If you refer out medical malpractice cases, you’ve had more of them declined than you’d like. Matthew Slingbaum of Slingbaum Law P.A. has the inside information on why.
He was a medical malpractice victim before he became a medical malpractice lawyer. He started at a medical malpractice defense firm and worked for insurance carriers, then went back to school for a master’s in public health at Nova Southeastern as the only student in the program without a medical background. He finished first in his class. In 2022, after two decades inside other firms, he opened his own practice in Oakland Park, Florida.
In the latest episode of the Trial Lawyer View by Synergy podcast, I asked him how medical negligence cases get evaluated, and where AI belongs in medical record review. He also addressed the single most common reason a referred case gets turned down.
Suffering and a provable case are not the same thing
Matthew’s time as a patient taught him the lesson he now teaches clients: “Suffering and injury and having a provable case are not the same thing.”
Clients come to him looking for three things:
1. An explanation of what happened to them
2. An acknowledgment: this should not have happened
3. Someone taking them seriously
His job is to take something deeply personal and build a case strong enough to survive expert review, pre-suit, litigation, and trial. The hard part comes when those don’t all align. “A bad outcome does not necessarily establish negligence,” he said. “That distinction can be frustrating. I know it was for me.”
He says the frustration made him more disciplined about how he approaches cases and how he explains the news to clients.
How defense carriers value a medical malpractice case
Two things from his defense years changed how he handles plaintiff cases.
First, carriers value a case on the range of probable outcomes and the risk of a big verdict at each stage. How bad the conduct looks, or how badly the client was hurt, barely enters the calculation. “The carrier’s really not looking and saying, how good of a person was this?” he said.
Second, the defense evaluates the plaintiff’s lawyer almost as carefully as the claim. They look at whether you understand the medicine and whether you retained and prepared the right experts. Your preparation changes the number they put on the case.
Why a med mal lawyer went back for a master’s in public health
A medical negligence practice runs on medical experts. Matthew wanted two things from the MPH program: contacts and a working knowledge of the science.
The program put him in classrooms with physicians across specialties, nurses, and medical students. Those relationships now give him informal opinions before his firm spends money on a case, and formal experts once a case moves forward.
He also didn’t want his read on the medicine to depend entirely on hired experts. Understanding the methodology behind the literature changed how he selects cases, how he questions experts, and how he explains complex medicine to clients and juries.
The payoff shows up in depositions. “I’ve seen depositions take place where experts will just kind of start spinning that attorney around,” he said. If you don’t understand the medicine, you have no way to stop the line of answers in the moment. There’s no phone call to make mid-deposition. Your own background is, in his words, “that safety net.”
Medical malpractice case evaluation: how to review the records
Matthew’s firm reviews a new case in this order:
· Start with the client. Get their account of what happened, what they were told, what changed, and what they believe went wrong. Much of the factual detail never makes the records.
· Pull everything. A note from a random appointment six years earlier is exactly what the defense will use against you.
· Build around the critical event. Start with the main issue and pull the labs, films, physician notes, and consults from the same window.
· Go back in time. Establish the patient’s baseline, preexisting conditions, and anything the defense will argue contributed.
· Go forward. Review every record after the event, including subsequent facilities, to track prognosis.
· Test standard of care. What would a similar physician have done with this patient?
· Prove causation. Matthew calls this step connect the dots. Link the alleged negligence to the specific injury the client is claiming.
· Value the damages. Lost wages, future care, equipment, home modifications, and what the client did before the injury versus now.
· Check viability. Is there insurance or another source of recovery?
Viability knocks out a lot of cases after the first three tests pass. Matthew has this conversation with potential clients almost every week: the care was poor and the case still won’t pay for itself.
Why strong medical malpractice cases still get turned down
Structural problems drive the no:
No insurance requirement – As Matthew explains, Florida doesn’t require facilities or physicians to carry malpractice insurance. Clients rarely know this until he tells them.
Sovereign immunity – At a state-affiliated hospital, individual staff members are immune from suit and the facility sits under statutory caps. A client with several million dollars in damages recovers $200,000 at most. Two cases with the same violation of the standard of care get two different answers depending on which hospital the patient walked into.
The wrongful death statute – Experts in other states call Florida “the free kill state.” As Matthew explained, when an adult 25 or older dies from medical negligence with no spouse or child, the family has no claim for pain and suffering, which in practice means no case. He described telling parents he had no case for their daughter’s death. “Had she died in a car accident on the way to the hospital, we could take that case.”
