The Economics of Med-Mal Case Selection: Why One Bad Intake Costs Six Figures
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See the 60-second demo →Contingency medical-malpractice practice has an economic structure that makes case selection existential. Under ABA Model Rules 1.5 and 1.8(e), the firm takes its fee only on recovery and advances the litigation costs itself — experts, records, depositions. When a funded case loses, there is no fee, and the advanced costs are, as a practical matter, gone. The firm bears essentially 100% of the downside.
The Asymmetry
That structure creates a brutal asymmetry. A won case returns a fee. A lost case after full workup is a six-figure hole in the firm's own capital. Two or three of those in a year can erase the margin from a much larger number of wins. So the firm is not really betting on whether it can win at trial — it is betting, at intake, on whether the case has a provable breach and a clean causal chain. The closed-claims data (Studdert et al., NEJM, 2006) is the reassurance and the warning: merit predicts payment, so a case with real merit tends to resolve in your favor — and a case without it tends not to, no matter how much you spend.
The portfolio math: you don't need to win every case. You need to stop funding the ones that can't win.
Where the Money Goes
The bulk of pre-trial cost in a med-mal case is expert review and testimony, plus the records work that precedes it. Those costs are largely incurred before you know whether the case holds up — which is exactly why a rigorous, low-cost screen at intake has such high leverage: it moves the go/no-go decision earlier, before the expensive commitments.
Move the go/no-go decision earlier
Our free Case Merit Score gives you a fast, defensible read on breach and causation strength before you commit expert dollars — every point traced to the record, no invented citations. Screen first, fund second.
Run a Free Case Merit Score →Selection Is the Portfolio Strategy
For a small or solo firm, disciplined case selection is not a back-office nicety — it is the business strategy. Protecting the cost budget so it can be deployed against the cases that clear the screen is what keeps a contingency practice solvent and growing. The highest-return hour a med-mal lawyer spends is often the one at intake that turns a tempting-but-weak case into a fast, confident no.
General information for attorneys, not legal advice, and no substitute for your independent professional judgment. Verify all statistics and authorities against current sources before relying on them.
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