I 
108TH CONGRESS 
1ST SESSION H. R. 1116
To reform the medical malpractice insurance business, to provide for Federal 
alternative medical malpractice insurance, and to limit frivolous lawsuits. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 6, 2003
Mr. CONYERS (for himself, Ms. BERKLEY, Mr. BAIRD, Mr. BERMAN, Mr. 
WEXLER, Mr. DELAHUNT, Mr. NADLER, Ms. NORTON, and Mr. 
PASCRELL) introduced the following bill; which was referred to the Com-
mittee on the Judiciary, and in addition to the Committee on Energy and 
Commerce, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To reform the medical malpractice insurance business, to 
provide for Federal alternative medical malpractice insur-
ance, and to limit frivolous lawsuits.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medical Malpractice 
Insurance and Litigation Reform Act’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents for this Act is as follows:
Sec. 1. Short title. 
Sec. 2. Table of contents. 
TITLE I—MEDICAL MALPRACTICE INSURANCE REFORM 
Sec. 101. Prohibition on anticompetitive activities by medical malpractice insur-
ers. 
Sec. 102. Medical malpractice insurance price comparison. 
Sec. 103. Procedural requirements for medical malpractice insurers’ proposed 
rate increases. 
TITLE II—FEDERAL MEDICAL MALPRACTICE INSURANCE 
ASSOCIATION 
Sec. 201. Establishment; purpose. 
Sec. 202. Board of directors. 
Sec. 203. Administration. 
Sec. 204. Rates. 
Sec. 205. Investment policy. 
Sec. 206. Medical malpractice risk management program. 
Sec. 207. Seed money to be funded by Treasury Department loan. 
Sec. 208. Disclosure of data by medical malpractice insurers. 
Sec. 209. Annual report by Chairperson. 
Sec. 210. Financial matters. 
Sec. 211. Definitions. 
TITLE III—LIMITING FRIVOLOUS MEDICAL MALPRACTICE SUITS 
Sec. 301. Health care specialist affidavit. 
Sec. 302. Sanctions for frivolous actions and pleadings. 
Sec. 303. Mandatory mediation. 
Sec. 304. Applicability. 
Sec. 305. Definitions.
TITLE 
I—MEDICAL 
MAL-
PRACTICE 
INSURANCE 
RE-
FORM 
SEC. 101. PROHIBITION ON ANTICOMPETITIVE ACTIVITIES 
BY MEDICAL MALPRACTICE INSURERS. 
Notwithstanding any other provision of law, nothing 
in the Act of March 9, 1945 (15 U.S.C. 1011 et seq., com-
monly known as the ‘‘McCarran-Ferguson Act’’) shall be 
construed to permit commercial insurers to engage in any 
form of price fixing, bid rigging, or market allocations in 
connection with the conduct of the business of providing
medical malpractice insurance. This section does not apply 
to the information-gathering and rate-setting activities of 
any State commissions of insurance, or any other State 
regulatory body with authority to set insurance rates. 
SEC. 102. MEDICAL MALPRACTICE INSURANCE PRICE COM-
PARISON. 
(a) INTERNET SITE.—Not later than 90 days after 
the date of the enactment of this Act, and after consulta-
tion with the medical malpractice insurance industry, the 
Secretary of Health and Human Services shall establish 
an interactive internet site which shall enable any health 
care provider licensed in the United States to obtain a 
quote from each medical malpractice insurer licensed to 
write the type of coverage sought by the provider. 
(b) ONLINE FORMS.—
(1) IN GENERAL.—The internet site shall en-
able health care providers to complete an online 
form that shall capture a comprehensive set of infor-
mation sufficient to generate a quote for each in-
surer. The Secretary shall develop transmission soft-
ware components which allow such information to be 
formatted for delivery to each medical malpractice 
insurer based on the requirements of the computer 
system of the insurer.
insurer changes its rates, such rate changes shall be imple-
mented at the internet site by the Secretary, in consulta-
tion with the insurer, as soon as practicable, but in no 
event later than 10 days after such changes take effect. 
During any period during which an insurer has changed 
its rates but the Secretary has not yet implemented such 
changed rates on the internet site, quotes for that insurer 
shall not be obtainable at the internet site. 
(f) USER-FRIENDLY
FEATURES.—The Secretary 
shall design the internet site to incorporate user-friendly 
formats and self-help guidance materials, and shall de-
velop a user-friendly internet user-interface. 
(g) CONTACT INFORMATION.—The internet site shall 
also provide contact information, including address and 
telephone number, for each medical malpractice insurer 
for which a provider obtains a quote at the site. 
