Certificate of Good Faith - Tennessee Health Care Liability Action (T.C.A. § 29-26-122)

CERTIFICATE OF GOOD FAITH — TENNESSEE HEALTH CARE LIABILITY ACTION

TABLE OF CONTENTS

1. Caption
2. Title
3. Statement of Counsel and Statutory Basis
4. Certifications by Counsel
5. Disclosure of Prior Violations
6. Extension Disclosure (If Applicable)
7. Defendant's Certificate (Non-Party Fault) — Optional Variant
8. Signature Block
9. Certificate of Service
10. Tennessee Practice Notes
11. Sources and References

1. CAPTION

IN THE [CIRCUIT / CHANCERY] COURT FOR [_____________________] COUNTY, TENNESSEE

[__________ JUDICIAL DISTRICT]

DOCKET NO. [________________________________]

2. TITLE

PLAINTIFF'S CERTIFICATE OF GOOD FAITH

(Filed Pursuant to T.C.A. § 29-26-122)

3. STATEMENT OF COUNSEL AND STATUTORY BASIS

The undersigned, [ATTORNEY NAME], BPR No. [####], counsel of record for Plaintiff [PLAINTIFF NAME] in the above-captioned health care liability action, files this Certificate of Good Faith pursuant to T.C.A. § 29-26-122, contemporaneously with the filing of the Complaint, and certifies as follows:

4. CERTIFICATIONS BY COUNSEL

4.1. Consultation with competent expert(s). The undersigned has consulted with one or more competent expert(s) regarding the care and treatment described in the Complaint.

4.2. Signed written statement obtained. The undersigned has obtained a signed written statement from each such expert confirming that:

• a. Upon information and belief, the expert is competent under T.C.A. § 29-26-115 and § 29-26-117 to express an opinion or opinions in this case, in that the expert was, during the one (1) year immediately preceding [DATE OF ALLEGED INJURY], licensed to practice in Tennessee or in a state contiguous to Tennessee a profession or specialty that would render the expert's testimony relevant to the issues in this case, and that the expert practiced such profession or specialty in one of these states during that year; AND
• b. The expert believes, based on the information available from the medical records reviewed concerning the care and treatment of Plaintiff for the incident or incidents at issue, that there is a good-faith basis to maintain this action consistent with the requirements of T.C.A. § 29-26-115.

4.3. Records reviewed. The expert(s) reviewed the medical records of Plaintiff produced by the providers identified in the pre-suit notice served pursuant to T.C.A. § 29-26-121, including without limitation:

• ☐ Records of [PROVIDER 1] for the date(s) of service [___/___/_____] to [___/___/_____]
• ☐ Records of [PROVIDER 2] for the date(s) of service [___/___/_____] to [___/___/_____]
• ☐ Records of [HOSPITAL / FACILITY] for the admission(s) of [___/___/_____]
• ☐ Imaging studies, laboratory results, operative reports, anesthesia records, nursing notes, and discharge summaries
• ☐ [Other records identified during the pre-suit notice period]

4.4. No improper purpose. This Certificate of Good Faith is not filed for any improper purpose and is filed in compliance with Tenn. R. Civ. P. 11.

5. DISCLOSURE OF PRIOR VIOLATIONS

5.1. Pursuant to T.C.A. § 29-26-122(d)(4), the undersigned discloses the number of prior violations of T.C.A. § 29-26-122 by the undersigned in the four (4) years preceding the filing of this Certificate:

☐ None.

☐ Prior violations: [____]. Particulars: [CASE STYLE, COURT, DOCKET NO., NATURE OF VIOLATION].

6. EXTENSION DISCLOSURE (IF APPLICABLE)

☐ Not applicable. No extension was sought; the Certificate is filed contemporaneously with the Complaint.

☐ Extension granted. On [DATE], the Court entered an Order extending the time for filing this Certificate to [DATE] for the following reason(s):

• ☐ A health care provider with relevant medical records failed to timely produce records on Plaintiff's timely request under T.C.A. § 29-26-121.
• ☐ Other good cause shown: [DESCRIBE].

A copy of the Order granting extension is attached as Exhibit 1.

7. DEFENDANT'S CERTIFICATE (NON-PARTY FAULT) — OPTIONAL VARIANT

(Use this section if a defendant is asserting non-party fault that requires expert testimony — file within 30 days after the answer/amended answer asserting non-party fault, T.C.A. § 29-26-122(b).)

7.1. The undersigned, counsel of record for Defendant [DEFENDANT NAME], certifies pursuant to T.C.A. § 29-26-122(b) that, in connection with the allegations of fault asserted against non-party [NON-PARTY NAME] in Defendant's [Answer / Amended Answer] filed on [DATE]:

• a. The undersigned has consulted with one or more experts who have provided a signed written statement;
• b. Each such expert is, upon information and belief, competent under T.C.A. § 29-26-115 to express an opinion in this case;
• c. Each such expert has stated that, based on review of the available medical records, there is a good-faith basis to allege fault against the non-party consistent with T.C.A. § 29-26-115.

