Malpractice Settlement Demand Letter Sample

Below is a sample demand letter from a medical malpractice case that thankfully settled before a lawsuit was filed. The names and parties have been changed.

Medical Malpractice Demand Letters Rarely Lead to Pre-Suit Settlement

First, a few comments about medical malpractice demand letters. These cases are challenging to settle before a suit is filed. Why? Assessing these cases’ settlement value without going through the litigation process is difficult. How well did the experts hold up? Are the plaintiffs sympathetic? How likable is the doctor, and how convincing will he be in defending the care rendered?

Let Victims’ Lawyers Make Mistakes

There is a second reason these cases are so complex to settle pre-suit: the insurance companies. In Maryland and most states, the insurance companies have a policy of making plaintiffs’ attorneys work to get settlements, particularly if you do not have a history of getting malpractice verdicts and settlements. Because lawyers who do not know what they are doing often make mistakes in working up the claim.

In some tort cases, a plaintiffs’ lawyer has to screw up the claim pretty badly to kill an otherwise good case. In medical malpractice claims, at least with the procedural rules we have in Maryland, a neophyte malpractice lawyer takes just a few missteps to make a fatal mistake to the entire claim. The Maryland legislature and our courts are just not forgiving of these mistakes in healthcare negligence.

Make Plaintiffs’ Lawyers Work

The final reason these cases are hard to settle at the outset is that the insurance companies want to make even the best malpractice lawyers work for their settlement. They want lawyers to know that there are no quick and easy malpractice settlements, and that they must work and spend money on experts and all the other elements required for a medical negligence case to obtain a settlement.

Many malpractice lawyers in Maryland chalk this up to spite, a hatred of trial lawyers. While it is likely a factor in the calculus, that sentiment is overblown. The reality is that this paradigm is part of a more comprehensive strategy employed by these insurance companies. Medical malpractice insurance companies thrive because victims and their lawyers often fail to bring viable claims. Most people with a winning malpractice case do not bring a claim because they do not want to or cannot find a lawyer to help them.

If the ratio were reversed, it would spell ruin for these insurance companies. So if lawyers are aware that they can send out a demand package in small malpractice cases and obtain reasonable settlements, it encourages them to take those cases in the first place. If everyone with a viable malpractice claim could find a lawyer to take their claim, these insurance companies would collapse. So, the hardball tactic of “you are going to have to file suit” is part of a more long-term strategy for these insurers.

Example Demand Letter

The sample demand letter below is to a hospital. This is an entirely different animal than suing a doctor with malpractice insurance. Hospitals are willing to settle cases pre-suit if it is a case they believe they will lose at trial, and the lawyer bringing the claim has a history of successfully resolving claims. Hospitals are aware that malpractice lawsuits are a common consequence. But they do not want to lose at trial because it tarnishes their brand. So many hospitals are willing to settle cases pre-suit for good values if the liability case is solid.

So sometimes, our malpractice lawyers skip making a demand.  We will send a follow-up letter to the effect of, “Let us know if you are interested before we file a malpractice lawsuit.”  Few malpractice lawsuits will settle out of court before a lawsuit is filed.  But it is often worth the effort because you can save yourself – and, more importantly, your clients – time and effort with a pre-suit settlement.

Please note that some jurisdictions require a letter of intent to sue.  This is not a template for an intent-to-sue letter.

Sample Malpractice Settlement Demand

Sandy Manchester, RN, J.D.
Senior Counsel, Claims and Litigation
Bethany Moss Medical Center
345 Jackson Street
Baltimore, Maryland 21201

Re: Medical Malpractice claim of the late Maggie Marryman

Date of Death: September 15, 2024

Dear Ms. Manchester:

As you know, Miller & Zois represents the parents of Maggie Marryman, a 30-year-old woman who died unnecessarily during a routine medical procedure performed at your facility. We are writing to extend the opportunity to resolve this wrongful death claim without the need for prolonged litigation.

On September 15, 2024, Ms. Marryman underwent an elective ERCP at Bethany Moss Medical Center to address suspected gallstone-related biliary obstruction. According to her primary care provider, she had no significant comorbidities, led an active lifestyle, and was planning her wedding. She entered your hospital expecting a straightforward outpatient procedure. Instead, her life ended on the procedure table.

During the ERCP, Ms. Marryman developed an air embolism—an infrequent but well-documented risk associated with this procedure. The embolism traveled to her heart and became trapped in the right ventricle. Despite 60 minutes of resuscitative efforts, the embolism was never diagnosed, never addressed, and ultimately caused her death. The autopsy findings confirm this sequence. The tragedy is not just in the outcome—but in the inaction.

At no point during the code did the anesthesiologist or gastroenterologist consider the possibility of a venous air embolism, despite her abrupt hemodynamic collapse and the known risks associated with ERCP. There was no attempt to reposition the patient in left lateral decubitus, no transesophageal echocardiogram performed, no aspiration of the right atrium. None of the standard protocols for suspected embolism were even attempted.