(h) REPORT.—Not later than December 31, 2004, 
the Secretary shall submit a report to the Congress on 
the development, implementation and effects of the inter-
net site. Such report shall be based on—
(1) the Secretary’s consultation with health 
care providers, medical malpractice insurers, State 
insurance commissioners, and other interested par-
ties; and
(2) the Secretary’s analysis of other informa-
tion available to the Secretary. 
The report shall describe the Secretary’s views concerning 
the extent to which this section has contributed to increas-
ing the availability of medical malpractice insurance, and 
the effect this section has had on the cost of medical mal-
practice insurance. 
SEC. 103. PROCEDURAL REQUIREMENTS FOR MEDICAL 
MALPRACTICE INSURERS’ PROPOSED RATE 
INCREASES. 
(a) IN GENERAL.—Each State shall have in effect a 
policy under which—
(1) any health care professional (as defined in 
title III of this Act) licensed by the State has stand-
ing in any State administrative proceeding to chal-
lenge a proposed rate increase in medical mal-
practice insurance; and 
(2) a provider of medical malpractice insurance 
in the State may not implement a rate increase in 
such insurance unless the provider, at minimum, 
first submits to the appropriate State agency a de-
scription of the rate increase and a substantial jus-
tification for the rate increase.
(b) RULEMAKING.—The Attorney General shall pro-
mulgate rules to carry out this section.
(c) EFFECTIVE DATE.—The requirements of this sec-
tion shall take effect 1 year after the date of the enact-
ment of this Act. 
TITLE 
II—FEDERAL 
MEDICAL 
MALPRACTICE 
INSURANCE 
ASSOCIATION 
SEC. 201. ESTABLISHMENT; PURPOSE. 
(a) ESTABLISHMENT.—There is established a body 
corporate to be known as the Federal Medical Malpractice 
Insurance Association, which shall be in the Department 
of Health and Human Services. 
(b) OFFICES.—The Association shall maintain its 
principal office in the District of Columbia and shall be 
deemed, for purposes of venue in civil actions, to be a resi-
dent thereof. Agencies or offices may be established by the 
Association in such other place or places as it may deem 
necessary or appropriate in the conduct of its operations. 
(c) PURPOSE.—The purpose of the Association shall 
be to provide medical malpractice insurance based on cus-
tomary coverage terms and liability amounts in states 
where such insurance is unavailable or is unavailable at 
reasonable and customary terms, as determined by the As-
sociation. 
SEC. 202. BOARD OF DIRECTORS. 
(a) APPOINTMENT OF BOARD.—
(1) IN GENERAL.—There is hereby established 
a board of directors for the Association, consisting 
of 5 members appointed by the President, with the 
advice and consent of the Senate. 
(2) INITIAL APPOINTMENTS.—The first 5 mem-
bers shall be appointed not later than 90 days after 
the date of the enactment of this Act. Of the first 
5 members appointed, each shall serve a term end-
ing on July 1 of one of the following years: 2004, 
2005, 2006, 2007, and 2008, as determined by lot 
amongst themselves. 
(3) SUBSEQUENT MEMBERS; VACANCIES.—Each 
member appointed after the first 5 members shall be 
appointed to a term of 5 years. In the case of a va-
cancy, the member appointed to fill the vacancy shall 
serve the remainder of the uncompleted term to 
which the vacancy relates. 
(b) ELIGIBILITY.—Any person may be a director 
who—
(1) does not have any interest as a stockholder, 
employee, attorney, agent, broker, or contractor of 
an insurance entity who writes medical malpractice 
insurance or whose affiliates write medical mal-
practice insurance; and
(2) is of good moral character and who has 
never pleaded guilty to, or been found guilty of, a 
felony. 
(c) CHAIRPERSON.—The board shall annually elect a 
chairperson and any other officers it deems necessary for 
the performance of its duties. Board committees and sub-
committees may also be formed. 
(d) AUTHORITY.—The board is vested with full 
power, authority, and jurisdiction over the Association. 
The board may perform all acts necessary or convenient 
in the administration of the Association or in connection 
with the insurance business to be carried on by the Asso-
ciation. In this regard, the board is empowered to function 
in all aspects as a governing body of a private insurance 
carrier. 
SEC. 203. ADMINISTRATION. 
