Rhode Island Pre-Suit Demand & Tolling Framework (no statutory NOI required)

RHODE ISLAND PRE-SUIT DEMAND & TOLLING FRAMEWORK

Voluntary Pre-Suit Communication — No Statutory NOI Required

PART A — PRE-SUIT DEMAND LETTER TO PROVIDER AND/OR CARRIER

[LAW FIRM LETTERHEAD]

[DATE]

VIA CERTIFIED MAIL — RETURN RECEIPT REQUESTED
AND VIA EMAIL: [_______________]

[NAME OF PHYSICIAN / HOSPITAL ADMINISTRATOR]
[NAME OF ENTITY]
[STREET ADDRESS]
[CITY], Rhode Island [ZIP]

cc: [INSURANCE CARRIER CLAIMS ADJUSTER]
[CARRIER ADDRESS]

Re: Patient: [PATIENT NAME]
Date(s) of Care: [__/__/____] to [__/__/____]
Our Client: [CLIENT NAME]
Pre-Suit Demand for Settlement of Medical Malpractice Claim

Dear [Provider / Risk Manager / Adjuster]:

This firm represents [CLIENT NAME] in connection with serious injuries sustained as a direct and proximate result of medical care rendered by [PROVIDER / FACILITY] on or about the dates referenced above. We write to provide a comprehensive pre-suit demand and to invite early, good-faith resolution of this claim before litigation is commenced.

Please note: Rhode Island law does not require a statutory notice of intent to sue or a pre-suit waiting period. This letter is sent voluntarily, in the spirit of efficient resolution and to comply with our professional obligation to consider settlement before filing.

1. Summary of the Claim

On [DATE], [PATIENT] presented to [FACILITY] complaining of [PRESENTATION]. Over the course of [PERIOD], [PATIENT] was evaluated and treated by [PROVIDERS]. We contend the following deviations from the applicable standard of care occurred:

a. [Specific breach #1, with dates, providers, and clinical detail.]
b. [Specific breach #2.]
c. [Specific breach #3.]

These deviations were a substantial factor in causing the following injuries:

a. [Injury / complication #1.]
b. [Injury / complication #2.]
c. [Permanent / continuing harm.]

2. Standard of Care, Breach, and Causation

A qualified expert in [SPECIALTY] has reviewed the medical records and confirmed each element of the claim consistent with the standards of R.I. Gen. Laws § 9-19-41. The expert opines, to a reasonable degree of medical probability, that:

• The standard of care required [_______________];
• That standard was breached by [_______________];
• The breach caused [_______________];
• A reasonable practitioner exercising due care would have produced a materially better outcome.

We are prepared to identify our expert and produce the expert's report at the appropriate stage if litigation becomes necessary.

3. Damages

In addition, Rhode Island law grants statutory prejudgment interest under R.I. Gen. Laws § 9-21-10 from the date the cause of action accrued. The accrued and accruing prejudgment interest materially affects the present value of any judgment and should be considered in any settlement evaluation.

Rhode Island has no statutory cap on noneconomic or total damages in medical malpractice cases. Joint and several liability is preserved among joint tortfeasors under R.I. Gen. Laws ch. 10-6, with rights of contribution.

4. Settlement Demand

To resolve all claims, our client demands the sum of $[__________], inclusive of all liens and costs. This demand is open for [30 / 45 / 60] days from the date of this letter, after which we reserve the right to withdraw it and to pursue all remedies in court without further notice.

5. Litigation Hold and Preservation Demand

Pending resolution, we demand that you and your insurer immediately preserve, and direct all custodians to preserve:

a. Complete medical records (paper and electronic);
b. EHR audit trails and metadata;
c. Imaging studies in DICOM format with all annotations;
d. Pathology slides, tissue blocks, and reports;
e. Telemetry and fetal monitoring strips;
f. Pharmacy and MAR records;
g. Operative and anesthesia records;
h. Code blue / rapid response documentation;
i. Incident reports, root-cause analyses, and quality-improvement files (objections to privilege reserved);
j. Credentialing and peer-review files for the involved providers (objections reserved);
k. Email, text, Teams/Slack, and pager communications among providers regarding this patient;
l. Policies, protocols, and order sets in effect at the time of care;
m. Staffing records (assignments, ratios, breaks);
n. All communications with the carrier or third-party administrator regarding this matter.

