Alabama Medical Malpractice Settlement Agreement and Release

ALABAMA MEDICAL MALPRACTICE SETTLEMENT AGREEMENT AND RELEASE

Use note: This form is designed for a living, competent adult settling an identified Alabama medical-injury claim. Stop and obtain a claim-specific court-approval and authority plan before using it for a minor, protected person, estate, survival claim, or wrongful-death claim. Under Ala. Code § 6-5-410, an Alabama wrongful-death action is commenced by the personal representative and has its own recovery and distribution rules; replacing the claimant's name in this form is not enough.

1. SETTLEMENT PROFILE

1.1 Effective date and parties

This Agreement is made as of [__/__/____] by and among:

The persons and entities that will receive a release are listed individually in Exhibit A. A parent, affiliate, employee, contractor, insurer, or other person is not released merely because that category appears in boilerplate.

1.2 Claim and action

The parties dispute liability, causation, damages, defenses, and any other matter not expressly admitted here. Settlement is a compromise and not an admission of malpractice, fault, damages, or professional discipline.

1.3 Alabama Medical Liability Act screen

Ala. Code § 6-5-542 defines the covered health-care-provider and standard-of-care framework. Counsel shall confirm whether each claim and defendant is governed by the Alabama Medical Liability Act, another statute, or both.

The settlement parties do not rely on negotiations to extend a filing deadline. Counsel shall docket Ala. Code § 6-5-482, including its two-year act-or-omission period, six-month discovery provision, four-year outside limit, and special rule for a child under age four, together with every applicable accrual, tolling, repose, and claim-preservation issue.

If an action must be filed or remains pending, counsel shall also evaluate the mandatory venue rules in Ala. Code § 6-5-546. This contract does not select a claim forum that the statute forbids.

2. AUTHORITY AND APPROVAL GATES

Complete every applicable gate before funding:

• ☐ Claimant is a competent adult settling Claimant's own claims.
• ☐ Any loss-of-consortium or other derivative claimant is identified and signs this Agreement.
• ☐ No patient death is involved.
• ☐ If death is involved, Alabama counsel has replaced this form with a wrongful-death / estate-specific agreement and confirmed the personal representative's authority under Ala. Code § 6-5-410.
• ☐ No claimant is a minor or protected person.
• ☐ If a minor or protected person is involved, counsel has identified the required representative, guardian ad litem, hearing, court findings, order, restricted account, bond, annuity, trust, or conservatorship procedure.
• ☐ Any bankruptcy trustee, personal representative, guardian, conservator, insurer, employer plan, or other person with ownership or control of a claim has been identified.
• ☐ All required corporate, insurer, governmental, and court approvals are documented in Exhibit B.
• ☐ The persons signing for entities have written authority.

Unresolved authority issue: [NONE / DESCRIBE]

No release becomes effective for a person who lacks authority to give it.

3. SETTLEMENT CONSIDERATION

3.1 Gross settlement amount

Subject to the conditions in this Agreement, [PAYOR] shall pay a gross settlement amount of $[________].

The gross amount is allocated for payment administration as follows; the allocation does not bind a tax authority, public-benefit program, lienholder, or other nonparty:

3.2 Payment method

Payment shall be made by ☐ wire transfer ☐ trust check ☐ cashier's check ☐ other: [________________________________].

Receiving trust account or escrow: [________________________________]

Funding deadline: [__/__/____], subject only to these express conditions: [________________________________].

A payor may not treat delivery of money to the claimant as resolving a known Medicare, Medicaid, court-approval, or other holdback obligation stated in this Agreement.

3.3 Structured settlement — optional separate exhibit

☐ No structured settlement is used.

☐ A structured settlement is described in Exhibit C, approved by settlement, tax, benefits, and special-needs counsel as applicable. The exhibit must identify the assignment, assignee, annuity issuer, exact payment schedule, rated age assumptions, death-benefit terms, beneficiary designations, fees, ownership, anti-assignment terms, and consequences of insolvency. This Agreement does not promise tax qualification, present value, ratings, or joint liability unless Exhibit C expressly and accurately does so.

3.4 Nonmonetary consideration

Select and describe any nonmonetary term:

• ☐ None.
• ☐ Medical-record correction or addendum process: [________________________________].
• ☐ Return of property or records: [________________________________].
• ☐ Written communication: [________________________________].
• ☐ Other lawful term: [________________________________].

