ADA website demand letters and lawsuits: what a medical practice should do

A letter arrives from a law firm you have never heard of. It says a blind patient tried to use your practice website with a screen reader, could not book an appointment or read your forms, and that your practice is violating the Americans with Disabilities Act. It asks you to fix the site, pay the firm’s fees and sign a settlement, and it gives you a short deadline. A letter can come with a draft complaint attached. A few practices learn about the claim only when a lawsuit is served.

This guide is for owners and managers of independent practices, dental offices, med spas, chiropractic and integrative clinics. It explains what these letters are, which federal and state laws they rely on, what the HHS rules for practices that receive federal financial assistance add, what to do in the first days after a letter arrives, and why an overlay widget is not an answer. For the technical side of making a site accessible, see our guide to website accessibility for medical practices.

The short version

• Do not ignore it, and do not answer it yourself. Note the date it arrived and the deadline, keep the envelope, and call a health care or disability rights defense attorney.
• A medical office is a public accommodation under the ADA. Title III lists the professional office of a health care provider by name.
• Private plaintiffs under Title III can get an injunction and attorney’s fees, not money damages. State laws are a different story: California’s Unruh Act sets a minimum of 4,000 dollars in damages per violation.
• Federal courts have not read the ADA the same way for websites. The Ninth Circuit tied coverage to the website’s connection to a physical place, which a practice with an office has.
• Practices that receive HHS financial assistance have a written standard. The HHS Section 504 rule requires WCAG 2.1 Level AA, with compliance dates now set for May 11, 2027, or May 10, 2028, depending on size.
• The DOJ’s 2024 Title II web rule covers public entities only. A private practice is not a public entity, though a county or hospital district clinic can be.
• An overlay widget does not end the claim. The FTC took action against one overlay maker in 2025 over claims that its tool could make any website meet WCAG.

What an ADA website demand letter is

A demand letter is a letter from a lawyer that states a claim and asks for something before a lawsuit is filed. In website accessibility cases, the letter says that a person with a disability, such as a blind or low vision person who uses a screen reader, ran into barriers on your website. It names barriers such as images without text alternatives, forms that cannot be completed by keyboard, or booking tools a screen reader cannot read.

The letter asks for two things. The first is a fix, which can come with a deadline and a named standard such as WCAG 2.1 Level AA. The second is money, framed as attorney’s fees and costs, and in states with damages laws, as damages. It may propose a settlement agreement with a release, a timeline for remediation and a confidentiality clause.

A letter is not a lawsuit, and it does not by itself create a court deadline. Its own deadline is the sender’s, not a judge’s. It can still be the first step toward a filed case, and what you say in reply can matter later, which is why the reply should come from counsel.

Why the ADA reaches a practice website

Title III of the ADA bars discrimination on the basis of disability by places of public accommodation. The statute’s list of public accommodations at 42 U.S.C. 12181(7)(F) names the professional office of a health care provider, along with hospitals and pharmacies. A medical, dental, chiropractic or med spa office open to the public fits that description.

The Department of Justice has said in its March 18, 2022 guidance that businesses open to the public must make the goods and services they provide accessible, including those provided online. The same guidance says the Department does not have a regulation setting detailed web standards for businesses, and that businesses have flexibility in how they comply. That gap is part of why these claims are argued in court rather than settled by a single rule.

Federal appeals courts have not all read the statute the same way for websites. In Robles v. Domino’s Pizza, decided January 15, 2019, the Ninth Circuit held that the ADA applied to the company’s website and app, and it called the connection between the website and the physical restaurants critical to its analysis. The Supreme Court denied review of that case on October 7, 2019, so it has not settled the question for the whole country. For a practice, the practical point is that its website books visits, shares forms and gives directions to a physical office, which is the kind of connection the Ninth Circuit relied on.

What a plaintiff can recover

Under federal law, a private person suing under Title III gets the remedies set out in 42 U.S.C. 2000a-3(a), which provides for a civil action for preventive relief, such as an injunction. Title III does not give a private plaintiff money damages. The ADA’s fee provision at 42 U.S.C. 12205 lets a court award a reasonable attorney’s fee, litigation expenses and costs to the prevailing party, and that fee claim is what drives the money side of a federal letter.