(a) ADMINISTRATOR.—The board shall appoint, and 
fix the pay of, an administrator, who shall serve at the 
pleasure of the board. The administrator shall be ap-
pointed from among individuals with proven successful ex-
perience as an executive at the general management level 
in the insurance industry. The administrator shall act as 
the Association’s chief executive officer, in charge of the 
day-to-day operations and management of the Association.
The first administrator shall be appointed not later than 
90 days after the date of the enactment of this Act. 
(b) COMMENCEMENT OF OPERATIONS.—The board 
shall ensure that the Association is fully operational not 
later than 180 days after the date of the enactment of 
this Act. 
SEC. 204. RATES. 
The board shall have full power and authority to es-
tablish rates to be charged by the Association for insur-
ance. The board shall contract for the services of or hire 
an independent actuary, a member in good standing with 
the American Academy of Actuaries, to develop and rec-
ommend actuarially sound rates. Rates shall be set at 
amounts sufficient, when invested, to carry all claims to 
maturity, meet the reasonable expenses of conducting the 
business of the Association and maintain a reasonable sur-
plus. The Association shall conduct a medical malpractice 
insurance program that shall be neither more nor less than 
self-supporting. The Association is authorized to purchase 
reinsurance related to its underlying insurance obligations. 
SEC. 205. INVESTMENT POLICY. 
The board shall formulate and adopt an investment 
policy and supervise the investment activities of the Asso-
ciation. The administrator may invest and reinvest the 
surplus or reserves of the Association subject to any limi-
tations imposed on domestic insurance companies by ap-
plicable laws. The Association may retain an independent 
investment counsel. The board shall periodically review 
and appraise the investment strategy being followed and 
the effectiveness of such services. Any investment counsel 
retained or hired shall periodically report to the board on 
investment results and related matters. 
SEC. 206. MEDICAL MALPRACTICE RISK MANAGEMENT 
PROGRAM. 
The administrator shall formulate, implement, and 
monitor a medical malpractice risk management program 
for all policyholders. To the extent practicable, the admin-
istrator shall obtain input from the National Association 
of Insurance Commissioners in developing such program. 
The administrator or board may refuse to insure, or may 
terminate the insurance of, any insured who disregards 
the medical malpractice risk management plan. In deter-
mining the premium payable by an insured, the Associa-
tion shall consider the compliance of the insured with the 
Association’s medical malpractice risk management. 
SEC. 207. SEED MONEY TO BE FUNDED BY TREASURY DE-
PARTMENT LOAN. 
(a) NO APPROPRIATION.—The Association shall not 
receive any appropriation, directly or indirectly, except as 
provided in subsection (b).
(b) INITIAL LOANS.—During the first year of the As-
sociation’s operations, the Secretary of the Treasury shall 
make 1 or more loans to the Association in such amounts 
as may be necessary for start-up funding and initial cap-
italization of the Association. The board of the Association 
shall make application to the Department of the Treasury 
for the loans, stating the amount to be loaned to the Asso-
ciation. The loans shall be for a term of 5 years and, at 
the time the application for such loans is approved, shall 
bear interest at an annual rate determined by the Sec-
retary of the Treasury. Thereafter, the Association may 
seek such additional loans or funding as may be author-
ized by law. 
SEC. 208. DISCLOSURE OF DATA BY MEDICAL MAL-
PRACTICE INSURERS. 
Not later than March 1 of each year, each insurer 
writing medical malpractice insurance coverage to a health 
care provider shall file with the Chairperson a copy of the 
annual statement it files with the department of insurance 
in the State in which it is domiciled. Each such insurer 
shall also file the following information with the Chair-
person, to the extent it is not disclosed on the insurer’s 
annual statement: 
(1) Information on closed claims.
(2) Information regarding verdicts, payment, 
and severity of injury in connection with verdicts. 
(3) Information on rate changes. 
(4) Information on premiums and losses by 
medical specialty. 
(5) Information on premiums and losses by ex-
perience of the insured. 
(6) Information on the performance of the in-
vestments of the insurer. 
SECTION 209. ANNUAL REPORT BY CHAIRPERSON. 
(a) IN GENERAL.—The Chairperson shall file an an-
nual report with the President and the Congress, which 
shall include—
(1) a statement of the Association’s accounts, 
funds, and securities; 
(2) copies of any other reports required to be 
filed by applicable law and by the National Associa-
tion of Insurance Commissioners; 
(3) any appropriate request for additional 
loans; 
(4) an assessment of the medical malpractice 
insurance marketplace; and 
(5) to the extent practicable, an assessment as 
to why health care providers are unable to obtain 
malpractice insurance in certain markets, or are un-
able to obtain malpractice insurance at reasonable 
and customary terms. 