No term requires a false record, false report, interference with a regulator, or waiver of a duty that cannot be waived.

4. MEDICARE, MEDICAID, AND OTHER RECOVERY CLAIMS

4.1 Recovery inventory

4.2 Medicare process

If Medicare made a conditional payment, 42 C.F.R. § 411.24 gives CMS recovery rights against primary payers and entities that receive a primary payment, requires reimbursement within sixty days after receipt of a primary payment, and can require the primary payer to reimburse Medicare even after paying another party when Medicare was not timely reimbursed.

Before unrestricted distribution, the responsible parties shall:

• confirm Medicare status and case identifiers;
• report the claim and settlement through the applicable CMS process;
• obtain and review conditional-payment information;
• request the final demand or other required final amount;
• preserve the agreed holdback until the obligation is resolved; and
• retain proof of payment, waiver, compromise, appeal, or other closure.

The Medicare holdback may be released only under this written instruction: [________________________________].

4.3 Alabama Medicaid process

Ala. Code § 22-6-6 subrogates the State of Alabama to a Medicaid recipient's recovery rights to the extent of actual medical-assistance payments. The recipient must protect those rights. If the recipient files a civil action connected to the injury, subsection (c) requires written notice and a copy of the complaint and amendments to the Medicaid director and Alabama Attorney General within ten days after filing.

• Alabama Medicaid notified: ☐ Not applicable ☐ Yes, on [__/__/____] ☐ Pending
• Agency / recovery contractor contact: [________________________________]
• Claim number: [________________________________]
• Written resolution or holdback instruction: [________________________________]

4.4 No blanket lien warranty

Claimant does not warrant that every government or private recovery claim is already known or finally calculated. Instead, the parties adopt the inventory, notice, escrow, cooperation, dispute, and payment process stated here. Responsibility for an omitted interest is allocated as follows, subject to nonwaivable law: [________________________________].

No party may impair the United States', Alabama's, or another nonparty's rights by characterizing the settlement or release in a manner inconsistent with the facts.

5. RELEASE

5.1 Released occurrence

“Released Occurrence” means only the care, acts, omissions, events, injuries, and damages identified in Section 1.2 and Exhibit D, during the period [DATE] through [DATE].

5.2 Claimant's release

When the Release Effective Conditions in Section 5.5 are satisfied, Claimant releases each person specifically named in Exhibit A from claims that Claimant owns as of the Effective Date, whether presently known or unknown, arising from the Released Occurrence.

5.3 Claims not released

The release does not include:

• duties created by this Agreement or an approved structured-settlement exhibit;
• care, acts, omissions, or injuries outside the Released Occurrence;
• later, independent malpractice or other future conduct;
• a claim owned by a nonsigning spouse, child, estate, bankruptcy estate, governmental entity, benefit plan, insurer, or other person;
• Medicare, Medicaid, tax, child-support, reimbursement, reporting, licensing, disciplinary, or regulatory rights of a nonparty;
• a workers' compensation or employment claim unless expressly identified and lawfully released in Exhibit D; or
• a right that applicable law does not permit the claimant to waive.

5.4 Derivative claimant release

Each derivative claimant identified below releases only that claimant's own claims arising from the Released Occurrence, subject to the same exclusions:

5.5 Release effective conditions

The release becomes effective only when:

• the required parties have signed;
• all required court and representative approvals are entered and final;
• cleared funds and any structured-settlement funding are delivered as required;
• the Medicare, Medicaid, and other required holdbacks are funded; and
• the claimant receives a completed copy of this Agreement and its exhibits.

If these conditions are not satisfied by [__/__/____], the consequence is: [TERMINATION / EXTENSION / OTHER]. Counsel shall state how any expiring claim is preserved during that period: [________________________________].

5.6 Provider release — optional

☐ Provider gives no affirmative release beyond accepting the dismissal and Claimant's performance.

☐ Upon the Release Effective Conditions, Provider releases Claimant from claims for fees, costs, contribution, or other matters specifically listed here: [________________________________]. This does not release fraud in obtaining the settlement or breach of this Agreement unless expressly approved by counsel.

6. DISMISSAL AND CASE CLOSURE

6.1 Dismissal sequence

If an action is pending, Claimant's counsel shall hold signed dismissal papers in trust and file them only after:

• cleared funding and required holdbacks;
• entry of any minor, protected-person, estate, bankruptcy, probate, or other approval order;
• confirmation of which parties and claims will be dismissed; and
• satisfaction of any action-specific filing condition.

