the Missouri Constitution." The court was explicit about the casualty: "To the extent that the decision in Adams By and Through Adams v. Children’s Mercy Hosp., 832 S.W.2d 898, 907 (Mo. banc 1992), is inconsistent with this decision, it is overruled" — eliminating the authority on which two decades of Missouri cap jurisprudence had rested.

Equal protection supplies the second doctrinal route. Estate of McCall v. United States, 134 So. 3d 894 (Fla. 2014) held "that the cap on wrongful death noneconomic damages provided in section 766.118, Florida Statutes, violates the Equal Protection Clause of the Florida Constitution." Applying the principle that "[t]o satisfy the rational basis test, a statute must bear a rational and reasonable relationship to a legitimate state objective, and it cannot be arbitrary or capriciously imposed," the court reasoned that "aggregate caps or limitations on noneconomic damages violate equal protection guarantees under the Florida Constitution when applied without regard to the number of claimants entitled to recovery. This inherently discriminatory action and resulting invidious discrimination do not pass constitutional muster." The decision also embraced a continuing-rationality check on crisis legislation: "even if section 766.118 may have been rational when it was enacted based on information that was available at the time, it will no longer be rational where the factual premise upon which the statute was based has changed."

The contrary line treats caps as ordinary economic legislation subject only to rational-basis review. Fein v. Permanente Medical Group, 38 Cal. 3d 137 (Cal. 1985) upheld MICRA’s $250,000 cap against due process and equal protection attack, concluding that "it is clear that section 3333.2 is rationally related to legitimate state interests," that "the Legislature limited the application of section 3333.2 to medical malpractice cases because it was responding to an insurance “crisis” in that particular area," and that "the Legislature clearly had a reasonable basis for drawing a distinction between economic and noneconomic damages, providing that the desired cost savings should be obtained only by limiting the recovery of noneconomic damage." That statute remains in force in amended form: under Cal. Civ. Code § 3333.2, "[c]ivil liability for damages for noneconomic losses against one or more health care providers, collectively, shall not exceed three hundred fifty thousand dollars ($350,000), regardless of the number of health care providers," and following the 2022 amendments "the dollar amounts set forth in subdivision (b) shall increase by forty thousand dollars ($40,000) each January 1st for 10 years up to seven hundred fifty thousand dollars ($750,000), and the dollar amounts set forth in subdivision (c) shall increase each January 1st by fifty thousand dollars ($50,000) for 10 years up to one million dollars ($1,000,000)." Texas has taken the same legislative path: under Tex. Civ. Prac. & Rem. Code § 74.301, noneconomic damages against a physician or non-institutional provider "shall be limited to an amount not to exceed $250,000 for each claimant, regardless of the number of defendant physicians or health care providers other than a health care institution against whom the claim is asserted or the number of separate causes of action on which the claim is based," while all health care institutions together "shall be limited to an amount not to exceed $500,000 for each claimant."

The split therefore turns on state constitutional text and history rather than on any federal doctrine. Where a state constitution preserves the jury-trial right as it existed at common law — Georgia measuring from 1798, Missouri from 1820 — courts have held that a statutory ceiling that automatically overrides the jury’s assessment of noneconomic damages nullifies a constitutionally protected finding of fact and cannot stand in any amount, and Georgia’s 2026 reaffirmation shows that doctrine hardening rather than eroding. Where the challenge sounds in equal protection, the results divide between courts like Florida’s, which found aggregate caps irrational as applied to multiple claimants and open to reexamination once the actuarial crisis that justified them recedes, and the many courts following the California approach, which defer to a legislative judgment that limiting noneconomic recoveries restrains malpractice-insurance costs. In cap states such as California and Texas the statutes operate with full force — California now under an escalating schedule that will reach $750,000 for injury and $1,000,000 for wrongful death — while in the strike-down states the verdict stands as the jury returned it.