(b) OBLIGATIONS
OF CHAIRPERSON.—The Chair-
person shall determine what data shall be included under 
section 208 by insurers writing medical malpractice insur-
ance coverage to a health care provider. 
SEC. 210. FINANCIAL MATTERS. 
(a) BUDGET.—The administrator shall annually sub-
mit to the board for its approval an estimated budget of 
the entire expense of administering the Association for the 
succeeding calendar year having due regard to the busi-
ness interests and contract obligations of the Association. 
(b) DETERMINATION OF CASH DIVIDEND.—The in-
curred loss experience and expense of the Association shall 
be ascertained each year to include but not be limited to 
estimates of outstanding liabilities for claims reported to 
the Association but not yet paid and liabilities for claims 
arising from injuries which have occurred but have not 
yet been reported to the Association. If there is an excess 
of assets over liabilities, necessary reserves and a reason-
able surplus, then a cash dividend shall be declared or a 
credit allowed to any health care provider who has com-
plied with the Association’s medical malpractice risk man-
agement program.
SEC. 211. DEFINITIONS. 
In this title, the following definitions apply: 
(1) ASSOCIATION.—The term ‘‘Association’’ 
means the Federal Medical Malpractice Insurance 
Association established under section 201. 
(2) MEDICAL MALPRACTICE INSURANCE.—The 
term ‘‘medical malpractice insurance’’ means insur-
ance against legal liability of the insured, and 
against loss, damage, or expense incident to a claim 
of such liability arising out of the death or injury of 
any person due to medical, dental, podiatric, cer-
tified nurse-midwifery, or hospital malpractice by 
any licensed physician, dentist, podiatrist, certified 
nurse-midwife, certified registered nurse anesthetist, 
hospital, or clinical psychologist. 
(3) HOSPITAL.—The term ‘‘hospital’’ means 
any of the following: 
(A) Any facility defined as a hospital 
under State law and issued an operating certifi-
cate as a hospital or nursing home, and those 
distinct parts of a facility that are subject to 
the powers of visitation, examination, inspec-
tion, and investigation of the State mental hy-
giene agency which provide hospital or nursing 
home service.
(B) Any ambulance service which is reg-
istered or certified under State law and which 
is designed and equipped to provide definitive 
acute medical care pursuant to rules and regu-
lations of the State health agency, which must 
include, but not be limited to, the provision of 
advanced life support services. 
(C) Any community mental health center 
operated by a State or unit of local government, 
holding an operating certificate issued by the 
State mental hygiene agency. 
(D) Any certified public or voluntary non-
profit home care service agency which possesses 
a valid certificate of approval issued under 
State public health law. 
TITLE III—LIMITING FRIVOLOUS 
MEDICAL MALPRACTICE SUITS 
SEC. 301. HEALTH CARE SPECIALIST AFFIDAVIT. 
(a) REQUIRING SUBMISSION WITH COMPLAINT.—No 
medical malpractice liability action may be brought by any 
individual unless, at the time the individual brings the ac-
tion (except as provided in subsection (b)(1)), it is accom-
panied by the affidavit of a qualified specialist that in-
cludes the specialist’s statement of belief that, based on 
a review of the available medical record and other relevant
material, there is a reasonable and meritorious cause for 
the filing of the action against the defendant. 
(b) EXTENSION IN CERTAIN INSTANCES.—
(1) IN GENERAL.—Subject to paragraph (2), 
subsection (a) shall not apply with respect to an in-
dividual who brings a medical malpractice liability 
action without submitting an affidavit described in 
such subsection if, as of the time the individual 
brings the action, the individual has been unable to 
obtain adequate medical records or other informa-
tion necessary to prepare the affidavit. 
(2) DEADLINE
FOR
SUBMISSION
WHERE
EX-
TENSION APPLIES.—In the case of an individual who 
brings an action for which paragraph (1) applies, 
the action shall be dismissed unless the individual 
(or the individual’s attorney) submits the affidavit 
described in subsection (a) not later than 90 days 
after obtaining the information described in such 
subparagraph. 
(c) QUALIFIED
SPECIALIST
DEFINED.—In sub-
section (a), a ‘‘qualified specialist’’ means, with respect 
to a medical malpractice liability action, a health care pro-
fessional who is reasonably believed by the individual 
bringing the action (or the individual’s attorney)—
(1) to be knowledgeable in the relevant issues 
involved in the action, 
(2) to practice (or to have practiced) or to teach 
(or to have taught) in the same area of health care 
or medicine that is at issue in the action, and 
(3) in the case of an action against a physician, 
to be board certified in a specialty relating to that 
area of medicine. 