State laws can add damages. California’s Unruh Civil Rights Act, Civil Code section 51(f), says a violation of the ADA is also a violation of the Unruh Act. Civil Code section 52(a) allows actual damages and an amount up to three times actual damages, but in no case less than 4,000 dollars, plus attorney’s fees. New York’s Human Rights Law, Executive Law section 296(2)(a), makes it unlawful for a place of public accommodation to deny its accommodations, advantages, facilities or privileges because of disability. Other states have their own civil rights laws, so check yours.

If your practice receives federal financial assistance

Two HHS rules apply to practices that receive federal financial assistance from HHS. Whether your practice is a recipient depends on its payers and programs, so ask counsel.

• Section 504, 45 CFR 84.84. A recipient must make its web content and mobile apps meet WCAG 2.1 Level A and AA success criteria, unless it can show a fundamental alteration or undue financial and administrative burdens. As amended on May 11, 2026, the dates are May 11, 2027, for recipients with fifteen or more employees and May 10, 2028, for those with fewer than fifteen.
• Section 1557, 45 CFR 92.204. A covered entity must make its health programs and activities provided through information and communication technology accessible, with the same fundamental alteration and undue burden limits. Recipients must make health programs provided through websites and mobile apps meet Section 504 as interpreted consistent with Title II of the ADA.

These rules give a practice a named standard to work toward, and a demand letter that cites WCAG 2.1 Level AA is pointing at the same target. Our guide to Section 1557 website notices covers the notice side of that rule.

The DOJ Title II rule applies to public entities

In 2024 the Department of Justice adopted a web and mobile accessibility rule under Title II of the ADA, at 28 CFR 35.200. Title II covers state and local governments, and the rule applies to public entities. As amended on April 20, 2026, the compliance dates are April 26, 2027, for public entities with a total population of 50,000 or more, and April 26, 2028, for smaller public entities and special district governments.

An independent practice is not a public entity, so this rule does not apply to it directly. A clinic run by a county, a public hospital district or a state university can be one. A letter that cites the Title II rule against a private practice is citing the wrong rule, which is one more thing for your attorney to look at.

What to do in the first days

• Record the facts. Note when and how the letter arrived, keep the envelope or email, and calendar the deadline it gives.
• Call counsel before you reply. A health care or disability rights defense attorney can tell you whether the claim, the plaintiff and the firm have a record, and what a reply should and should not say. Do not admit a violation, promise a payment or sign anything first.
• Tell your insurer. Read your liability and cyber policies, or ask your broker, for notice requirements. A policy can set a time limit for reporting a claim.
• Preserve the site. Do not delete pages or take the site down in a panic. Save a dated copy of the pages named in the letter, and tell your web developer to keep change logs from here on.
• Get a real audit. Have the site tested against WCAG 2.1 Level AA by a person using a keyboard and a screen reader, not only by an automated scan. Ask for a written list of issues with the page, the criterion and the fix.
• Fix and document. Fix the barriers in order of impact on patients: booking, forms, phone and address, then the rest. Keep dated records of what was fixed and when.
• Give patients another way in today. Make sure the phone number on the site is easy to find and that the front desk can book and send forms by other means for anyone who asks.

Fixing the site does not by itself end a claim that has already been made, and your attorney will decide how the fixes are presented. It does reduce the chance of the next letter, and it helps real patients now.

Why an overlay widget is not the answer

An overlay is a script added to a website that offers a toolbar or claims to repair accessibility problems automatically. The Department of Justice guidance says automated checkers and overlays can be helpful tools but need to be used carefully, and that a clean report does not mean everything is accessible.

In January 2025 the FTC published a proposed consent order against one overlay maker. The FTC’s analysis says the company claimed its plug-in could make any website meet WCAG, and that the complaint alleged those claims were false, misleading or unsubstantiated. The order bars the company from making such claims without competent and reliable evidence. A widget added after a letter arrives may leave the barriers the letter names in place. The fix is in the site’s code, content and testing.

