50-state law guide
Before a medical malpractice lawsuit: notice, merit, and review rules by state.
Many states require steps before a medical malpractice lawsuit can be filed: a written notice to the provider, an expert’s certificate or affidavit that the claim has merit, or a review by a panel. This table shows those steps, and whether they pause the deadline, for all 50 states and the District of Columbia, with a link to each statute or court rule.
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What has to happen before a medical malpractice lawsuit?
It depends on the state where the care happened. Some states let a lawsuit be filed right away. Others require one or more steps first, or soon after filing, and missing one can get a case dismissed or delay it.
In our table, 27 of the 51 jurisdictions call for an expert’s certificate, affidavit, or report, 12 call for a written notice before filing, 12 send some claims to a review panel or similar body, and 6 have no pre-suit step in the statutes and rules we read. For 3, the rule needs more context than a table cell can give (“See statute”). 12 combine more than one.
These steps take time, often weeks or months, and they run alongside the statute of limitations. That’s one reason attorneys usually want to start well before a deadline. This is general information, not legal advice; an attorney licensed in the state can tell you which steps apply.
Notice and expert requirements in all 50 states and DC
Find your state below. Where we’ve written a full deadline guide for a state, the state’s name links to it. Each statute link goes to the official code or court rules, or a public copy of them.
| State | In short | Notice before filing | Expert certificate or affidavit | Statute or rule |
|---|---|---|---|---|
| Alabama | None found in statute | None found in statute | None found in statute | See statute |
| Alaska | No pre-suit step; court may appoint an expert panel after the answer | None found in statute | None found in statute | Alaska Stat. § 09.55.536(a) |
| Arizona | Certify with the complaint whether expert testimony is needed | None found in statute | Certify with the complaint if an expert is needed; if so, serve an expert affidavit with disclosures | Ariz. Rev. Stat. § 12-2603(A) Ariz. Rev. Stat. § 12-2603(B) |
| Arkansas | See statute | See statute | See statute | See statute |
| California | Notice of intent at least 90 days before filing | Notice of intent to sue to each defendant at least 90 days before filing | None found in statute | Cal. Code Civ. Proc. § 364(a) |
| Colorado | Certificate of review within 60 days after serving the complaint | None found in statute | Attorney's certificate of review, after consulting a qualified expert, within 60 days after service | Colo. Rev. Stat. § 13-20-602(1)(a) Colo. Rev. Stat. § 13-20-602(3)(a), (c) |
| Connecticut | Good-faith certificate plus expert opinion letter filed with complaint | None found in statute | Good-faith certificate plus a similar health care provider's written opinion, with the complaint | Conn. Gen. Stat. § 52-190a(a) |
| Delaware | Expert affidavit of merit must accompany the complaint | None required; an optional notice of intent to investigate can toll the deadline | Affidavit of merit signed by a qualified expert, with CV, filed with the complaint | Del. Code tit. 18, § 6853(a)(1) Del. Code tit. 18, § 6856(4) |
| District of Columbia | Notice of intent 90 days before filing; mediation after filing | Notice of intent to each defendant at least 90 days before filing | None found in statute | D.C. Code § 16-2802(a) D.C. Code § 16-2821 |
| Florida | Expert opinion, notice of intent, then a 90-day presuit screening | Notice of intent to each prospective defendant; no suit for 90 days after notice | Verified written medical expert opinion, provided when the notice of intent is mailed | Fla. Stat. § 766.106(2)(a) Fla. Stat. § 766.106(3)(a) Fla. Stat. § 766.203(2) |
| Georgia | Expert affidavit filed with the complaint | None found in statute | Affidavit of a competent expert naming at least one negligent act, filed with the complaint | O.C.G.A. § 9-11-9.1(a) |
| Hawaii | Panel inquiry with certificate of consultation before filing suit | None found in statute | Certificate of consultation with a physician in the same specialty, filed with the panel inquiry | Haw. Rev. Stat. § 671-12(a) Haw. Rev. Stat. § 671-12.5(a)(1) |
