Medical Malpractice Case Screening Template (30-Minute Evaluation Framework)

By John Mahoney | April 2026 | 7 min read

Most plaintiff firms reject 90-95% of the medical-malpractice intake calls they receive. The economics demand it: a viable med mal case requires $40,000-$200,000 in case-development cost and 18-36 months of attorney time. Pursuing weak cases is a financial death sentence for a small firm.

The reciprocal problem: rejecting cases too aggressively leaves real injuries on the table. The screening function is a triage problem, not a "no" function. Here is the 30-minute framework experienced med mal attorneys use to make defensible decisions fast.

The four-element gate

Every viable med mal case clears four elements: (1) a clear standard of care, (2) a deviation from it, (3) causation linking the deviation to a specific injury, and (4) damages substantial enough to justify the case-development cost. Screening kills cases that fail any one element. Strong cases clear all four with room to spare.

Run the elements in this order, because failure at element #1 saves you from doing the work for #2-4.

Element 1: Standard of care (5-10 minutes)

The first 10 minutes of every screening call should answer: What was the standard of care, and is it well-defined enough to litigate?

Cases die early when the standard of care is contested even within the relevant specialty. The clearest med mal cases involve violations of bright-line rules: missed pulmonary embolism in a textbook presentation, retained surgical instrument, medication 10x overdose, failure to monitor a patient on continuous infusion, anastomotic leak missed for 5+ days post-op. The hardest cases involve judgment calls in scenarios where reasonable physicians could disagree.

Questions to ask intake clients:

• What were you treated for?
• What did the doctor / nurse / facility do or fail to do?
• What do you believe should have been done differently?
• Has any physician told you the care was substandard? (HUGE signal — preserve this and follow up.)
• Are there any specialty-society guidelines you've researched that bear on the care at issue?

Decision rule: if you can't articulate the violated standard of care in one sentence after 10 minutes, the case is too soft. Decline or refer.

Element 2: Deviation evidence (5 minutes)

Once you have a candidate standard of care, ask: Is there documentary evidence the standard was violated?

The strongest deviation evidence lives in the contemporaneous medical record. Audit trails, vital sign records, lab values, imaging reports, nursing notes — the deviation either appears in the record or it doesn't. If the patient's account of the deviation isn't corroborated by any record, the case is significantly harder.

Pre-litigation, you usually only have the patient's account + the discharge summary. Use these to triangulate:

• Did the discharge summary acknowledge any complication or unexpected outcome?
• Did the providers offer any explanation for the outcome?
• Did the patient receive any document admitting fault, error, or expressing condolence?
• Were any records flagged as "for review" or routed through a hospital risk management department?

Decision rule: if the patient's account is the only evidence of deviation, the case is too risky. Strong cases have at least some record corroboration even at intake.

Element 3: Causation (10 minutes)

Causation is where most med mal cases die. The patient was sick before the treatment. The patient would have suffered the bad outcome anyway. The deviation may be real but didn't cause this specific injury.

Ask:

• What was the patient's pre-existing condition?
• What was the natural history of the condition without the deviation?
• What outcome do we believe would have occurred with proper care?
• Is there published literature establishing that the deviation more-likely-than-not changed the outcome?

The medical literature test is the killer. If you can't find peer-reviewed evidence that timely intervention would have prevented the injury (or a stage / severity downgrade in oncology cases, etc.), causation is weak. The defense will produce its own expert saying the same outcome would have occurred regardless of the deviation.

Decision rule: if the natural history of the underlying condition would likely have produced the same outcome, the case is a wash. Decline.

Element 4: Damages (5 minutes)

The final element is economic. Even with a clear deviation and clear causation, a case is uneconomic if damages don't cover case-development cost + attorney fees + plaintiff recovery.

Quick damages math:

State damages caps make this even more pointed. In states with hard caps on non-economic damages ($250K-$500K typical), wrongful death cases involving non-earner victims are economically marginal even with strong liability.

Decision rule: project damages conservatively (below the patient's stated number). If the conservative projection covers $50K case costs + 33-40% contingency fee + meaningful client recovery, take the case. Otherwise refer.

Statute of limitations (always check first)

This belongs at the top of your intake checklist, not as an afterthought. SOL on med mal claims varies wildly by state — 1 year (KY, LA, TN), 2 years (most), 3 years (NY for many cases), with discovery-rule overlays and minor-tolling provisions. Check the SOL before you spend 30 minutes on intake.

For SOL deadlines in any state, see our free SOL calculator.

The screening output: a one-page case memo

End every intake call with a one-page memo answering these 6 questions in writing:

1. What is the alleged deviation, in one sentence?
2. What is the standard of care, with citation to a guideline or authoritative source?
3. What is the causal injury, with the natural-history counterfactual?
4. What are the damages, projected conservatively?
5. What is the SOL deadline, with discovery-rule analysis if relevant?
6. Decision: take, refer, or decline?

This memo becomes the kernel of your case file if you take the case, and your defensible record of decision if you decline. Saving these memos for 6+ years also gives you a self-audit tool: review declined cases that later resulted in published verdicts and refine your screening criteria.

John Mahoney is the founder of MedLegal AI. He builds AI tools for medical-malpractice plaintiff attorneys. Questions? [email protected]