Medical Malpractice Settlement Agreement and Mutual Release

MEDICAL MALPRACTICE SETTLEMENT AGREEMENT AND MUTUAL RELEASE

(Connecticut)

1. PARTIES AND RECITALS

1.1 Parties

The foregoing are each a "Party" and collectively the "Parties."

1.2 Recitals

A. Claimant alleges that the medical care rendered by Provider on or about [DATE(S) OF CARE] at [FACILITY] caused personal injury (the "Claim").
B. The Claim is the subject of the civil action captioned [CASE CAPTION], Docket No. [___], pending in the Connecticut Superior Court, Judicial District of [___] (the "Action").
C. The Action was commenced with a written opinion of a similar health care provider and a certificate of good faith under Conn. Gen. Stat. § 52-190a.
D. The Parties wish to fully, finally, and forever resolve the Claim and the Action without any admission of liability, fault, or wrongdoing.

NOW, THEREFORE, for valuable consideration, the receipt and sufficiency of which are acknowledged, the Parties agree as follows.

2. DEFINITIONS

"Action" – the civil action described in Recital B.
"Claim" – the matters described in Recital A and all Released Claims defined in Section 4.
"Effective Date" – the last date of signature by all Parties.
"Lienholder" – any person or entity asserting a statutory, contractual, or equitable right of reimbursement or subrogation, including Medicare, Medicaid (Conn. DSS, § 17b-265), ERISA plans, hospital liens, and Medicare Advantage organizations.
"Released Parties" – Provider, Insurer, and their affiliates, owners, employees, agents, officers, directors, successors, assigns, reinsurers, and attorneys.
"Settlement Amount" – the total consideration described in Section 3.1.

3. SETTLEMENT CONSIDERATION

3.1 Total Settlement Amount

Insurer shall pay, on behalf of Provider, the total sum of $[__________] (the "Settlement Amount"), payable as follows:

3.2 Periodic Payments (Optional)

☐ The Parties elect periodic payment treatment consistent with Conn. Gen. Stat. §§ 52-225f, 52-225g, and 52-225h, and IRC § 130. Insurer shall assign its future-payment obligation to a qualified assignee, which shall fund the payments through an annuity issued by [ANNUITY ISSUER]. The annuity payment schedule is attached as Exhibit A.

3.3 Timing

Insurer shall fund the Settlement Amount within [thirty (30)] days after the latest to occur of: (a) full execution of this Agreement; (b) receipt of a fully executed W-9 and any required Form 1099 documentation; (c) receipt of court approval (if required, e.g., minor or incapacitated person); and (d) resolution or set-aside of Medicare/Medicaid lien obligations.

3.4 Allocation

The Settlement Amount is allocated as follows for tax and lien purposes, without binding any taxing authority or Lienholder:

4. RELEASES

4.1 Claimant's Release

Claimant fully, finally, and forever releases the Released Parties from any and all claims, demands, causes of action, damages, costs, expenses, and liabilities of every kind, known or unknown, arising out of or related to the care described in Recital A or the Action, including all claims for negligence, lack of informed consent, EMTALA violations, vicarious liability, loss of consortium, and any derivative or future claims.

4.2 No Admission

This Agreement is a compromise of disputed claims. Neither this Agreement nor the Settlement Amount constitutes an admission of liability, fault, or wrongdoing by any Released Party.

4.3 Mutual Release

Provider and Insurer release Claimant from any counterclaim or claim for costs arising out of the Action, subject to Claimant's continuing obligations herein.

5. DISMISSAL OF THE ACTION

Within [fourteen (14)] days after Insurer's payment of the Settlement Amount and resolution of liens, Claimant shall file a stipulation of withdrawal/dismissal with prejudice of the Action under Conn. Practice Book § 14-1 et seq., with each Party bearing its own costs and fees except as set forth herein.

6. LIENS, MEDICARE, MEDICAID, AND SET-ASIDES

6.1 Claimant Responsibility

Claimant is solely responsible for identifying, negotiating, and satisfying all Liens, including:

6.2 Medicare Secondary Payer Compliance

Claimant represents Claimant's Medicare-eligibility status as [currently enrolled / not enrolled / within 30 months of eligibility] and shall reasonably consider the need for a Medicare Set-Aside arrangement. Claimant shall provide the BCRC Final Demand letter to Insurer before disbursement.

6.3 Indemnification of Lien Claims

Claimant shall indemnify, defend, and hold harmless the Released Parties from any Lien-related claim, double-damages action under 42 U.S.C. § 1395y(b)(3)(A), or DSS recovery action, up to the amount of the Settlement Amount actually received by Claimant.

6.4 Section 111 Reporting

Insurer shall comply with Mandatory Insurer Reporting under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (42 U.S.C. § 1395y(b)(8)).

7. CONFIDENTIALITY AND NON-DISPARAGEMENT

7.1 Confidentiality of Settlement Terms

The Parties shall keep the Settlement Amount and economic terms confidential, except for disclosures: (a) to attorneys, accountants, tax advisors, auditors, reinsurers, and lien-holders on a need-to-know basis; (b) as required by law, subpoena, court order, NPDB reporting (42 U.S.C. § 11131), or insurance regulator reporting; and (c) as required to enforce this Agreement.