| Idaho | Prelitigation hearing panel (Board of Medicine) before suing | None found in statute | None found in statute | Idaho Code § 6-1001 |
| Illinois | Affidavit and health professional's written report with the complaint | None found in statute | Affidavit plus a reviewing health professional's written report, attached to the complaint | 735 ILCS 5/2-622(a) 735 ILCS 5/2-622(a)(1) |
| Indiana | Medical review panel opinion before suing a qualified provider | None found in statute | None found in statute | Ind. Code § 34-18-8-4 |
| Iowa | Expert certificate of merit within 60 days of the defendant's answer | None found in statute | Expert certificate of merit affidavit served within 60 days of the answer, before discovery | Iowa Code § 147.140(1)(a) |
| Kansas | No required pre-suit step; a party may ask for a screening panel | None found in statute | None found in statute | K.S.A. 65-4901(a) |
| Kentucky | Certificate of merit filed with the complaint | None found in statute | Certificate of merit (consulted a qualified expert) filed with the complaint | KRS 411.167(1)-(2) |
| Louisiana | Medical review panel before suing a covered provider | None found in statute | None found in statute | La. R.S. 40:1231.8(B)(1)(a)(i) |
| Maine | Notice of claim, then a mandatory prelitigation screening panel | Sworn notice of claim served on the provider and filed with the Superior Court | None found in statute | 24 M.R.S. § 2903(1) 24 M.R.S. § 2853(1) 24 M.R.S. § 2851 |
| Maryland | File the claim with HCADRO first; expert certificate within 90 days | None found in statute | Certificate of a qualified expert, with the expert's report, filed within 90 days | Md. Code, Cts. & Jud. Proc. § 3-2A-04(a)-(b) Md. Code, Cts. & Jud. Proc. § 3-2A-04(b)(3) |
| Massachusetts | 182-day notice before suit; tribunal reviews the case after filing | Written notice to each provider 182 days before filing (90 days in some cases) | None found in statute | G.L. c. 231, § 60L(a), (c) G.L. c. 231, § 60B |
| Michigan | 182-day notice of intent; affidavit of merit filed with the complaint | Written notice of intent to each provider at least 182 days before filing | Affidavit of merit signed by a qualified health professional, filed with the complaint | MCL 600.2912b(1) MCL 600.2912d(1) |
| Minnesota | Affidavit of expert review served with the summons and complaint | None found in statute | Attorney's affidavit of expert review, served with the summons and complaint | Minn. Stat. § 145.682, subd. 2 Minn. Stat. § 145.682, subd. 3 |
| Mississippi | Written notice of intent at least 60 days before filing | Written notice of intent to each defendant at least 60 days before filing | See statute | Miss. Code Ann. § 15-1-36(15) |
| Missouri | Health care affidavit of merit within 90 days after filing suit | None found in statute | Affidavit citing a qualified provider's written opinion, due 90 days after filing | Mo. Rev. Stat. § 538.225.1 Mo. Rev. Stat. § 538.225.5 |
| Montana | Montana Medical Legal Panel review required before filing suit | None found in statute | None found in statute | Mont. Code Ann. § 27-6-301 |
| Nebraska | Medical review panel first for Act-qualified providers, unless waived | None found in statute | None found in statute | Neb. Rev. Stat. § 44-2840(2), (4) Neb. Rev. Stat. § 44-2840(1) |
| Nevada | Medical expert affidavit must be filed with the complaint | None found in statute | Affidavit of a medical expert in a similar practice area, filed with the complaint | Nev. Rev. Stat. § 41A.071 |
| New Hampshire | No current pre-suit step confirmed; screening panels repealed 2023 | See statute | None found in statute | N.H. Rev. Stat. Ann. ch. 519-B (repealed) |
| New Jersey | Affidavit of merit within 60 days after the defendant's answer | None found in statute | Affidavit from an appropriate licensed person, due within 60 days after the answer is filed | N.J. Stat. Ann. § 2A:53A-27 |
| New Mexico | Medical review commission decision before suing independent providers | None found in statute | None found in statute | N.M. Stat. Ann. § 41-5-15(A) |
| New York | Attorney certificate of merit filed with the complaint | None found in statute | Attorney certifies a consult with a licensed physician (or dentist, podiatrist), with the complaint | N.Y. C.P.L.R. § 3012-a(a) |
| North Carolina | Complaint must state an expert reviewed the care (Rule 9(j)) | None found in statute | Complaint must assert a likely expert reviewed the care and records and will testify it fell short | N.C. Gen. Stat. § 1A-1, Rule 9(j) |