The dismissal shall be ☐ with prejudice as to the released parties and claims ☐ other: [________________________________].

Costs are allocated as follows: [________________________________].

6.2 Enforcement jurisdiction

If the parties want the pending court to enforce the settlement after dismissal, counsel shall identify and obtain any order required to preserve that authority before the case is closed.

6.3 Remaining parties or claims

Claims, defendants, cross-claims, liens, or proceedings not resolved by this Agreement: [NONE / DESCRIBE].

7. REQUIRED REPORTING AND CONFIDENTIALITY

7.1 Alabama insurer report

If an insurance company that sells medical-liability insurance to an Alabama physician, professional entity, hospital, or other health-care provider pays this settlement, Ala. Code § 27-26-5 requires the insurer to report the settlement to the appropriate state licensing agency within thirty days after the agreement to settle. The report includes the policyholder or involved physician, claimant, allegation summary, injuries, and settlement terms. The reporting insurer is [________________________________] and its responsible official is [________________________________].

7.2 NPDB report

Under 45 C.F.R. §§ 60.3, 60.5, and 60.7, an entity that makes a payment for the benefit of a health-care practitioner in settlement or partial settlement of a written medical-malpractice claim must report the payment to the National Practitioner Data Bank and appropriate state licensing board within thirty days. The reporting entity is [________________________________]. The parties shall provide accurate information reasonably needed for the report. Under § 60.7(d), the settlement payment does not create a presumption that malpractice occurred.

Nothing in this Agreement changes whether a payment is reportable, directs how a report should characterize facts contrary to law, or requires payment to be structured to evade reporting.

7.3 Confidentiality election

Select one after checking the court record, reporting duties, insurer requirements, public-entity law, tax, benefits, and professional rules:

• ☐ No contractual confidentiality obligation.
• ☐ The parties will not voluntarily disclose the settlement amount or nonpublic terms except as this section permits.

Any confidentiality obligation permits disclosure to courts, regulators, licensing boards, the NPDB, CMS, Medicaid, tax authorities, benefit programs, lienholders, insurers, reinsurers, auditors, attorneys, tax and financial advisors, immediate family or caregivers who agree to confidentiality, and as otherwise required by law or reasonably necessary to perform or enforce the settlement. It does not restrict truthful testimony, protected reporting, cooperation with government, or disclosure of information already lawfully public.

7.4 Public filing controls

Before filing this Agreement, counsel shall determine whether a redacted filing, separate settlement approval record, sealing motion, or other lawful process is appropriate. No party promises that a court will seal a record.

7.5 Statements about the dispute

☐ No non-disparagement term is selected.

☐ The parties shall not knowingly publish a false statement of fact about the Released Occurrence or settlement. This term does not prohibit opinions, truthful statements, privileged communications, required reports, testimony, or protected government communications.

8. TAX, BENEFITS, AND FUTURE CARE

8.1 No tax representation

Each recipient shall obtain independent tax advice. No party guarantees exclusion from income, allocation, deductibility, reporting form, or treatment of attorney fees, interest, punitive damages, confidentiality consideration, structured payments, or other components.

8.2 Public and private benefits

Before payment, Claimant shall obtain advice concerning Medicare, Medicaid, SSI, disability, means-tested benefits, special-needs planning, and any other benefit that may be affected. Any trust or planning vehicle must be approved and established separately before funds are transferred to it.

8.3 Future medical care

This Agreement does not promise Medicare approval of a future-medical allocation or shift responsibility for future care contrary to law. The parties' factual statement concerning future care is: [________________________________].

9. REPRESENTATIONS AND ACKNOWLEDGMENTS

9.1 Claimant

Claimant represents, after reasonable inquiry, that:

• Claimant has disclosed known assignments, bankruptcy interests, derivative claims, liens, reimbursement claims, and benefit interests in Exhibit E;
• Claimant has not sold or released the claims except as disclosed;
• Claimant has reviewed the agreement and had the opportunity to ask counsel questions;
• Claimant understands the release is final when its conditions are met; and
• Claimant is not relying on a tax, benefits, reporting, licensing, or future-care promise not written here.

9.2 Provider and payor

Provider and Payor represent that:

• the signers have authority;
• the funding instructions accurately state the agreed consideration;
• required insurer, licensing-board, NPDB, Medicare, Medicaid, and tax processes have an identified owner; and
• no undisclosed side agreement changes the release or consideration.

