Tex. Civ. Prac. & Rem. Code §§ 74.051, 74.251, 74.301, 74.351
Medical malpractice in Texas — the 120-day expert report that decides the case
A claim in Texas district and county courts · Last verified August 26, 2026
A health care liability claim in Texas is an ordinary negligence claim wrapped in a procedural statute that decides most cases before the merits are reached. Chapter 74 imposes a pre-suit notice, a records authorization, damage caps, and one requirement that ends more Texas malpractice cases than any defense: an expert report served on each defendant within 120 days of that defendant's answer.
Fail it and the dismissal is with prejudice, and the statute makes an award of the defendant's attorney's fees mandatory.
What the claim is
A physician, nurse, hospital or other provider departed from the accepted standard of care, and a patient was injured or died as a result.
Where the right comes from
Statute. Chapter 74 of the Civil Practice and Remedies Code — the Texas Medical Liability Act, enacted in 2003 — sitting on top of common-law negligence. The definition of a health care liability claim in § 74.001(a)(13) is broad, and defendants litigate hard to bring claims inside it because the chapter's requirements come with it.
What a plaintiff has to prove
- The defendant is a physician or health care provider.
- The applicable standard of care, and that the defendant departed from it.
- Proximate cause — the departure caused the injury.
- Damages.
Every element but damages requires expert testimony. A jury is not permitted to decide what a reasonable physician would have done from common experience.
How long you have to file
Two years under CPRC § 74.251(a), measured from the occurrence of the breach or tort, or from the last date of the relevant course of treatment or hospitalisation.
Ten years, absolutely. Section 74.251(b) is a statute of repose: no claim may be brought more than 10 years after the act or omission, whatever the discovery date.
The 60-day notice tolls the limitations period for 75 days.
What has to happen before you file
A 60-day pre-suit notice. CPRC § 74.051 requires written notice to each defendant at least 60 days before suit, accompanied by an authorization allowing the release of protected health information.
And then, after filing, the expert report. CPRC § 74.351 requires the claimant to serve on each party an expert report with the expert's curriculum vitae not later than the 120th day after the date each defendant files its answer.
The report must give a fair summary of the expert's opinions on three things: the applicable standard of care, the manner in which the care failed to meet it, and the causal relationship between that failure and the injury.
A court may grant one 30-day extension to cure a deficient report. If no report is served, or the report is found deficient and not cured, the court shall dismiss with prejudice and shall award the defendant reasonable attorney's fees and costs of court.
What the claim pays
Economic damages — past and future medical expenses, lost earning capacity, cost of future care. These are not capped.
Non-economic damages, capped by CPRC § 74.301:
| Defendant | Cap per claimant |
|---|---|
| Physicians and providers other than institutions, all combined | $250,000 |
| A single health care institution | $250,000 |
| All health care institutions combined, where more than one is liable | $500,000 |
The caps are per claimant and inclusive of everyone for whom vicarious liability might apply. A claimant suing both physicians and institutions faces a maximum non-economic exposure of $750,000 across the two categories.
Exemplary damages under chapter 41, subject to its own standards and caps.
No attorney's fees to a claimant. The only fee provision in the chapter runs to a defendant on a failed expert report.
Common defenses
- No expert report, or a deficient one. The dispositive motion in most Texas malpractice cases.
- No breach of the standard of care, supported by the defendant's own experts.
- No causation — the injury was the natural progression of the disease, or a known complication.
- Limitations or repose.
- Informed consent. The risk that materialised was disclosed and accepted.
- The claim is a health care liability claim, where the plaintiff pleaded ordinary negligence to avoid chapter 74 — or is not one, where the plaintiff wants out of it.
What people get wrong
A bad outcome is not malpractice. Medicine carries risk. The claim requires proof that the provider departed from what a reasonable provider would have done.
The 120-day clock runs from the answer, not from filing. And it runs separately for each defendant. Adding a defendant late starts a new clock for that party.
Dismissal is with prejudice and comes with a fee award. The expert report is not a formality; it is the case.
The cap is per claimant, not per defendant. Suing five physicians does not produce five caps.
Economic damages are not capped. Lifetime care costs and lost earnings can dwarf the non-economic figure, which is why those cases are worth bringing despite the cap.
Where it came from
Texas passed the Medical Liability Act in 2003 in response to a rise in premiums and a contraction in the availability of insurance for physicians. It replaced an earlier expert-report regime with a stricter one, imposed the notice and authorization requirements, and set the non-economic caps.
The caps survived constitutional challenge because Texas voters approved Proposition 12 that November, amending the constitution to authorise the Legislature to limit non-economic damages in health care liability claims.
Chapter 74 has been stable since, and the litigation has moved to its edges — whether a particular claim is a health care liability claim at all, and whether a particular expert report is adequate.
Common questions
How long do I have to sue for medical malpractice in Texas?
Two years from the act or from the end of the relevant treatment, with an absolute 10-year outer limit.
What is the expert report?
A written report from a qualified expert, served within 120 days of each defendant's answer, that states the standard of care, how the provider failed to meet it, and how that caused the injury.
What happens if I miss it?
The court dismisses the claim with prejudice and awards the defendant its attorney's fees and costs.
Do I have to send notice first?
Yes. Sixty days' written notice with an authorization for the release of your medical records.
What is the damages cap?
$250,000 in non-economic damages against physicians and non-institutional providers combined, $250,000 against a single institution, and $500,000 against all institutions combined — per claimant.
Are my medical bills and lost wages capped?
No. Economic damages are uncapped.