7.2. Disclosure of prior § 29-26-122 violations by the undersigned in the four (4) years preceding this filing:

☐ None.

☐ Prior violations: [____]. Particulars: [CASE STYLE, COURT, DOCKET NO., NATURE].

8. SIGNATURE BLOCK

Date: [DATE]

Respectfully submitted,

[LAW FIRM NAME]

By: [________________________________]

[ATTORNEY NAME], BPR No. [####]

Counsel for [Plaintiff / Defendant]

[STREET ADDRESS]

[CITY], Tennessee [ZIP]**

Telephone: [NUMBER]

Facsimile: [NUMBER]

Email: [EMAIL]

9. CERTIFICATE OF SERVICE

I hereby certify that on this [____] day of [_______________], 20[____], a true and correct copy of the foregoing Certificate of Good Faith was served upon all counsel of record (or, where a party is unrepresented, upon the party) by [U.S. mail, postage prepaid / hand delivery / electronic service via the Court's e-filing system / facsimile / email pursuant to written agreement under Tenn. R. Civ. P. 5.02] at the following addresses:

[SERVICE LIST]

[________________________________]

[ATTORNEY NAME]

10. TENNESSEE PRACTICE NOTES

• Strict compliance. The Certificate must accompany the complaint where expert testimony is required by T.C.A. § 29-26-115. Filing late or filing a defective COGF subjects the action to dismissal with prejudice on motion. T.C.A. § 29-26-122(c). The Tennessee Supreme Court has rejected use of "saving statute" workarounds where the COGF is defective. Davis v. Ibach, 465 S.W.3d 570 (Tenn. 2015).
• No identification of expert. The COGF certifies counsel's consultation; do NOT name the expert in the certificate. The expert's identity is ordinarily protected through the discovery phase. Brandon v. Williamson Med. Ctr., 343 S.W.3d 784 (Tenn. Ct. App. 2010).
• Locality / contiguous-state rule. Reviewing expert must satisfy the locality / contiguous-state rule of § 29-26-115(b) and § 29-26-117 (TN, AL, AR, GA, KY, MS, MO, NC, VA). Confirm before retaining.
• Multiple experts permitted (and recommended where multiple specialties involved). A single COGF may rely on more than one expert; the certificate must remain accurate as to each.
• Defendants asserting non-party fault. Subject to a separate 30-day COGF deadline under § 29-26-122(b). Calendar carefully to avoid waiver of comparative-fault allocation.
• "Common knowledge" exception. Where the negligence is so obvious that no expert testimony is required (rare), § 29-26-122 does not apply by its terms (cross-reference § 29-26-115). Plead the basis carefully and consider filing a "no-expert-required" affidavit to insulate against motion practice.
• Pro se plaintiffs. § 29-26-122 applies to pro se plaintiffs; the trial court has limited discretion to relieve a pro se plaintiff from compliance.
• Disclosure of prior violations. Counsel MUST disclose any § 29-26-122 violation in the four preceding years (§ 29-26-122(d)(4)).
• Sanctions. § 29-26-122(d) directs the court to impose sanctions for noncompliant COGFs, including reasonable expenses (attorneys' fees) and reporting to the Board of Professional Responsibility.
• AOC form. A revised AOC form (rev. 9/24) is available at https://tncourts.gov/ — this template tracks that form's structure.

11. SOURCES AND REFERENCES

• T.C.A. § 29-26-122 — Filing of Certificate of Good Faith — https://www.capitol.tn.gov/
• T.C.A. § 29-26-115 — Claimant's burden; expert testimony
• T.C.A. § 29-26-117 — Expert witness qualification
• T.C.A. § 29-26-121 — Pre-suit notice
• Tenn. R. Civ. P. 11 — Signing of pleadings
• Tennessee Administrative Office of the Courts — Certificate of Good Faith Form (rev. 9/24) — https://tncourts.gov/sites/default/files/certificate_of_good_faith_-_med_mal_case_plaintife_form_revised_924.pdf
• Davis v. Ibach, 465 S.W.3d 570 (Tenn. 2015)
• Brandon v. Williamson Med. Ctr., 343 S.W.3d 784 (Tenn. Ct. App. 2010)
• Myers v. AMISUB (SFH), Inc., 382 S.W.3d 300 (Tenn. 2012)
• Stevens ex rel. Stevens v. Hickman Cmty. Health Care Servs., Inc., 418 S.W.3d 547 (Tenn. 2013)

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. The Tennessee Certificate of Good Faith is a mandatory filing requirement under T.C.A. § 29-26-122. Failure to comply is grounds for dismissal with prejudice. An attorney licensed in Tennessee must review and customize this document before filing. Verify all citations and current statutory language before use.