A medical malpractice claim in Texas is governed by Chapter 74 of the Civil Practice and Remedies Code, which sets a two-year filing deadline, requires 60 days of pre-suit notice by certified mail, demands a qualified expert report within 120 days of each defendant’s answer, and caps non-economic damages after any verdict. Miss one of those steps and the case can end before it’s really begun. Chapter 74 controls Texas medical malpractice from the first letter you send to the final judgment, so the order of operations matters as much as the merits.
Does Your Case Fall Under Chapter 74
Chapter 74 applies to any healthcare liability claim — a lawsuit against a physician or healthcare provider for treatment, failure to treat, or any other departure from accepted medical standards that causes injury or death. The legal theory you pick doesn’t matter. If the underlying facts involve medical care, Chapter 74 governs, whether the claim is framed in tort or contract.1State of Texas. Texas Code Civil Practice and Remedies Code 74 – Medical Liability
The definitions sweep broadly. “Physician” reaches individual doctors and the professional associations, partnerships, and nonprofit health corporations they form. “Healthcare provider” covers nurses, dentists, podiatrists, pharmacists, chiropractors, optometrists, and healthcare institutions, plus the officers, directors, shareholders, employees, and independent contractors acting within their role for a covered provider.2State of Texas. Texas Code Civil Practice and Remedies Code 74.001 – Definitions
One boundary worth noting: a workers’ compensation claim by an employee against an employer is not a healthcare liability claim, even when the facts involve medical care. That kind of case runs on a separate track under the Texas Labor Code.
The Two-Year Deadline and the 10-Year Backstop
You have two years to file. The clock runs from the date of the alleged negligent act or from the date the related treatment or hospitalization ended, whichever is later. Texas does not use a broad discovery rule for medical malpractice, so the window generally opens with the event itself, not with the moment you realized something had gone wrong.3State of Texas. Texas Code Civil Practice and Remedies Code 74.251 – Statute of Limitations on Health Care Liability Claims
Young children get one exception. A minor under 12 at the time of the alleged malpractice has until their 14th birthday to file, or have a claim filed for them, even if more than two years have passed. For older minors, for adults with disabilities, and for everyone else, the plain two-year deadline applies.3State of Texas. Texas Code Civil Practice and Remedies Code 74.251 – Statute of Limitations on Health Care Liability Claims
Behind the two-year rule sits a hard 10-year statute of repose. No healthcare liability claim can be filed more than 10 years after the act or omission that caused it, regardless of when the injury was discovered or who the claimant is. Even a case involving something as clear as a surgical instrument left in the body is barred after a decade.3State of Texas. Texas Code Civil Practice and Remedies Code 74.251 – Statute of Limitations on Health Care Liability Claims
Pre-Suit Notice: 60 Days Before You File
Before filing, you must send written notice of the claim to every physician and healthcare provider you plan to sue. The notice goes by certified mail, return receipt requested, at least 60 days before the lawsuit is filed. The waiting period gives the provider and their insurer time to investigate and, if they choose, resolve the claim before litigation begins.4State of Texas. Texas Code Civil Practice and Remedies Code 74.051 – Notice
The notice has to include a signed medical authorization allowing the defendant to obtain your protected health information. Section 74.052 dictates the exact form of that authorization, which is designed to satisfy federal HIPAA privacy standards. Leave it out and the defendant can freeze proceedings until 60 days after they finally receive it, which can add months of delay once the suit is filed.5State of Texas. Texas Code Civil Practice and Remedies Code 74.052 – Medical Authorization
Sending the pre-suit notice tolls the two-year statute of limitations for 75 days, and the tolling applies to all parties and potential parties. That helps if you’re bumping up against the deadline and need the full waiting period, but it’s a narrow cushion, not a real extension. Plan backward from your two-year date and send the notice with room to spare.4State of Texas. Texas Code Civil Practice and Remedies Code 74.051 – Notice
The 120-Day Expert Report
This is where most Chapter 74 cases live or die. After filing, the claimant must serve one or more expert reports, together with each expert’s curriculum vitae, on every defendant within 120 days after that defendant files their original answer. The report is proof that a qualified medical professional has reviewed the case and thinks it has merit.6State of Texas. Texas Code Civil Practice and Remedies Code 74.351 – Expert Report
The report must cover three specific things: the applicable standard of care for the patient’s treatment, the specific ways the provider failed to meet it, and the causal link between that failure and the patient’s injury. All three are required. A report that lays out the standard of care and the breach but skims over causation is legally insufficient. Defendants get 21 days after receiving a report to file objections to its adequacy, and objections not raised in that window are waived.6State of Texas. Texas Code Civil Practice and Remedies Code 74.351 – Expert Report
What Happens if the Report Is Late or Deficient
Miss the 120-day deadline and the consequences are mandatory. If no expert report has been served in time, the court must, on the defendant’s motion, dismiss the claim with prejudice and award the defendant reasonable attorney’s fees and court costs. Dismissal with prejudice means the claim cannot be refiled. The statute uses “shall,” so the judge has no discretion to excuse a missed deadline.6State of Texas. Texas Code Civil Practice and Remedies Code 74.351 – Expert Report
There is one narrow escape. If a report was served on time but the court finds elements of it deficient, the court may grant a single 30-day extension to fix the problems. That option applies only to deficient reports, not to cases where no report was filed at all. If the claimant doesn’t receive notice of the ruling until after the deadline has passed, the 30 days runs from when they first received that notice.6State of Texas. Texas Code Civil Practice and Remedies Code 74.351 – Expert Report
The parties can also extend the 120 days by written agreement, but that takes cooperation from a defendant whose alternative is dismissal. Treat 120 days as absolute and line up an expert before the lawsuit is filed.
