Maryland Medical Malpractice Laws: Health Care Malpractice Claims Act

Maryland medical malpractice lawsuits have procedural requirements that do not apply to ordinary personal injury cases. In most cases, a plaintiff cannot simply file a malpractice complaint in Circuit Court. The claim begins with Maryland’s Health Care Alternative Dispute Resolution Office, requires a certificate and report from a qualified medical expert, and then usually proceeds to court after arbitration is waived.

These rules are contained primarily in Maryland’s Health Care Malpractice Claims Act, Courts and Judicial Proceedings Article, § 3-2A-01 through § 3-2A-10. Missing one of these procedural requirements can delay or even result in dismissal of an otherwise viable malpractice claim.

Maryland’s legislative branch has created law that guides medical malpractice lawsuits. The statutory law is located in the Maryland Code, Courts & Judicial Proceedings Article, Title 3, Subtitle 2A. These rules are interpreted by Maryland courts.

This is a brief summary of the Code sections pertaining to medical malpractice lawsuits in Maryland. Keep in mind that Maryland case law has interpreted many of these provisions, and those interpretations are part of the current requirements for medical malpractice lawsuits.

§ 3-2A-01: Definitions

Some of the key defined terms are:

1. Health care provider: includes hospitals, related institutions, medical day care centers, hospice programs, assisted living programs, freestanding ambulatory care facilities, physicians, physician assistants, osteopaths, optometrists, chiropractors, registered and licensed practical nurses, dentists, podiatrists, psychologists, licensed certified social workers-clinical, and physical therapists.
2. Noneconomic damages: Noneconomic damages include pain, suffering, inconvenience, physical impairment, disfigurement, loss of consortium and other non-monetary damages.

For wrongful death cases, noneconomic damages include mental anguish, emotional pain and suffering, loss of society, companionship, comfort, protection, care, marital care, parental care, filial care, attention, advice, counsel, training, guidance, education and other non-monetary damages.

§ 3-2A-02: Procedures, Standard of Care, and Expert Qualifications

This section establishes that claims against “health care providers” that fall within the statute must follow these rules. It also requires that claims for medical malpractice may not state an amount of damages, but may only say that the damages the claimant seeks are “more than the required jurisdictional amount.”

This section describes the standard that health care providers are held to. They must act in accordance with the standards of practice of members in the same profession with similar training and experience in the same or similar communities at the time of the treatment.

There has long been discussion among Maryland malpractice lawyers about whether this language creates a true “locality standard” of care. Smart Maryland malpractice lawyers should prepare the evidence assuming the statutory language matters and elicit evidence, where appropriate, that the local and national standards of care are the same. Practically, most health care providers are going to agree that, absent compelling circumstances like a doctor treating a patient in a very rural area with minimal medical equipment available, the standards of care are often the same everywhere.

This section also describes the requirements for experts who testify or sign certificates of qualified experts. They must have had clinical experience, provided consultation relating to clinical practice, or taught medicine in the defendant’s specialty or a related field of health care, or in the field in which the defendant provided treatment, within five years of the alleged negligence.

In most cases, if the defendant is board certified in a specialty, the expert must also be board certified in the same or a related specialty. There are statutory exceptions. This section has been extensively interpreted by Maryland courts.

2025 Maryland Supreme Court Decision on Who Can Sign the Expert Certificate

In Canton Harbor Healthcare Center, Inc. v. Robinson, the Supreme Court of Maryland addressed an important question about who can qualify as the expert signing a certificate.

The was a nursing home bed sore case.  The certificate was signed by a registered nurse. The nursing home argued that a nurse could not give the required causation opinion.

The Maryland Supreme Court affirmed the Appellate Court’s ruling allowing the claim to proceed. The court concluded that, under the circumstances of that case, a qualified registered nurse could give a causation opinion concerning a previously diagnosed pressure ulcer allegedly caused by breaches of nursing standards.

It is smart to take the risk and just name a nurse on your Certificate of Merit?  We would say emphatically no.  Naming a nurse is not a bad idea in addition to a doctor but we have never had a malpractice case in our 24 year history where we did not have a doctor sign a certificate.