| North Dakota | Expert opinion affidavit served within 3 months after filing | None found in statute | Affidavit with an admissible expert opinion, served within 3 months after the action starts | N.D. Cent. Code § 28-01-46 |
| Ohio | Affidavit of merit filed with the complaint (court rule) | Optional written notice letter; not required, but it can extend the filing deadline | Expert affidavit of merit for each defendant, filed with the complaint (extension by motion) | Ohio Civ.R. 10(D)(2) Ohio Rev. Code § 2305.113(B)(1) |
| Oklahoma | See statute | None found in statute | See statute | 12 O.S. § 19.1 John v. Saint Francis Hospital, 2017 OK 81 (on OSCN) 12 O.S. § 19 (repealed) 63 O.S. § 1-1708.1E (repealed) |
| Oregon | Mediation, arbitration, or court conference within 270 days of filing | Optional notice of adverse health care incident to the Oregon Patient Safety Commission | None found in statute | ORS 31.250 ORS 31.262(3) |
| Pennsylvania | Certificate of merit with the complaint or within 60 days (court rule) | None found in statute | Certificate of merit, based on a licensed professional's written statement, within 60 days of filing | Pa.R.C.P. 1042.3(a) |
| Rhode Island | None found in statute | None found in statute | None found in statute | See statute |
| South Carolina | Notice of intent with expert affidavit, then pre-suit mediation | File and serve a Notice of Intent to File Suit before filing the lawsuit | Expert witness affidavit filed together with the Notice of Intent | S.C. Code § 15-79-125(A) S.C. Code § 15-79-125(C) S.C. Code § 15-36-100(B) |
| South Dakota | None found in statute | None found in statute | None found in statute | See statute |
| Tennessee | Notice 60 days before filing; certificate of good faith with complaint | Written notice to each provider to be named, at least 60 days before filing | Certificate of good faith, based on a signed expert statement, filed with the complaint | Tenn. Code Ann. § 29-26-121(a)(1) Tenn. Code Ann. § 29-26-122(a) |
| Texas | Notice 60 days before suit; expert report due after each answer | Certified-mail notice with medical authorization to each provider, 60 days before suit | Expert report served within 120 days after each defendant's answer (after suit is filed) | Tex. Civ. Prac. & Rem. Code § 74.051(a) Tex. Civ. Prac. & Rem. Code § 74.351(a) |
| Utah | Notice of intent 90 days ahead, then prelitigation panel review | Notice of intent to each prospective defendant at least 90 days before filing | None required; the statute makes the affidavit of merit optional | Utah Code § 78B-3-412(1) Utah Code § 78B-3-416(1)-(2) Utah Code § 78B-3-423(1)-(2) |
| Vermont | Certificate of merit filed with the complaint | None found in statute | Certificate of merit, based on a qualified expert consult, filed with the complaint | 12 V.S.A. § 1042(a) |
| Virginia | Expert opinion certified when service of process is requested | None found in statute | Signed written expert opinion obtained before requesting service; certified by the complaint | Va. Code § 8.01-20.1(A) |
| Washington | No pre-suit step in statute; mediation required before trial | None found in statute | None; the former certificate of merit law was repealed in 2023 | RCW 7.70.100(1) RCW 7.70.150 (repealed) |
| West Virginia | Notice of claim and certificate of merit, 30 days before filing | Notice of claim by certified mail to each provider at least 30 days before filing | Screening certificate of merit, signed under oath by a qualified expert, served with the notice | W. Va. Code § 55-7B-6(a)-(b) |
| Wisconsin | Mediation request required, filed before suit or within 15 days after | None found in statute | None found in statute | Wis. Stat. § 655.44(4)-(5) Wis. Stat. § 655.445(1) |
| Wyoming | See statute: an older review panel law is still in the code | None found in statute | None found in statute | Wyo. Stat. §§ 9-2-1513 to 9-2-1523 (repealed) |
Download this table (CSV) · Statute text last checked October 27, 2026
Review panels, mediation, and the deadline
Some states send claims to a medical review panel, a tribunal, or a commission, or require mediation, before a case can go forward. Several also pause the statute of limitations while a notice period or review runs, but the rules on how long the pause lasts are specific to each state.