(d) CONFIDENTIALITY
OF
SPECIALIST.—Upon a 
showing of good cause by a defendant, the court may as-
certain the identity of a specialist referred to in subsection 
(a) while preserving confidentiality. 
SEC. 302. SANCTIONS FOR FRIVOLOUS ACTIONS AND 
PLEADINGS. 
(a) SIGNATURE REQUIRED.—Every pleading, written 
motion, and other paper in any medical malpractice liabil-
ity action shall be signed by at least 1 attorney of record 
in the attorney’s individual name, or, if the party is not 
represented by an attorney, shall be signed by the party. 
Each paper shall state the signer’s address and telephone 
number, if any. An unsigned paper shall be stricken unless 
omission of the signature is corrected promptly after being 
called to the attention of the attorney or party. 
(b) CERTIFICATE OF MERIT.—By presenting to the 
court (whether by signing, filing, submitting, or later ad-
vocating) a pleading, written motion, or other paper, an 
attorney or unrepresented party is certifying that to the 
best of the person’s knowledge, information and belief, 
formed after an inquiry reasonable under the cir-
cumstances—
(1) it is not being presented for any improper 
purpose, such as to harass or to cause unnecessary 
delay or needless increase in the cost of litigation; 
(2) the claims, defenses, and other legal conten-
tions therein are warranted by existing law or by a 
nonfrivolous argument for the extension, modifica-
tion, or reversal of existing law or the establishment 
of new law; and 
(3) the allegations and other factual contentions 
have evidentiary support or, if specifically so identi-
fied, are reasonable based on a lack of information 
or belief. 
(c) MANDATORY SANCTIONS.—
(1) FIRST VIOLATION.—If, after notice and a 
reasonable opportunity to respond, a court, upon 
motion or upon its own initiative, determines that 
subsection (b) has been violated, the court shall find 
each attorney or party in violation in contempt of 
court and shall require the payment of costs and at-
torneys fees. The court may also impose additional
appropriate sanctions, such as striking the plead-
ings, dismissing the suit, and sanctions plus interest, 
upon the person in violation, or upon both such per-
son and such person’s attorney or client (as the case 
may be). 
(2) SECOND VIOLATION.—If, after notice and a 
reasonable opportunity to respond, a court, upon 
motion or upon its own initiative, determines that 
subsection (b) has been violated and that the attor-
ney or party with respect to which the determination 
was made has committed one previous violation of 
subsection (b) before this or any other court, the 
court shall find each such attorney or party in con-
tempt of court and shall require the payment of 
costs and attorneys fees, and require such person in 
violation (or both such person and such person’s at-
torney or client (as the case may be)) to pay a mon-
etary fine. The court may also impose additional ap-
propriate sanctions, such as striking the pleadings, 
dismissing the suit and sanctions plus interest, upon 
such person in violation, or upon both such person 
and such person’s attorney or client (as the case 
may be). 
(3) THIRD VIOLATION.—If, after notice and a 
reasonable opportunity to respond, a court, upon
motion or upon its own initiative, determines that 
subsection (b) has been violated and that the attor-
ney or party with respect to which the determination 
was made has committed more than one previous 
violation of subsection (b) before this or any other 
court, the court shall find each such attorney or 
party in contempt of court, refer each such attorney 
to one or more appropriate State bar associations 
for disciplinary proceedings, require the payment of 
costs and attorneys fees, and require such person in 
violation (or both such person and such person’s at-
torney or client (as the case may be)) to pay a mon-
etary fine. The court may also impose additional ap-
propriate sanctions, such as striking the pleadings, 
dismissing the suit, and sanctions plus interest, 
upon such person in violation, or upon both such 
person and such person’s attorney or client (as the 
case may be). 
SEC. 303. MANDATORY MEDIATION. 
(a) IN GENERAL.—In any medical malpractice liabil-
ity action, before such action comes to trial, mediation 
shall be required. Such mediation shall be conducted by 
one or more mediators who are selected by agreement of 
the parties or, if the parties do not agree, who are quali-
fied under applicable State law and selected by the court.
(b) REQUIREMENTS.—Mediation under subsection 
(a) shall be made available by a State subject to the fol-
lowing requirements: 
(1) Participation in such mediation shall be in 
lieu of any alternative dispute resolution method re-
quired by any other law or by any contractual ar-
rangement made by or on behalf of the parties be-
fore the commencement of the action. 