§ 3-2A-03: Health Care Alternative Dispute Resolution Office

This section establishes the Health Care Alternative Dispute Resolution Office, commonly called HCADRO, as an executive branch office with a director appointed by the Governor with the advice and consent of the Senate.

The current director is Harry L. Chase.

The office has the power to conduct arbitration of medical malpractice cases. However, that power is rarely used because most claimants waive arbitration and proceed to court.

The office still provides a useful function because Maryland malpractice claims subject to the Act begin there and the office maintains records concerning claims filed in Maryland.

 

§ 3-2A-03A: Health Claims Arbitration Fund

In order to file a claim with HCADRO, a $40 filing fee is required. A $25 fee is required to file a response to a claim.

§ 3-2A-04: Filing the Claim and Certificate of Qualified Expert

This section deals with service of filed claims and also addresses the certificates of qualified experts.

The parties may engage in discovery, including interrogatories or depositions, as to the basis of the certificates.

In cases where informed consent is not the only issue, the claim shall be dismissed without prejudice if the claimant does not file a certificate of qualified expert within 90 days of the complaint. The certificate must attest that the defendant departed from the standards of care and that the departure proximately caused the plaintiff’s injury. A report from the attesting expert must also be attached.

The statute provides for an extension of up to 90 days if the statute of limitations has expired and the failure to timely file the certificate was neither willful nor the result of gross negligence. The statute also provides for extensions for good cause.

If the defendant disputes liability, the defendant is required to file a certificate of qualified expert within 120 days from the date the plaintiff’s certificate was served.

The 25% rule: Experts who testify or sign certificates concerning the standard of care may not have devoted more than 25% of their professional activities to activities directly involving testimony in personal injury claims during the 12 months immediately before the claim was first filed.

This provision has been extensively interpreted by Maryland courts.

The statute now also contains an important protection when a case is dismissed because the certificate expert failed to satisfy these requirements. Unless there is a showing of bad faith, the same claim may be refiled once before the later of the applicable limitations deadline or 120 days after dismissal.

§ 3-2A-05: Claim Arbitration

This section deals with the procedure of claims arbitration in HCADRO. Arbitration is seldom actually used. Claimants typically waive arbitration and file in court after complying with the certificate requirements.

§ 3-2A-06: Review of an Arbitration Award by a Court

If the parties actually submit to arbitration, a party may reject the award for any reason by filing a notice of rejection within 30 days after service of the award or within the statutory period following disposition of a timely application for modification or correction.

The rejecting party may then file an action in court to nullify the award. If a party elects a jury trial in accordance with the Maryland Rules, the case may be tried by a jury.

§ 3-2A-06A: Mutual Election to Waive Arbitration

The parties may mutually agree to waive arbitration at any time before the hearing of a claim. If they do, the claimant must file a complaint in the appropriate court within 60 days after the election to waive arbitration is filed.

§ 3-2A-06B: Waiver of Maryland Medical Malpractice Arbitration

A claimant may waive arbitration after filing the required certificate of qualified expert. A defendant may likewise waive arbitration after the claimant has filed the required certificate.

Within 60 days after the filing of an election to waive arbitration by any party, the plaintiff must file a complaint and a copy of the election in the appropriate Circuit Court or United States District Court.

Failure to file the lawsuit within 60 days may be grounds for dismissal if an adverse party moves for dismissal and the court finds that the delay caused prejudice.

After an election to waive arbitration is filed, a party that adds an additional health care provider as a defendant must file the required certificate of qualified expert for that new defendant.

§ 3-2A-06C: Alternative Dispute Resolution

This section deals with a court’s ability to order alternative dispute resolution for medical malpractice cases.

§ 3-2A-06D: Supplemental Certificates of Qualified Experts

Within 15 days after the date discovery is required to be completed, each party must file a supplemental certificate of qualified expert for each defendant unless the statute does not apply, including when the defendant has admitted liability.

These supplemental certificates must include the expert’s basis for defining the standard of care, the expert’s qualifications to testify to the standard of care, and the specific standard of care.