Spoliation of any of the foregoing will be the subject of appropriate remedies, including spoliation instructions, sanctions, and adverse inferences.

6. Statutory Inadmissibility Notices

Pursuant to R.I. Gen. Laws § 9-19-35, your failure (if any) to bill our client for services rendered will not be admissible to prove liability, but is preserved for damages purposes. Pursuant to R.I. Gen. Laws § 9-19-36, advance payments will not be construed as admissions of liability.

7. Tolling Proposal

To facilitate good-faith pre-suit negotiations without prejudice, we are willing to enter into a written tolling agreement (form attached as Part C). Please advise within [14] days whether the proposed tolling agreement is acceptable. Absent a signed tolling agreement, we will calendar and meet the applicable statute of limitations under R.I.G.L. § 9-1-14.1.

8. Mediation

We are open to early mediation through a Rhode Island-experienced neutral. Please advise whether your client and carrier are willing to mediate, and if so, please propose three (3) acceptable neutrals.

9. Communications

All communications regarding this matter should be directed to undersigned counsel. Please do not contact our client directly. We expect that the [PROVIDER / FACILITY] will notify its professional liability carrier promptly upon receipt of this letter and will provide that carrier's name, claim number, and contact information within [14] days.

10. Reservation of Rights

This letter is for purposes of pre-suit settlement discussions only. Nothing herein shall be construed as a waiver of any claim, right, defense, evidentiary objection, or protection. Statements herein are inadmissible under Fed. R. Evid. 408 and R.I. R. Evid. 408 to prove liability.

We look forward to your prompt response.

Very truly yours,

________________________________________
[ATTORNEY NAME], Esq. (R.I. Bar No. [_______])
[FIRM NAME]
[STREET ADDRESS]
[CITY], Rhode Island [ZIP]
Tel: ([___]) [___-____]
Email: [_______________________]

Enclosures:

• HIPAA-Compliant Authorization for Release of Records (Part B)
• Proposed Tolling Agreement (Part C)
• Litigation Hold (Part D)
• Pre-Suit Mediation Invitation (Part E)

PART B — HIPAA-COMPLIANT AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS

AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION

Patient Name: [_______________________________________]
Date of Birth: [__/__/____]
Address: [_______________________________________]
Phone: [_______________________________________]
SSN (last 4): xxx-xx-[____]

I, the undersigned, hereby authorize [PROVIDER / FACILITY] to disclose the following protected health information:

☐ Complete medical record
☐ Hospital records (admission through discharge)
☐ Physician notes and orders
☐ Nursing records, MAR, flowsheets
☐ Imaging reports AND films/DICOM images
☐ Pathology reports, slides, blocks
☐ Laboratory results
☐ Operative reports
☐ Anesthesia records
☐ EHR audit trails
☐ Pharmacy records
☐ Billing records and itemized statements
☐ All other documents related to my care

For dates of service: [__/__/____] to [__/__/____]

To: [ATTORNEY / FIRM NAME]
[ADDRESS]

Purpose of Disclosure: Legal representation; investigation and possible prosecution of medical malpractice claim.

Special Categories (separate authorization may be required by RI law):

☐ Mental health / behavioral health records (R.I.G.L. § 5-37.3)
☐ HIV-related information (R.I.G.L. § 23-6.3)
☐ Substance use treatment records (42 C.F.R. Part 2)
☐ Genetic testing information

Expiration: This authorization expires one (1) year from the date of signature, or upon completion of the legal matter, whichever is earlier.

Right to Revoke: I understand I may revoke this authorization in writing at any time, except to the extent action has been taken in reliance upon it.

Re-Disclosure: I understand that information disclosed pursuant to this authorization may be subject to re-disclosure and may no longer be protected by federal and state privacy laws.

