o Over the last five years medical malpractice premiums for major insurers have more than doubled, while claims payouts have remained essentially flat.

o For some malpractice insurers, incurred losses (payouts plus loss reserve changes) also decreased.

o Malpractice insurers accumulated large amounts of surplus in the last three years.

"Insurance companies say lots of things [in] lobbying battles and we take them with a grain of salt," said Mr. Angoff, now a lawyer with Roger Brown & Associates in Jefferson City, Mo. But recalling his days as commissioner, he said, "What we look at very seriously is data in annual statements that companies file under oath every year," noting that this data formed the basis of his report.

For the largest 15 insurers, med mal premiums went up over 120 percent--"exactly what we would expect," he said. What was surprising, he continued, is that "in real terms," or inflated-adjusted dollars, "medical malpractice claims payments went down." He explained that claims payments reported on insurer statements rose by 5.7 percent, but the general inflation rate is 13 percent and medical inflation is higher than that.

"This is wacky," he remarked, flipping through the report and reading off claim payment and premium trends for particular companies.

He also noted that for many insurers, not just paid losses but incurred losses (paid losses plus losses reserve changes) went down. A table in the report shows that 14 of 15 insurers had declining incurred losses in 2003 and 2004, for an overall average decline of 21.1 percent, compared to a 9.3 percent jump in premiums.

Mr. Blumenthal said, "We're dealing here with hurricane-force trends that cannot be explained away by quibbles [over methodology] or percentage points."

Missouri Attorney General Jay Nixon and Michigan Insurance Commissioner Linda Watters also released statements questioning whether insurers were price-gouging in response to the report.

Responding to a question of whether the imposition of tort reforms, such as caps on non-economic damages in some states in recent years, may explain the declines in paid and projected losses, Mr. Angoff admitted that he had not done a state-by-state analysis. "But the results are so significant that I wouldn't think they could have much of an impact."

J. Robert Hunter, director of insurance for the Consumer Federation of America, said: "The [insurance] cycle is the same whether there are caps or not. Prices skyrocket and then go down."

Mr. Blumenthal pointed out that the same trends prevail in Connecticut--premiums rising 213 percent and claims paid falling 1.6 percent--adding that caps in other states "have been too recent to be the cause" of the trends.

"There's no single cause for these trends. What's important is the juxtaposition of these undeniable patterns," he said.

Mr. Blumenthal added: "This report in no way diminishes the need for improving the tort system and making medicine safer. [But] it rivets attention on the need to hold the insurance industry accountable for...potential profiteering. It has escaped accountability."

Mr. Agnoff's report was co-released by Washington-based CFA, CJ&D, and several other national consumer organizations: Alliance for Justice, Public Citizen, USAction and U.S. PIRG.