| State | Panel or mediation | Effect on the deadline | Who the rules cover | Statute or rule |
|---|---|---|---|---|
| Alabama | None found in statute | None found in statute | See statute | See statute |
| Alaska | Court appoints a 3-person expert advisory panel after the answer, unless not needed | None found in statute | Health care providers, including those serving a government entity | Alaska Stat. § 09.55.536(a) Alaska Stat. § 09.55.536(a), (i) |
| Arizona | None found in statute | None found in statute | Claims against health care professionals | Ariz. Rev. Stat. § 12-2603(A) |
| Arkansas | None found in statute | See statute | See statute | See statute |
| California | None found in statute | Notice served in the last 90 days before the deadline extends it 90 days from service | Licensed health care providers, clinics, and health facilities | Cal. Code Civ. Proc. § 364(d) Cal. Code Civ. Proc. § 364(f)(1) |
| Colorado | None found in statute | None found in statute | Licensed professionals, including physicians and acupuncturists | Colo. Rev. Stat. § 13-20-602(1)(a) Colo. Rev. Stat. § 13-20-602(3)(a), (c) |
| Connecticut | None found in statute | Automatic 90-day extension of the limitation period on petition to the court clerk | Negligence claims against health care providers | Conn. Gen. Stat. § 52-190a(a) Conn. Gen. Stat. § 52-190a(b) |
| Delaware | None found in statute | Optional notice of intent by certified mail tolls up to 90 days past the deadline | Health-care providers licensed in Delaware under Title 24 or Title 16 | Del. Code tit. 18, § 6856(4) Del. Code tit. 18, § 6801(4) |
| District of Columbia | Court-ordered mediation after the suit is filed, before further litigation | Notice served in the last 90 days before the deadline extends it 90 days from service | Licensed or authorized health care providers, individuals and facilities | D.C. Code § 16-2803 D.C. Code § 16-2821 D.C. Code § 16-2801(2) |
| Florida | 90-day presuit review by the defendant's insurer; it may require a screening panel | Mailing the notice tolls the limitation period during the 90-day presuit period | All medical negligence claims, including wrongful death and state claims | Fla. Stat. § 766.106(3)(a) Fla. Stat. § 766.106(4) Fla. Stat. § 766.203(1) |
| Georgia | None found in statute | No tolling; the affidavit may follow within 45 days in narrow deadline cases | Listed licensed professionals (doctors, nurses, dentists, others) and facilities | O.C.G.A. § 9-11-9.1(a) O.C.G.A. § 9-11-9.1(b)-(c) O.C.G.A. § 9-11-9.1(g) |
| Hawaii | Inquiry to a medical inquiry and conciliation panel (or agreed ADR) before any suit | Filing the inquiry tolls the deadline until 60 days after the panel ends (12-month cap) | Physicians, PAs, podiatrists, health facilities, midwives, and their employees | Haw. Rev. Stat. § 671-12(a) Haw. Rev. Stat. § 671-16(a) Haw. Rev. Stat. § 671-18 Haw. Rev. Stat. § 671-1 |
| Idaho | Informal, nonbinding hearing panel through the Board of Medicine, required first | Deadline tolled while the claim is before the panel and for 30 days after | Physicians and surgeons, and licensed acute care general hospitals | Idaho Code § 6-1001 Idaho Code § 6-1005 |
| Illinois | None found in statute | No tolling; the report may follow within 90 days if the deadline is about to run | Medical, hospital, and other healing art malpractice claims | 735 ILCS 5/2-622(a) 735 ILCS 5/2-622(a)(2) |
| Indiana | Proposed complaint to the insurance commissioner; medical review panel opinion first | Filing the proposed complaint tolls the deadline until 90 days after the panel opinion | Health care providers qualified under the Medical Malpractice Act | Ind. Code § 34-18-8-4 Ind. Code § 34-18-7-3 Ind. Code § 34-18-3-1 |
| Iowa | None found in statute | None found in statute | Health care providers as defined in Iowa Code 147.136A | Iowa Code § 147.140(7) |
| Kansas | Optional screening panel the court convenes on a party's request, before or after suit | Requesting a panel before filing tolls the deadline until 30 days after its report | Health care providers (medical malpractice claims) | K.S.A. 65-4901(a) K.S.A. 65-4908 |