9.3 No admission; independent decision

The parties enter the settlement to avoid the cost, delay, burden, and uncertainty of continued dispute. Each party has made an independent decision with counsel and has not relied on a statement outside the signed agreement.

10. DEFAULT AND ENFORCEMENT

10.1 Payment default

If required funding is not delivered when due, Claimant shall give written notice and [____] business days to cure, unless delay would impair a nonwaivable deadline or court order. After an uncured default, Claimant may seek the unpaid amount and other relief permitted by the Agreement and applicable law.

Optional agreed interest on an uncured, due amount: [____]% per year, not exceeding the lawful rate. ☐ No default interest selected.

10.2 Nonpayment breach

For a nonpayment breach that can be cured, the breaching party has [____] business days after detailed written notice. No cure period applies if a court order or nonwaivable law requires immediate action.

10.3 Attorneys' fees

Select one:

• ☐ Each party bears its own fees in an enforcement dispute except where law or another signed agreement provides otherwise.
• ☐ The substantially prevailing party may recover reasonable enforcement fees and costs, subject to judicial review.
• ☐ Other: [________________________________].

10.4 Forum and jury

An enforcement action may be brought only in a court with subject-matter jurisdiction and lawful venue. Agreed forum, if enforceable: [________________________________].

No jury-trial waiver is included. Any proposed waiver must be separately drafted and reviewed under current Alabama law for the parties, agreement, and claims involved.

10.5 No stipulated judgment without signed terms

No party may enter a consent or stipulated judgment unless its amount, credit for payments, notice, cure, filing conditions, and scope are stated in a separately signed exhibit and any required court approval is obtained.

11. GENERAL TERMS

11.1 Notices

Contract notices shall be delivered to the counsel and party contacts in Section 1 by: [PERSONAL DELIVERY / OVERNIGHT SERVICE / CERTIFIED MAIL / AGREED EMAIL]. Notice is effective: [________________________________]. Government, lien, insurer, NPDB, court, and licensing notices must follow the law governing them.

11.2 Entire agreement; exhibits

This Agreement and signed Exhibits A through [____] are the entire settlement. An amendment must be in a writing signed by the affected parties and approved by a court or representative when the original agreement required that approval.

11.3 Governing law

Alabama law governs, without using a conflicts rule to select another state's law, except that controlling federal law governs federal reporting, Medicare, tax, and benefit issues.

11.4 Severability

If a provision is unenforceable, it shall be severed or enforced only to the lawful extent. A court may not broaden the Released Occurrence, released parties, or claims beyond the parties' signed description.

11.5 Counterparts and electronic signatures

The parties may sign counterparts and exchange signature copies electronically, subject to any court, guardianship, probate, insurer, notarization, identity, or record requirement identified by counsel.

11.6 No automatic assignment

No party may assign the Agreement except as expressly permitted in an approved structured-settlement, insurer-payment, trust, estate, or court order. An assignment does not eliminate the assignor's duties unless the affected party expressly agrees.

12. SIGNATURES

CLAIMANT

DERIVATIVE CLAIMANT, IF ANY

PROVIDER / SETTLING DEFENDANT

ADDITIONAL SETTLING DEFENDANT

INSURER OR OTHER PAYOR — ACKNOWLEDGMENT OF FUNDING AND REPORTING DUTIES

COUNSEL APPROVAL

EXHIBITS

• Exhibit A: Individually named released parties.
• Exhibit B: Authority, representative, insurer, and court approvals.
• Exhibit C: Structured-settlement terms, if any.
• Exhibit D: Released Occurrence and released-claim schedule.
• Exhibit E: Medicare, Medicaid, lien, assignment, bankruptcy, benefits, and derivative-claim disclosures.
• Exhibit F: Funding, escrow, and holdback instructions.
• Exhibit G: Dismissal papers and approval orders.
• Exhibit H: Other: [________________________________].

SOURCES AND VERIFICATION NOTES

• Alabama Legislature, current Code text for Ala. Code §§ 6-5-482, 6-5-410, 6-5-542, 6-5-546, 22-6-6, and 27-26-5, retrieved through the Legislature's official Code database.
• eCFR, 42 C.F.R. § 411.24 — Recovery of conditional payments.
• eCFR, 45 C.F.R. Part 60 — National Practitioner Data Bank, including §§ 60.3, 60.5, and 60.7.

END OF DOCUMENT