Then there’s the cost – A serious case requires “upwards of a six-figure investment in hard costs.” Experts, expert depositions, treating physician depositions paid out of pocket, records, economists, life care planners. Add thousands of attorney and staff hours. Medical malpractice is also the only area in Florida where Matthew must retain an expert before he files. He files an auto case or a class action the next day once he confirms the requirements. A med mal case waits on experts and the cost of hiring them.
“A case may involve a legitimate mistake and real injury, but it still might not support the cost and risk necessary to move forward,” he said.
The number one reason a referred med mal case gets rejected
It is causation that causes a rejection most of the time. A referring lawyer sends over a case where the care looks negligent, and Matthew often agrees the care was poor. The problem is proving the substandard care most likely caused the injury.
“It’s not simply a bad care or bad outcome kind of case,” he said. “A lot of times it’s a bad care plus causation kind of case.”
His advice for referring lawyers: don’t put blinders on. Before you call a med mal firm, get the full factual background from the client, including what they were told and what changed. A death barred under the medical malpractice statute might still be a product liability claim with none of the same limits. If you limit the conversation to “I think the doctor did something wrong,” you miss the other claim.
Where AI helps with medical record review, and where the danger starts
Vendors are selling law firms AI tools for medical record review. Matthew uses the technology and has a clear line on where to stop.
Where AI helps:
· Finding one operative note or lab result inside 8,000 pages in a minute or two
· Indexing a large record for quick reference
· Spotting lab trends across a chart
Where AI fails:
· Records arrive as copied images and handwritten notes, and AI misreads or skips them
· The output sounds confident while weeks of the record are missing
· One wrong abbreviation or one lab value decides the entire case
· “One handwritten note, just a sentence, can turn the entire case from something that’s not going to be able to proceed to a really significant case,” he said.
· AI also misses pattern breaks. A nurse charts the same way every day, then one entry deviates in a subtle way. Nothing flags. A lawyer who has read charts for years notices and asks why. Matthew doesn’t expect software to catch this yet.
His rule: use AI for defined assignments inside guardrails, and keep the attorney reviewing the records and holding final judgment on the case.
A lost case changed how he preps clients
I asked Matthew about a case he lost. One still shapes his practice.
The case involved a catastrophic injury during physical therapy. The firm had strong expert support and had spoken with the client dozens of times. Then, in deposition, the client got confused about which physical therapist caused the injury and insisted on a man who wasn’t working the day of the incident. The case sank.
The lesson: client preparation matters as much as attorney preparation, and one session the day before the deposition isn’t enough. His firm now runs several prep sessions so a nervous first-time witness gets used to the format before the real thing.
I added my own version from my experience handling Medicaid Ahlborn lien reduction hearings. In Medicaid lien reduction hearings, my witnesses are other lawyers, and unprepared lawyers have sunk hearings too. “Even as lawyers, if we don’t prepare properly, it impacts the end result.”
What he underestimated about owning a law firm
Matthew opened his firm in 2022 after more than 20 years inside other firms. He underestimated how many business decisions compete with the legal work.
As a partner running a department, you focus on cases. As an owner, you still own the cases, plus the systems, the staff, the culture, and the environment everyone else needs to do their jobs.
Picking practice management software or a health plan takes little effort as a single decision. The problem is volume. New decisions arrive every day, and you’re the only person who makes them. The fix is sorting fast: which decisions to delegate and which to keep.
Complex litigation was never a 9 to 5 job, and owning the firm added a second one. Days of 16 and 17 hours became normal.
Matthew’s view: empathy drives the investigation
In catastrophic injury and wrongful death cases, Matthew said, the client needs to be heard, and everyone touching the file needs to show empathy. He treats empathy as part of the casework. Understanding what the client lost drives the investigation and the quality of the package the defense sees.
“We’re all in customer service, so to speak,” he said. Clients text him late at night, or on the birthday of the person they lost. He picks up.
Empathy is one of Synergy’s corporate values too. Our team hears the same message internally: an aggressive lien reduction means more dollars in the hands of an injured client who will need them.
🎧 Listen to the full podcast conversation on Trial Lawyer View here: https://partnerwithsynergy.com/podcast/matthew-slingbaum/
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