| Kentucky | See statute | No tolling; certificate may follow within 60 days of service if the deadline is close | Physicians, surgeons, dentists, licensed hospitals, long-term-care facilities | KRS 411.167(1)-(2) KRS 413.140(1)(e) KRS 411.167(2)(b) |
| Louisiana | Proposed complaint reviewed by a medical review panel; suit after its opinion or 12 months | Filing the panel request suspends the deadline until 90 days after notice of the opinion | Health care providers covered (qualified) under the Medical Malpractice Act | La. R.S. 40:1231.8(B)(1)(a)(i) La. R.S. 40:1231.8(B)(1)(b) La. R.S. 40:1231.8(A)(2)(a) La. R.S. 40:1231.8(A)(1)(a) |
| Maine | Mandatory prelitigation screening and mediation panel; bypassed only if all parties agree | Deadline tolled from the notice of claim until 30 days after the panel's findings | Health care practitioners and providers, and their employees or agents | 24 M.R.S. § 2903(1) 24 M.R.S. § 2853(5) 24 M.R.S. § 2851 24 M.R.S. § 2859 |
| Maryland | Claim filed with HCADRO for arbitration first; either side may waive it for court | Filing the HCADRO claim counts as filing the action for the deadline | Listed licensed providers; claims above the District Court jurisdiction limit | Md. Code, Cts. & Jud. Proc. § 3-2A-04(a)-(b) Md. Code, Cts. & Jud. Proc. § 3-2A-06B(a)-(c) Md. Code, Cts. & Jud. Proc. § 5-109(d) Md. Code, Cts. & Jud. Proc. § 3-2A-01(f) Md. Code, Cts. & Jud. Proc. § 3-2A-02(a) |
| Massachusetts | Malpractice tribunal reviews the plaintiff's offer of proof after the defendant answers | None found in statute; suits filed within 6 months of the deadline skip the notice | Licensed providers listed in c. 231, § 60B: physicians, hospitals, nurses, more | G.L. c. 231, § 60L(j) G.L. c. 231, § 60B G.L. c. 231, § 60B (definition) |
| Michigan | None found in statute | Notice tolls the deadline if it would run out during the notice period (see statute) | Health professionals and health facilities | MCL 600.2912b(1) MCL 600.5856(c) |
| Minnesota | None found in statute | None found in statute | Physicians, surgeons, dentists, hospitals and other health care professionals | Minn. Stat. § 145.682, subd. 1 |
| Mississippi | None found in statute | Notice served in the last 60 days before the deadline extends it 60 days | Licensed physicians, hospitals, nurses, pharmacists and other listed providers | Miss. Code Ann. § 15-1-36(15) Miss. Code Ann. § 15-1-36(2) |
| Missouri | None found in statute | None found in statute | Health care providers, for injury or death from health care services | Mo. Rev. Stat. § 538.225.1 |
| Montana | Application to the Montana Medical Legal Panel before filing any complaint | Panel application tolls the deadline until 30 days after dismissal or decision | Physicians, dentists, podiatrists and licensed health care facilities | Mont. Code Ann. § 27-6-301 Mont. Code Ann. § 27-6-702 Mont. Code Ann. § 27-6-103(2)-(3) |
| Nebraska | Proposed complaint goes to a medical review panel first; claimant may waive | Panel request tolls the deadline until 90 days after the panel's opinion | Only providers qualified under the Nebraska Hospital-Medical Liability Act | Neb. Rev. Stat. § 44-2840(2), (4) Neb. Rev. Stat. § 44-2840(1) Neb. Rev. Stat. § 44-2844(1) Neb. Rev. Stat. § 44-2821(1) |
| Nevada | None found in statute | None found in statute | Providers of health care sued for professional negligence | Nev. Rev. Stat. § 41A.071 |
| New Hampshire | None; the screening panel law for medical injury claims was repealed in 2023 | See statute | See statute | N.H. Rev. Stat. Ann. ch. 519-B (repealed) |
| New Jersey | None found in statute | None found in statute | Licensed persons, including physicians, nurses, dentists, and health facilities | N.J. Stat. Ann. § 2A:53A-26 |
| New Mexico | Application to the medical review commission, and its decision, before filing suit | The limitation period is tolled from submission until 30 days after the decision is served | Qualified independent providers (natural persons); not hospitals or facilities | N.M. Stat. Ann. § 41-5-15(A) N.M. Stat. Ann. § 41-5-14(A), (C) N.M. Stat. Ann. § 41-5-22 |
| New York | None found in statute | None found in statute | Medical, dental, and podiatric malpractice actions | N.Y. C.P.L.R. § 3012-a(a) |