Who Qualifies as an Expert
Chapter 74 sets different qualification standards depending on whom you’re suing, and getting this wrong can sink a case as effectively as missing a deadline.
Suits Against Physicians
The expert must be a physician who was practicing medicine when the testimony is given or was practicing medicine when the claim arose. “Practicing medicine” is read broadly to include training residents or students at an accredited medical school and serving as a consulting physician to other doctors who deliver direct patient care.7State of Texas. Texas Code Civil Practice and Remedies Code 74.401 – Qualifications of Expert Witness in Suit Against Physician
A license alone is not enough. The expert must have knowledge of the accepted standards of care for the specific diagnosis or treatment at issue and be qualified by training or experience to give opinions on those standards. Courts weigh board certification, substantial training in a relevant area, and active practice in a related field.7State of Texas. Texas Code Civil Practice and Remedies Code 74.401 – Qualifications of Expert Witness in Suit Against Physician
Suits Against Other Healthcare Providers
When the defendant is a nurse, pharmacist, chiropractor, or another non-physician provider, Section 74.402 requires the expert to practice in the same type of care or treatment the defendant delivered, to know the relevant standards of care, and to be qualified by training or experience to testify about them.8State of Texas. Texas Code Civil Practice and Remedies Code 74.402 – Qualifications of Expert Witness in Suit Against Health Care Provider
The court looks at certification from a state licensing agency or national certifying body and at active practice in a relevant area. The court retains some flexibility to depart from the standard criteria when there’s a good reason to admit the testimony, but it must state that reason on the record. A defendant’s own employees can qualify as experts, which occasionally matters in institutional cases.8State of Texas. Texas Code Civil Practice and Remedies Code 74.402 – Qualifications of Expert Witness in Suit Against Health Care Provider
Caps on Non-Economic Damages
Winning at trial doesn’t mean recovering everything the jury awards. Chapter 74 limits what you can collect for non-economic harm — pain, suffering, disfigurement, loss of companionship. Economic damages like past and future medical expenses, lost wages, and custodial care costs are not capped.
Non-economic damages against physicians and healthcare providers other than institutions are capped at $250,000 per claimant, no matter how many individual providers are named. Against a single healthcare institution, generally a hospital or nursing facility, the cap is also $250,000 per claimant. When two or more institutions are defendants, each institution’s liability is capped at $250,000, with a combined ceiling of $500,000 across all institutions.9State of Texas. Texas Code Civil Practice and Remedies Code 74.301 – Limitation on Non-Economic Damages
The worst-case exposure in a single claim involving both individual providers and multiple institutions tops out at $750,000: $250,000 from the physician and provider pool and $500,000 from the institutional pool.
Wrongful death and survival claims are capped differently. Section 74.303 limits total damages, including non-economic and exemplary damages, to $500,000 per claimant, adjusted for inflation using the Consumer Press Index since August 1977, which can raise the effective cap meaningfully over time. The wrongful death cap does not apply to past or future medical expenses, hospital costs, or necessary custodial care. Those economic damages sit outside the cap entirely.10State of Texas. Texas Code Civil Practice and Remedies Code 74.303 – Limitation on Damages
Chapter 74 Deadlines in One Place
The overlapping deadlines are the single biggest trap for claimants:
- Two-year statute of limitations, running from the negligent act or the end of the related treatment. Children under 12 have until their 14th birthday.
- 10-year statute of repose as an absolute outer limit.
- 60-day pre-suit notice by certified mail, with the medical authorization form attached.
- 75-day tolling of the limitations period once the pre-suit notice goes out.
- 120-day expert report and CV due after each defendant’s original answer. No report means mandatory dismissal with prejudice.
- 30-day cure period, available only when a timely report is found deficient.
- 21-day window for defendants to object to a report’s sufficiency, or the objection is waived.
These pieces interact. A claimant approaching the two-year mark has to fold the 60-day notice period into the timeline and should already have an expert identified. Waiting until after the suit is filed leaves barely four months to find a qualified physician, get them through the records, and produce a report that survives a sufficiency challenge. Start the expert consultation months before you file.