By most financial measures, the medical professional liability (MPL) insurance industry had one of its best years to date in 2010. The operating ratio was at an all-time low, and the combined ratio was nearly at its lowest points. Insurers were able once again to release reserves, and a large portion of the releases were returned as policyholder dividends. In fact, the MPL industry returned more dividends to its policyholders in 2010 than during any other year in its history. The industry's surplus also increased relative to 2009, providing additional capital support for what may be challenging and uncertain times ahead.