| North Carolina | None found in statute | A judge may extend the limitation period up to 120 days to comply, on a timely motion | Health care providers as defined in G.S. 90-21.11 | N.C. Gen. Stat. § 1A-1, Rule 9(j) |
| North Dakota | None found in statute | None found in statute | Physicians, nurses, hospitals, nursing and assisted living facilities, clinics | N.D. Cent. Code § 28-01-46 |
| Ohio | None found in statute | Notice sent within the 1-year period lets suit be filed up to 180 days after the notice | Medical, dental, optometric, and chiropractic claims (R.C. 2305.113) | Ohio Civ.R. 10(D)(2) Ohio Rev. Code § 2305.113(B)(1) |
| Oklahoma | None found in statute | None found in statute | See statute | See statute |
| Oregon | Arbitration, mediation, or judicial settlement conference within 270 days after filing | Filing the optional incident notice tolls the limitation period 180 days (or as agreed) | Health practitioners (ORS 31.740) and health care facilities (ORS 442.015) | ORS 31.250 ORS 31.272(2) |
| Pennsylvania | None found in statute | None found in statute | Licensed professionals, including MCARE Act health care providers | Pa.R.C.P. 1042.1(c)(1)(i) |
| Rhode Island | None found in statute | None found in statute | See statute | R.I. Gen. Laws ch. 10-19 (repealed) |
| South Carolina | Mandatory mediation within 90 to 120 days after the notice is served | Filing the Notice of Intent tolls all applicable limitation periods | Licensed health care providers and health care institutions | S.C. Code § 15-79-125(A) S.C. Code § 15-79-125(C) S.C. Code § 15-79-110(3), (6) |
| South Dakota | None found in statute | None found in statute | See statute | See statute |
| Tennessee | None found in statute | Proper notice extends the limitation and repose periods by 120 days | Health care providers in health care liability actions | Tenn. Code Ann. § 29-26-121(a)(1) Tenn. Code Ann. § 29-26-121(c) |
| Texas | None found in statute | Notice tolls the limitation period for 75 days | Physicians and health care providers facing a health care liability claim | Tex. Civ. Prac. & Rem. Code § 74.051(a) Tex. Civ. Prac. & Rem. Code § 74.051(c) |
| Utah | Prelitigation panel review (request within 60 days of notice); not for dentists | Panel request tolls the limitation period; late notice extends it to 120 days | Health care providers; the panel and certificate steps exclude dentists | Utah Code § 78B-3-412(1) Utah Code § 78B-3-412(4) Utah Code § 78B-3-416(1)-(2) Utah Code § 78B-3-416(4)(a) Utah Code § 78B-3-418(1) |
| Vermont | None found in statute | On petition to the clerk, an automatic 90-day extension of the limitation period | Health care providers (injuries on or after Feb. 1, 2013) | 12 V.S.A. § 1042(a) 12 V.S.A. § 1042(d) |
| Virginia | No pre-suit panel; either side may request a review panel after the answer | None found in statute | Health care providers in medical malpractice actions | Va. Code § 8.01-581.2(A) |
| Washington | None before suit; mandatory mediation applies before trial | A written good-faith mediation request before filing tolls the limitation period 1 year | Claims for injury resulting from health care | RCW 7.70.100(1) RCW 7.70.110 |
| West Virginia | No panel; a provider may demand pre-suit mediation after receiving the notice | Serving the notice tolls the limitation period (see statute for how long) | All health care providers | W. Va. Code § 55-7B-6(a) W. Va. Code § 55-7B-6(g) W. Va. Code § 55-7B-6(i)(1) |
| Wisconsin | Mediation request to the director of state courts, before suit or within 15 days after | A pre-suit mediation request tolls the limitation period until 30 days after mediation | Providers under Wis. Stat. ch. 655 (physicians, APRNs, hospitals, others) | Wis. Stat. § 655.44(4)-(5) Wis. Stat. § 655.445(1) Wis. Stat. § 655.002(1) |
| Wyoming | See statute: W.S. 9-2-1806 still prints a panel step before suit | See statute: the panel act tolls the deadline from the application | See statute | See statute |
The four kinds of pre-suit steps
- Notice before filing. A written notice to each provider, sent a set number of days before the lawsuit is filed. Some states set what the notice must include; Tennessee and Texas, for example, require a medical records authorization with it (Tenn. Code § 29-26-121; Tex. Civ. Prac. & Rem. Code § 74.051).