________________________________________ Date: [__/__/____]
[PATIENT / PERSONAL REPRESENTATIVE NAME]

If signed by personal representative, describe authority: [_______________________________________]

PART C — TOLLING AGREEMENT

TOLLING AGREEMENT

This Tolling Agreement ("Agreement") is entered into as of [__/__/____] by and between:

[CLIENT/PATIENT NAME] ("Claimant"); and

[PROVIDER / HOSPITAL / GROUP NAME] and its insurer [CARRIER NAME] ("Respondent").

RECITALS:

A. Claimant alleges that Respondent provided negligent medical care on or about [DATE(S)], causing injury to Claimant.
B. The parties wish to engage in good-faith pre-suit investigation and possible settlement without prejudice.
C. The parties desire to toll any applicable limitations period to permit such investigation and discussions.

AGREEMENT:

1. Tolling. All applicable statutes of limitations and statutes of repose, including R.I. Gen. Laws § 9-1-14.1, are hereby tolled and shall not run from the Effective Date through the Termination Date (the "Tolling Period").

2. Effective Date: [__/__/____].

3. Termination Date: The Tolling Period terminates upon the earliest of:
   a. [__/__/____] (no earlier than [__] days after Effective Date);
   b. Thirty (30) days following written notice of termination by either party; or
   c. Filing of a complaint by Claimant.

4. No Admissions. Nothing in this Agreement is, or shall be construed as, an admission of liability, fault, or damages. Statements made during pre-suit discussions remain inadmissible under R.I. R. Evid. 408 and Fed. R. Evid. 408.

5. No Waiver. No party waives any defense, claim, evidentiary objection, or right by entering into this Agreement, except the defense of any statute of limitations that would have otherwise run during the Tolling Period.

6. Authority. Each signatory represents that he/she has full authority to bind the party for whom he/she signs.

7. Governing Law. This Agreement is governed by Rhode Island law.

8. Counterparts; Electronic Signature. This Agreement may be executed in counterparts and by electronic signature, each of which is deemed an original.

CLAIMANT:

________________________________________ Date: [__/__/____]
[CLIENT NAME]

Counsel for Claimant:

________________________________________ Date: [__/__/____]
[ATTORNEY NAME], Esq.

RESPONDENT:

________________________________________ Date: [__/__/____]
[AUTHORIZED REPRESENTATIVE NAME / TITLE]

Counsel for Respondent (if applicable):

________________________________________ Date: [__/__/____]
[DEFENSE COUNSEL], Esq.

PART D — STANDALONE LITIGATION HOLD / PRESERVATION DEMAND

[LAW FIRM LETTERHEAD]
[DATE]

VIA CERTIFIED MAIL AND EMAIL

[GENERAL COUNSEL / RISK MANAGEMENT]
[FACILITY / PROVIDER]
[ADDRESS]

Re: Litigation Hold — Patient [NAME] — DOS [DATES]

You are hereby notified that litigation is reasonably anticipated regarding the medical care provided to [PATIENT NAME] on or between [DATE] and [DATE]. You are obligated to preserve all potentially relevant information in your possession, custody, or control. The duty to preserve extends to:

1. Paper records of every kind, including drafts and copies;
2. Electronic health records, including all versions, prior versions, and audit trail / metadata showing who accessed, modified, deleted, or printed the record and when;
3. Imaging studies, in their original DICOM format with all annotations, measurements, and reports;
4. Pathology, including slides, blocks, fluids, and reports;
5. Telemetry, monitoring strips, and waveform data;
6. Operative and anesthesia records;
7. Pharmacy and medication administration records;
8. Communications: email, secure messaging, pagers, Teams/Slack/internal chat, voicemail;
9. Incident reports, root-cause analyses, near-miss reports, and quality-improvement materials (privilege objections reserved);
10. Credentialing, peer-review, and personnel files for involved providers (privilege objections reserved);
11. Policies, protocols, order sets, and pathways in effect at the time of care;
12. Staffing records, assignments, and ratios;
13. Equipment maintenance and calibration logs for any equipment involved;
14. Surveillance video (if any).