How can a modern tertiary care hospital allow its physicians to miss a diagnosis so elementary that even first-year residents are taught to consider it?  The answer is rooted in a failure of vigilance, training, and systems. Air embolism during ERCP may be rare, but it is hardly unknown. Numerous studies and clinical guidelines emphasize the importance of rapid diagnosis and treatment. For example, Dr. Marek Mirski, in his frequently cited article “Diagnosis and Treatment of Vascular Air Embolism”, published in Anesthesiology (Vol. 106, Issue 1, 2007), emphasized that vascular air embolism is “no longer limited to neurosurgical procedures conducted in the sitting position,” and now presents in “diverse areas such as the interventional radiology suite or laparoscopic surgical center.” He warned nearly two decades ago that clinicians “must be aware of this silent but dangerous complication.”

There was nothing subtle about what happened to Ms. Marryman. And there was ample opportunity to intervene and save her life. Other hospitals have managed this same complication successfully. As one example, we have enclosed an article by Dr. H.M. Goins, documenting a case in which an air embolism was identified and evacuated in time to preserve the patient’s life. The same outcome was achievable here—if only someone had acted.

We also note that Bethany Moss Medical Center has almost certainly completed its internal peer review process regarding this death. We believe that review reached the same conclusion we have: that the failure to recognize and treat a common procedural complication directly resulted in Ms. Marryman’s preventable death, and that a jury will not view this failure favorably.

Enclosed you will find a disc containing Ms. Marryman’s complete hospital records and the autopsy report. We believe this case presents clear liability, and we are prepared to file suit if necessary. However, in the interest of avoiding litigation, we invite you to contact us after reviewing the materials to discuss an appropriate resolution of this claim.

Sincerely,
Ronald V. Miller, Jr.
Enclosures

9 Elements of a Medical Malpractice Settlement Demand Letter

A well-crafted medical malpractice demand letter serves as both a strategic tool and a persuasive narrative. Its purpose is not only to outline what occurred but also to frame the incident in a way that compels the recipient to recognize the exposure and consider early resolution. Not every demand letter requires every one of these elements. But the more you can incorporate, the more complete and effective your presentation will be. This list is not a checklist. It is a set of tools to be used as the case demands.

1. Patient Information: Begin by clearly identifying the patient. Include the full name, date of birth, and any relevant medical record numbers or identifiers. This ensures the recipient can promptly locate the necessary records and understand whose care is at issue.

2. Incident Description: Describe the alleged malpractice in a detailed, chronological format. Include the relevant providers’ dates, times, locations, and names. Clearly explain what the procedure or medical visit was intended to address, what went wrong, and how the providers failed to act appropriately. Precision and specificity are key. A vague timeline gives the defense room to reframe the narrative.

3. Medical Treatment Summary: Summarize the patient’s course of treatment before, during, and after the incident. This should include diagnoses, procedures, prescribed medications, complications, and any referrals to specialists.

4. Allegation of Negligence: Set out your claim’s legal and medical basis. Describe how the care fell below the accepted standard and explain why a reasonable provider would have acted differently. This section does not need to read like a complaint, but it should leave no doubt that you have a viable theory of liability. If expert support exists, reference it in general terms.

5. Injury and Impact Description: Explain the nature and extent of the harm caused. Include both physical and emotional injuries, long-term disabilities, pain and suffering, lost wages, and impact on daily life. Use language that conveys the depth of the loss. In one recent case, our client, a 42-year-old father of three, lost the use of his dominant arm due to a delayed diagnosis of compartment syndrome. He can not return to work and relies on his teenage children for basic household tasks.  You really have to spell that type of claim out in human terms.  This is less true in a malpractice case where the suffering from the injury is obvious. If it is a cerebral palsy birth injury case, everyone gets it.  Explain what the child will endure but do not belabour the obvious.

6. Medical Records and Documentation: Reference any attached records, imaging, expert reviews, and billing statements that support the claim. You want the reader to know you are not speculating—you are building this claim on hard evidence. Make it clear you have command of the file and expect the defense to take it seriously.

7. Demand for Compensation: Whether to include a specific demand depends on strategy. In most cases, we prefer not to include a specific number in the initial letter unless there is a compelling reason. Setting a number too early risks anchoring the negotiation prematurely. That said, in cases with clear liability and defined damages, it can sometimes be helpful to propose a settlement figure that reflects the severity of the injury. In all cases, we are clear that our client seeks full and fair compensation and expects a serious offer in return.

8. Settlement and Negotiation: Express a willingness to resolve the matter without litigation, but make it clear you are prepared to move forward with a lawsuit if necessary. Defense counsel and carriers take demand letters more seriously when they understand that filing suit is not a bluff. Use language that is firm but professional. You are not pleading—you are inviting resolution.

9. Deadline for Response: Set a firm but reasonable deadline for response, usually 20 to 30 days from the date of the letter. This creates urgency and avoids indefinite delays. Be prepared to follow up immediately once the deadline passes. In one matter, the hospital failed to respond for over two months—until we filed. Only then did the settlement discussion begin in earnest. The lesson: demand letters are not the end of advocacy—they are the beginning of leverage.

Sample Demand Letter Resources