- Expert certificate, affidavit, or report. A statement from a qualified health care professional, or a certificate from the attorney after consulting one, that the claim has a reasonable basis. Depending on the state, it’s due before filing, with the complaint, or within a set time after.
- Review panel, tribunal, or commission. A body that looks at the claim before trial, or before a lawsuit can be filed.
- Mediation. A required meeting with a neutral mediator to try to resolve the claim, before filing or before trial.
Why these steps matter for your deadline
A pre-suit step doesn’t replace the statute of limitations. In some states, sending a notice or filing with a panel pauses the clock for a set time; in others, it doesn’t, and the lawsuit still has to be filed on time. Getting an expert to review records also takes time.
That’s why the date the care happened, the date you first suspected a problem, and the state where the care happened all matter. See medical malpractice deadlines by state for each state’s time limits.
Government and federal providers have their own steps
State and local providers. Claims against a public hospital or other government provider often require a written notice of claim within a short time under the state’s tort claims law, separate from the steps in this table.
Federal facilities, such as VA medical centers and military treatment facilities: under the Federal Tort Claims Act, a lawsuit can’t be filed until the claim has first been presented to the federal agency and finally denied in writing. If the agency doesn’t make a final decision within six months after the claim is filed, the claimant may treat that as a denial (28 U.S.C. § 2675(a)). The written claim generally must be presented within 2 years after the claim accrues (28 U.S.C. § 2401(b)).
How to read the tables
- In short: a summary of the state’s pre-suit steps.
- Notice before filing: a written notice the statute requires before a lawsuit is filed.
- Expert certificate or affidavit: a merit statement from an expert, or a certificate from the attorney, and when it’s due.
- Panel or mediation: a review body or required mediation.
- Effect on the deadline: whether a step pauses (tolls) the statute of limitations, as the statute states it.
- Who the rules cover: some states apply these steps only to certain providers.
“See statute” means the rule needs more context than a table cell can give, or a court has limited it. “None found in statute” means the statutes and rules we read don’t set one; other laws or court decisions may still apply.
Full guides by state
These guides cover one state in depth, including its deadlines, exceptions, wrongful death, and government providers:
- Alaska medical malpractice deadlines
- Delaware medical malpractice deadlines
- District of Columbia medical malpractice deadlines
- Florida medical malpractice deadlines
- Idaho medical malpractice deadlines
- Iowa medical malpractice deadlines
- Massachusetts medical malpractice deadlines
- New Mexico medical malpractice deadlines
- North Dakota medical malpractice deadlines
- Oklahoma medical malpractice deadlines
- Oregon medical malpractice deadlines
- South Carolina medical malpractice deadlines
- Virginia medical malpractice deadlines
- West Virginia medical malpractice deadlines
- Wisconsin medical malpractice deadlines
- Wyoming medical malpractice deadlines
Sources and method
We read each state’s statute text, or its official court rules where a requirement is a rule of civil procedure, on October 27, 2026, and linked the section that supports each row. Where an official site wouldn’t load for us, we read a public copy of the code and linked it. We don’t rely on case law in this table. Where a court has struck down or limited a requirement, the cell says “See statute” rather than repeat it. If you see an error, write to support@malpracticeattorneys.com.
This page is general information, not legal advice. To understand what we do, read how our service works and where we operate.
Questions
Questions about pre-suit requirements.
What is an affidavit of merit in a medical malpractice case?
It’s a sworn statement, usually from a qualified health care professional, that the care fell below the standard and that the claim has a reasonable basis. States use different names, such as certificate of merit, certificate of review, or expert report, and set different deadlines for it. The table above shows each state’s rule.
Does sending a notice of intent stop the statute of limitations?
In some states, yes, for a set period; in others, no. The “Effect on the deadline” column shows what each state’s statute says. An attorney licensed in the state can tell you how it applies to your dates.
What happens if a required pre-suit step is skipped?
Depending on the state, a court may dismiss the case or require the step to be completed before the case goes forward. If the deadline has run in the meantime, that can end the claim. This is one reason to talk with an attorney early.
Do I have to do any of these steps myself?
These steps are usually handled by the attorney, working with medical experts. What you can do now is write down your dates, request your medical records, and talk with an attorney licensed in the state where the care happened.
Not sure which steps apply in your state?
Pre-suit rules depend on the state and the provider. An attorney licensed there can tell you what applies and how much time you have. Learn how our service works and where it operates.
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