(2) Each State shall disclose to residents of the 
State the availability and procedures for resolution 
of consumer grievances regarding the provision of 
(or failure to provide) health care services, including 
such mediation. 
(3) Each State shall provide that such medi-
ation may begin before or after, at the option of the 
claimant, the commencement of a medical mal-
practice liability action. 
(4) The Attorney General, in consultation with 
the Secretary of Health and Human Services, shall, 
by regulation, develop requirements with respect to 
such mediation to ensure that it is carried out in a 
manner that—
(A) is affordable for the parties involved; 
(B) encourages timely resolution of claims;
(C) encourages the consistent and fair res-
olution of claims; and 
(D) provides for reasonably convenient ac-
cess to dispute resolution. 
(c) FURTHER REDRESS AND ADMISSIBILITY.—Any 
party dissatisfied with a determination reached with re-
spect to a medical malpractice claim as a result of an al-
ternative dispute resolution method applied under this sec-
tion shall not be bound by such determination. The results 
of any alternative dispute resolution method applied under 
this section, and all statements, offers, and communica-
tions made during the application of such method, shall 
be inadmissible for purposes of adjudicating the claim. 
SEC. 304. APPLICABILITY. 
(a) IN GENERAL.—Except as provided in section 303, 
this title shall apply with respect to any medical mal-
practice liability action brought on or after the date of 
the enactment of this Act in any State or Federal court, 
except that this title shall not apply to a claim or action 
for damages arising from a vaccine-related injury or death 
to the extent that title XXI of the Public Health Service 
Act applies to the claim or action. 
(b) PREEMPTION.—The provisions of this title shall 
preempt any State law to the extent such law relates to
malpractice liability actions on the basis of section 1331 
or 1337 of title 28, United States Code. 
SEC. 305. DEFINITIONS. 
In this title, the following definitions apply: 
(1) ALTERNATIVE DISPUTE RESOLUTION METH-
OD.—The term ‘‘alternative dispute resolution meth-
od’’ means a method that provides for the resolution 
of medical malpractice claims in a manner other 
than through medical malpractice liability actions. 
(2) CLAIMANT.—The term ‘‘claimant’’ means 
any person who alleges a medical malpractice claim, 
and any person on whose behalf such a claim is al-
leged, including the decedent in the case of an action 
brought through or on behalf of an estate. 
(3) HEALTH CARE PROFESSIONAL.—The term 
‘‘health care professional’’ means any individual who 
provides health care services in a State and who is 
required by the laws or regulations of the State to 
be licensed or certified by the State to provide such 
services in the State. 
(4) HEALTH
CARE
PROVIDER.—The term 
‘‘health care provider’’ means any organization or 
institution that is engaged in the delivery of health 
care services in a State and that is required by the 
laws or regulations of the State to be licensed or cer-
tified by the State to engage in the delivery of such 
services in the State. 
(5) INJURY.—The term ‘‘injury’’ means any ill-
ness, disease, or other harm that is the subject of 
a medical malpractice liability action or a medical 
malpractice claim. 
(6) 
MANDATORY.—The 
term 
‘‘mandatory’’ 
means required to be used by the parties to attempt 
to resolve a medical malpractice claim notwith-
standing any other provision of an agreement, State 
law, or Federal law. 
(7) MEDIATION.—The term ‘‘mediation’’ means 
a settlement process coordinated by a neutral third 
party and without the ultimate rendering of a formal 
opinion as to factual or legal findings. 
(8) MEDICAL MALPRACTICE CLAIM.—The term 
‘‘medical malpractice claim’’ means a claim against 
a health care provider, a health care professional, or 
a blood or tissue bank licensed or registered by the 
Food and Drug Administration in which a claimant 
alleges that injury was caused by the provision of (or 
the failure to provide) health care services, except 
that such term does not include—
(A) any claim based on an allegation of an 
intentional tort; or
(B) any claim based on an allegation that 
a product is defective or unreasonably dan-
gerous. 
(9) MEDICAL
MALPRACTICE
LIABILITY
AC-
TION.—The term ‘‘medical malpractice liability ac-
tion’’ means a civil action brought in a State or Fed-
eral court against a health care provider, a health 
care professional, or a blood or tissue bank licensed 
or registered by the Food and Drug Administration 
in which the plaintiff alleges a medical malpractice 
claim. 
(10) STATE.—The term ‘‘State’’ includes the 
District of Columbia and any commonwealth, terri-
tory, or possession of the United States.
Æ