A plaintiff’s supplemental certificate must include the injury, how the standard of care was breached, what the health care provider should have done, and the required causation opinion.

The defendant’s supplemental certificate must describe how the defendant complied with the standard of care, what the defendant did to meet the standard, and, if applicable, state that any breach did not cause the plaintiff’s injury.

Extensions of time to file these certificates are allowed for good cause.

In actual Maryland malpractice litigation, parties sometimes agree that supplemental certificates will not be required. But that is a case-specific agreement. The statute itself imposes the supplemental certificate requirement in cases to which § 3-2A-06D applies.

Failure to file the required supplemental certificate can have serious consequences.

§ 3-2A-07: Payment of Costs and Attorney Fees

If the case is arbitrated, the arbitration panel may require a party or attorney to pay costs and expenses if the claim or defense was maintained in bad faith or without substantial justification.

§ 3-2A-08: Advance Payments and Their Effect

Payments made before arbitration or trial generally may not be revealed during those proceedings. However, the court or arbitration panel will determine whether a final award should be reduced by qualifying advance payments.

§ 3-2A-08A: Offer of Judgment

At any time not less than 45 days before trial, a party may serve an offer of judgment.

If the opposing party does not accept the offer within 15 days and the judgment finally obtained is not more favorable to that party than the offer, the party receiving the offer must pay the statutory costs incurred by the party making the offer after the offer was made.

§ 3-2A-09: Maryland Medical Malpractice Damages

This section deals with noneconomic damages and other damages issues in Maryland medical malpractice cases.

Maryland has a statutory cap on noneconomic damages in medical malpractice lawsuits. The applicable amount depends in part on when the cause of action arose and whether the case includes a wrongful death claim.

To see the Maryland medical malpractice damages cap for specific years, see our separate page devoted to that issue.

§ 3-2A-10: How the Health Care Malpractice Claims Act Is Construed

With the statutory exceptions for §§ 3-2A-08A and 3-2A-09, the provisions of Subtitle 2A are deemed procedural in nature. The statute says they may not be construed to create, enlarge, or diminish a cause of action that did not otherwise exist, except for the defense of failure to comply with the procedures required under the subtitle.

That distinction can matter when a malpractice claim has connections to more than one state. But choice-of-law issues can become complicated quickly, so lawyers should not assume that calling a statutory provision “procedural” automatically answers every conflict-of-law question.

Maryland Medical Malpractice Laws: Frequently Asked Questions

Do you have to file a Maryland malpractice claim with HCADRO first?

Yes  For claims that fall within Maryland’s Health Care Malpractice Claims Act, the claim begins with the Health Care Alternative Dispute Resolution Office before the case proceeds to Circuit Court.

What is a certificate of qualified expert?

The certificate is a required filing in almost every Maryland medical malpractice case. The certificate is from a qualified health care provider states that the defendant departed from the applicable standard of care and that the departure proximately caused the plaintiff’s injury. An expert report must also be attached.

How long does a plaintiff have to file the certificate?

The plaintiff generally has 90 days from the filing of the claim to file the certificate of qualified expert, subject to the statutory provisions governing extensions. But, really, you want to be ready to do when you file a lawsuit and should have the Certificate of Merit ready to go when you file suit.

Can you waive Maryland medical malpractice arbitration?

Yes. Arbitration is routinely waived. After the required certificate has been filed, the claimant or a defendant may elect to waive arbitration under § 3-2A-06B. The plaintiff then generally has 60 days after the election is filed to file the lawsuit in court. There have been cases where it make sense for us to conduct discovery in HCADRO before waiving out.

Is there a cap on damages in Maryland medical malpractice cases?

Maryland limits noneconomic damages in medical malpractice cases. The cap changes depending on the year the cause of action arose and other circumstances. Economic damages such as qualifying medical expenses and lost earnings are treated differently. See our Maryland malpractice damages cap page for the current amounts.

Contact Us

If you live in the Baltimore-Washington area and believe you have been a victim of medical negligence,our Baltimore malpractice lawyers will be happy to discuss your case with you over the phone at 800-553-8082, in person, or online.