Tort litigation is frequently criticized for producing outcomes that do not match merit. We examined 1,452 closed malpractice claims from five insurers to obtain objective clinical judgments of their underlying merit. We then analyzed predictors of discordant outcomes-payment of apparently nonmeritorious claims and nonpayment of apparently meritorious claims. In multivariate analyses, the odds of both forms of discordant outcome were significantly higher when reviewers judged it a close call as to whether a medical error had occurred. The odds of nonmeritorious claims receiving compensation were significantly higher among cases involving infants and health care facility codefendants and significantly lower when claims were decided by trial verdict. The strongest predictor of rejection of meritorious claims was resolution by trial verdict, which suggests that patients who have been harmed by error fare poorly when their claims are decided by juries. (c) 2007 by The University of Chicago. All rights reserved..