Auto-deletion policies must be suspended for these categories. Backup tapes and disaster-recovery copies must be preserved. Cloud-hosted vendors and outsourced services (e.g., teleradiology, transcription) must be notified. Spoliation will be the subject of sanctions.

________________________________________
[ATTORNEY NAME], Esq.

PART E — PRE-SUIT MEDIATION INVITATION

[LAW FIRM LETTERHEAD]
[DATE]

[ADJUSTER / DEFENSE COUNSEL]
[ADDRESS]

Re: Pre-Suit Mediation Invitation — [PATIENT NAME]

Without waiving any rights, our client invites the parties to participate in pre-suit mediation under the auspices of a mutually agreeable Rhode Island-experienced neutral. Pre-suit mediation has resolved many similar matters in this jurisdiction efficiently and on confidential terms.

We propose the following neutrals:

1. [Neutral name, organization, location]
2. [Neutral name, organization, location]
3. [Neutral name, organization, location]

We propose mediation within [60-90] days. The parties shall split the neutral's fee equally pending settlement. All communications will be confidential and inadmissible under R.I.G.L. § 9-19-44 (mediation confidentiality, where applicable) and R.I. R. Evid. 408.

Please advise within [14] days.

________________________________________
[ATTORNEY NAME], Esq.

OPERATIONAL CHECKLIST — RI PRE-SUIT WORKFLOW

☐ Confirm SOL run-date under R.I.G.L. § 9-1-14.1 (and any tolling) — calendar with 90-day, 60-day, 30-day, and 7-day reminders
☐ Send HIPAA / R.I.G.L. § 5-37.3 records request (Part B)
☐ Engage qualified screening expert (per R.I.G.L. § 9-19-41 / Sheeley)
☐ Obtain written merit opinion (filed internally per Rule 11)
☐ Send pre-suit demand letter (Part A)
☐ Send standalone litigation hold (Part D)
☐ Negotiate tolling agreement if SOL is approaching (Part C)
☐ Invite mediation (Part E)
☐ If no resolution within demand period: prepare and file Complaint in Superior Court (Providence/Bristol, Kent, Washington, or Newport division based on venue analysis)
☐ Confirm Federal Tort Claims Act § 2675(a) administrative claim filed if any defendant is a federally deemed provider (FQHC, VA, military) — different track, 6-month period
☐ Confirm municipal/state tort claim notices filed if applicable

Sources and References

• R.I. Gen. Laws § 9-1-14.1 — Limitation on medical malpractice actions
• R.I. Gen. Laws § 9-19-41 — Expert witnesses in malpractice cases
• R.I. Gen. Laws § 9-19-35 — Failure to bill inadmissible
• R.I. Gen. Laws § 9-19-36 — Advance payments inadmissible
• R.I. Gen. Laws § 9-20-4 — Comparative negligence
• R.I. Gen. Laws ch. 10-6 — Contribution Among Joint Tortfeasors
• R.I. Gen. Laws § 9-21-10 — Prejudgment interest
• R.I. Gen. Laws § 5-37.3 — Confidentiality of Health Care Communications and Information Act
• R.I. Gen. Laws § 23-6.3 — HIV records
• R.I. Gen. Laws ch. 10-7 — Wrongful Death
• Wilkinson v. Harrington, 243 A.2d 745 (R.I. 1968)
• Anthony v. Abbott Laboratories, 490 A.2d 43 (R.I. 1985)
• Sheeley v. Memorial Hospital, 710 A.2d 161 (R.I. 1998)
• 45 C.F.R. § 164.508 (HIPAA authorization)
• 42 U.S.C. § 233 / 28 U.S.C. § 2675(a) (FTCA, federally deemed providers)

DISCLAIMER: Rhode Island imposes no statutory pre-suit notice of intent to sue, no waiting period, no presuit screening panel, and no certificate of merit in medical malpractice actions. This document is a voluntary pre-suit demand and tolling framework. Verify the current text of all cited statutes and case law and consult Rhode Island licensed counsel before relying on this template.