The microstructure evolution, plastic deformation, and damage severity during the open die hot forging of a martensitic stainless steel were investigated using finite element (FE) simulation. A microstructure evolution model was developed and combined with a visco-elastoplastic model to predict the strain, the strain rate, and the temperature distribution, as well as the volume fraction and the size of dynamically recrystallized grains over the entire volume of an industrial size forging. The propensity to damage during hot forging was also evaluated using the Cockcroft & Latham model. The three models were implemented in the FE code and the results analyzed in terms of microstructure inhomogeneity and stress levels in different regions of the forging. A good agreement was obtained between the predicted and the experimental results, demonstrating that the simulation provided a realistic representation of the forging process at the industrial scale.