Questions to ask your attorney and your web team

• Is the claim in this letter about our website, our booking tool, our patient portal, or a third-party page we link to?
• Which laws does the letter cite, and do any state damages laws apply to us?
• Do we receive federal financial assistance from HHS, so that 45 CFR 84.84 and 92.204 apply to us?
• Who controls the third-party tools on our site, and what do their contracts say about accessibility?
• Has our site ever been tested by a person using a screen reader and a keyboard, and do we have the report?
• Does our liability or cyber policy cover this claim, and what notice does it require?
• What records will we keep from now on to show what we fixed and when?

Use and avoid

• Use: “We are reviewing your letter with counsel and will respond by [date].” sent by your attorney. Avoid: a reply from the office that admits the site is inaccessible or offers a payment.
• Use: “We aim to meet WCAG 2.1 Level AA. If any part of this site is hard to use, call [phone] and we will help.” on an accessibility page. Avoid: “This website fully meets the ADA.” when no audit backs it.
• Use: a manual audit against WCAG 2.1 Level AA with a written issue list. Avoid: an overlay widget installed in place of fixes.
• Use: dated change logs for each fix. Avoid: deleting the pages named in the letter.

An illustration

This example is invented. [Practice name], a chiropractic office in [Town], receives a letter saying a blind visitor could not complete the online booking form with a screen reader. The office manager calls the owner, who calls a defense attorney the same day and sends a copy to the practice’s insurance broker. The attorney handles all contact with the sender.

The web team saves a dated copy of the site, then has a tester go through the booking form, the new patient forms and the contact page by keyboard and with a screen reader. The report lists unlabeled form fields, a date picker that cannot be used by keyboard, and images of text on the forms page. The team fixes the form labels and the date picker first, replaces the images of text with real text, and records each fix with the date. The front desk is told to offer phone booking and emailed forms to anyone who asks, and the site’s accessibility page now gives the phone number for help.

Checklist

• The date the letter arrived and its deadline are recorded.
• An attorney has the letter, and no one at the office has replied on their own.
• The insurer or broker has been notified under the policy’s terms.
• A dated copy of the site is saved, and no pages were deleted.
• A manual WCAG 2.1 Level AA audit is done or scheduled.
• Fixes are made in order of patient impact and logged with dates.
• The phone number for help is easy to find on each page.
• Third-party booking, portal and form tools are checked and their contracts reviewed.
• No overlay widget is relied on as the fix.

How we help

We build practice websites, local SEO, Google Ads and lead generation and an AI front desk for independent practices. For accessibility, we build sites with semantic HTML, labeled forms and keyboard support aimed at WCAG 2.1 Level AA, test them by keyboard and screen reader, and keep dated records of fixes that your attorney can use. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. For the wider rules, see our healthcare marketing rules guide.

Sources

• 42 U.S.C. 12181: ADA definitions, including public accommodations
• 42 U.S.C. 12188: Enforcement of ADA Title III
• 42 U.S.C. 2000a-3: Civil actions for injunctive relief
• 42 U.S.C. 12205: Attorney’s fees
• U.S. Department of Justice: Guidance on Web Accessibility and the ADA (March 18, 2022)
• Robles v. Domino’s Pizza, LLC, No. 17-55504 (9th Cir. January 15, 2019)
• Supreme Court docket 18-1539, Domino’s Pizza, LLC v. Robles (petition denied October 7, 2019)
• 45 CFR 84.84: Requirements for web and mobile accessibility (Section 504)
• HHS: Extension of compliance dates for web content and mobile app accessibility (Federal Register, May 11, 2026)
• 45 CFR 92.204: Accessibility of information and communication technology (Section 1557)
• 28 CFR 35.200: Requirements for web and mobile accessibility (ADA Title II)
• DOJ: Extension of compliance dates for web accessibility of state and local government entities (Federal Register, April 20, 2026)
• California Civil Code section 51: Unruh Civil Rights Act
• California Civil Code section 52: Damages and attorney’s fees
• New York Executive Law section 296: Unlawful discriminatory practices
• FTC: Analysis of proposed consent order to aid public comment, 90 FR 647 (January 6, 2025)

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