The attorney's fee: compensation for the work
The contingency fee is the attorney's own compensation for handling the case — calculated as a percentage of the settlement or award. It's earnings, not a reimbursement, and it's what the attorney keeps for taking on the risk and the work of the case.
Case costs: real expenses the case required
Case costs are something entirely different: actual out-of-pocket expenses the case genuinely needed. This typically includes expert witness fees, court filing fees, the cost of obtaining medical records, deposition transcripts, and similar litigation expenses. These are reimbursed, not earned.
Why malpractice costs run especially high
A Pennsylvania medical malpractice claim typically requires more than one expert witness — often a standard-of-care expert to establish what the provider should have done, and a separate causation expert to connect the breach to the actual harm. Each expert's time reviewing records, preparing reports, and potentially testifying adds up, making the case cost total in a malpractice claim meaningfully larger than in a typical car accident case.
A gatekeeping cost before the case even proceeds
Pennsylvania generally requires a certificate of merit from a qualified expert early in a medical malpractice case, confirming there's a reasonable basis for the claim before it can move forward. That certification itself involves an upfront expert review cost — one of the first case expenses a malpractice claim typically incurs, well before any litigation costs begin accumulating.
Who fronts the money while the case is pending
Commonly, the attorney's office advances case costs as the litigation proceeds, with reimbursement coming out of the eventual settlement or award. Given how substantial malpractice-specific costs can be, it's worth confirming directly with a specific attorney how these costs are handled, including what happens to them if the case doesn't result in any recovery.