Letter of Claim in medical negligence: what it must say and what happens next
Published 16 October 2026
TL;DR
- In England and Wales, a Letter of Claim is the formal document that tells a healthcare provider what the claimant says went wrong and what they are claiming; the Pre-Action Protocol for the Resolution of Clinical Disputes sets out what it should contain
- The defendant should acknowledge the letter within 14 days and give a reasoned Letter of Response within four months
- Court proceedings should not normally be issued until four months after the Letter of Claim, unless a limitation deadline makes that impossible
- The Protocol does not change the legal time limit for bringing a claim
- This page covers England and Wales only; Scotland and Northern Ireland use different procedures
Jurisdiction: England and Wales. Based on the Pre-Action Protocol for the Resolution of Clinical Disputes as published on the Ministry of Justice website, checked 16 October 2026. Rules can change; a solicitor will work from the current version.
A Letter of Claim is the point at which a clinical negligence complaint becomes a formal legal claim. It is not a court document, and sending one does not start court proceedings. It is the step that gives the hospital, GP practice, dentist or other provider a fair chance to investigate and respond before anyone goes to court.
This guide explains what the Protocol says about the Letter of Claim, the timings that follow, and how the defendant's reply works. For the whole process from first enquiry to settlement, see the how to claim guide.
What is a Letter of Claim?
The Pre-Action Protocol for the Resolution of Clinical Disputes applies to claims against hospitals, GPs, dentists and other healthcare providers, NHS and private, where injury is alleged to result from clinical negligence (paragraph 1.1). The courts treat it as setting the standard of normal reasonable pre-action conduct (paragraph 1.4).
Under the Protocol, the Letter of Claim should be sent as soon as practicable once the claimant's side has reviewed the records and has expert advice supporting the grounds for a claim (paragraph 3.14). The Protocol includes a template for it. For NHS trusts, a copy goes to the NHS Litigation Authority (the body now operating as NHS Resolution).
The letter is not the same as formal court pleadings. The Protocol says it does not have the status of Particulars of Claim, and sanctions should not necessarily follow if the two later differ (paragraph 3.19).
What must a Letter of Claim include?
Paragraph 3.16 of the Protocol says the letter should contain:
- A clear summary of the facts, the adverse outcome, and the main allegations of negligence.
- The claimant's injuries, present condition and prognosis.
- The financial loss and the heads of damage claimed.
- How the claim is being funded, including whether the funding arrangement was entered into before or after April 2013.
- The discipline of any expert already instructed.
It should also refer to relevant documents and enclose any the defendant may not already hold (paragraph 3.17), and give enough detail for the defendant to focus its investigation and put a value on the claim (paragraph 3.18).
A claimant may include a Part 36 settlement offer with the letter, usually supported by a medical report, a schedule of loss and key documents (paragraph 3.21).
Timetable after the Letter of Claim
| Step | Timing under the Protocol | Paragraph |
|---|---|---|
| Defendant acknowledges the Letter of Claim and names who is handling it | Within 14 days of receipt | 3.23 |
| Defendant sends a reasoned Letter of Response | Within four months of the Letter of Claim | 3.24 |
| Earliest point to issue court proceedings | Four months after the Letter of Claim, unless limitation prevents it | 3.20 |
The Protocol allows timings to be varied to suit the case, but if it is not followed the court will expect an explanation (paragraph 1.5.2). If the defendant needs longer than four months, the request should be made as soon as the need is known and within the four months, with reasons (paragraph 3.25).
What does the Letter of Response say?
Paragraph 3.24 sets out what a reasoned answer should include:
- Clear admissions, where the defendant accepts that something went wrong.
- Partial admissions, with reasons, and whether any admission is binding.
- Specific comments on each allegation of negligence.
- The expert disciplines the defendant relies on.
- Any records or documents the defendant says it needs.
- Details of any other potential defendants.
Where liability is admitted but the value of the claim needs more work, the Protocol expects the parties to agree a reasonable period to resolve it (paragraph 3.27). Where liability is disputed, they should discuss whether to issue proceedings and whether an early trial of a preliminary issue would help (paragraph 3.28).
Does the Protocol stop the time limit running?
No. The Protocol states that it does not alter statutory time limits (paragraph 1.6.1). If proceedings must be issued to beat a limitation deadline before the Protocol steps are finished, the parties should ask the court for a stay so the Protocol can be completed.
The standard period for most personal injury claims is three years, with rules about the date of knowledge and special rules for children and people lacking capacity under the Limitation Act 1980. Our time limits guide explains how this works in practice. The key point is that correspondence with the provider, a complaint, or the four-month response period does not pause the clock.
Before the Letter of Claim: records and expert evidence
The Letter of Claim comes after earlier steps. Under the Protocol, a request for health records should be answered with copies within 40 days (paragraph 3.4.1). If records or an explanation are not provided in that time, the claimant can apply to the court for pre-action disclosure (paragraph 3.7). The Protocol also contemplates a shorter Letter of Notification, sent once a breach or causation case has been identified, which the defendant should acknowledge within 14 days (paragraphs 3.10 to 3.12).
Expert reports are usually needed on breach of duty, causation, the claimant's condition and prognosis, and valuation (paragraph 4.1). Our guide to evidence in a medical negligence claim explains what records and expert input are normally needed.
After the response: settlement talks and alternatives to court
The Protocol says litigation should be a last resort and that parties should consider alternative dispute resolution such as negotiation, mediation, early neutral evaluation or an ombudsman scheme (paragraphs 5.1 and 5.2). Nobody can be forced to mediate, but staying silent in response to a reasonable invitation to try ADR may be treated as unreasonable and can affect costs (paragraph 5.4).
Before proceedings are issued, the parties are expected to review their positions (paragraph 6.1.1). If a court claim cannot be avoided, they should prepare a chronology of agreed and disputed facts and agree case management directions (paragraph 6.1.2).
For how a claim against an NHS provider typically unfolds, see our guide to making a claim against the NHS.
What should you do if you have received or want to send a Letter of Claim?
If you are a patient considering a claim, you do not need to draft the letter yourself. A solicitor experienced in clinical negligence will normally collect the records, obtain expert opinion and prepare it. If a provider has contacted you about a Letter of Claim or a response, keep every document and note every date, because deadlines under the Protocol and the limitation period run independently.
In Scotland there is no equivalent Protocol, and Northern Ireland has its own arrangements; see our pages on Scotland and Northern Ireland.
Sources
- Ministry of Justice, Pre-Action Protocol for the Resolution of Clinical Disputes (England and Wales), paragraphs cited above.
- Limitation Act 1980, legislation.gov.uk.
This page provides legal information, not legal advice. It does not assess any individual case and cannot guarantee any outcome. If you think you may have a claim, speak to a qualified solicitor who specialises in clinical negligence as soon as possible.