7.2 Required Reporting Preserved

Nothing in this Agreement limits any Party's obligation to make required reports to the NPDB (42 U.S.C. § 11131), the Connecticut Department of Public Health, the Insurance Commissioner, peer-review committees, or law-enforcement authorities, or any Party's right to communicate with regulators or testify under subpoena.

7.3 Non-Disparagement

Each Party shall refrain from making knowingly false statements disparaging the other; this clause does not prohibit truthful statements to regulators, courts, or in response to legal process.

8. TAX TREATMENT

8.1 IRC § 104(a)(2)

The Parties intend that amounts allocated to compensatory damages on account of personal physical injuries or physical sickness be excluded from gross income under 26 U.S.C. § 104(a)(2). No Party makes any tax representation, and each Party shall consult independent tax counsel.

8.2 Reporting

Insurer shall issue any required Forms 1099 consistent with Section 3.4. Attorneys' fees paid directly to counsel shall be reported on Form 1099-MISC/NEC, as applicable.

9. REPRESENTATIONS AND WARRANTIES

9.1 Authority. Each signatory has authority to bind the Party for whom they sign.
9.2 No Assignment. Claimant has not assigned or transferred any portion of the Claim except as disclosed.
9.3 Capacity. Claimant is competent; if a minor or protected person, court approval under Conn. Practice Book § 32 is attached as Exhibit B.
9.4 Independent Counsel. Each Party has had opportunity to consult independent counsel.
9.5 Voluntariness. Execution is knowing and voluntary.

10. DEFAULT AND REMEDIES

10.1 Default. Failure to make payment within the time set in Section 3.3, or breach of any material covenant, after [10] days' written notice and opportunity to cure.
10.2 Remedies. Cumulative; include specific performance, contract damages, and prejudgment interest under Conn. Gen. Stat. § 37-3a.
10.3 Attorneys' Fees. The substantially prevailing Party in any enforcement action is entitled to reasonable attorneys' fees and costs.

11. GENERAL PROVISIONS

11.1 Governing Law. Connecticut law governs, without regard to conflicts principles.
11.2 Venue. Connecticut Superior Court, Judicial District of [___]; exclusive.
11.3 Notices. To addresses in Section 1.1 by certified mail or recognized courier.
11.4 Severability. Invalid provisions severed; remainder enforceable.
11.5 Entire Agreement. Supersedes all prior negotiations and term sheets.
11.6 Modification. Only in writing signed by all Parties.
11.7 Counterparts; Electronic Signatures. Permitted under Conn. Gen. Stat. § 1-266 et seq.
11.8 Headings. For convenience only.
11.9 Joint Drafting. No provision construed against any Party as drafter.

12. EXECUTION

Acknowledgment (Notarial):

State of Connecticut, County of [___], ss: [CITY], [DATE] — Personally appeared the above-named Claimant, signer and sealer of the foregoing instrument, who acknowledged the same to be a free act and deed, before me.

Notary Public / Commissioner of the Superior Court: __________________________

CLOSING CHECKLIST

☐ Section 52-190a certificate and expert opinion in file
☐ All Lienholders identified and resolved
☐ Medicare Final Demand obtained; MSA analysis documented (if applicable)
☐ DSS / Medicaid lien resolved per § 17b-265
☐ Court approval obtained (minor / protected person, if applicable)
☐ Stipulation of withdrawal/dismissal with prejudice prepared
☐ NPDB report drafted by Insurer per 42 U.S.C. § 11131
☐ Form 1099 / W-9 obtained
☐ Annuity / qualified assignment executed (if periodic payments)
☐ Disbursement statement signed by Claimant

SCHEDULES AND EXHIBITS

• Exhibit A – Periodic Payment Schedule and Qualified Assignment
• Exhibit B – Court Approval Order (minor/protected person, if applicable)
• Exhibit C – Lien Resolution Documentation
• Exhibit D – Stipulation of Withdrawal/Dismissal With Prejudice
• Exhibit E – Disbursement Statement

SOURCES AND REFERENCES

• Conn. Gen. Stat. § 52-184c (Standard of Care; Similar Health Care Provider)
• Conn. Gen. Stat. § 52-190a (Certificate of Good Faith; Expert Opinion)
• Conn. Gen. Stat. §§ 52-225a, 52-225f to 52-225h (Collateral Source; Periodic Payments)
• Conn. Gen. Stat. § 52-572h (Comparative Negligence)
• Conn. Gen. Stat. § 52-584 (Statute of Limitations)
• Conn. Gen. Stat. § 17b-265 (DSS Medicaid Lien)
• Conn. Gen. Stat. § 38a-816 (Unfair Insurance Practices)
• Conn. Gen. Stat. § 49-73 (Hospital Lien – verify applicability)
• 42 U.S.C. § 1395y(b)(2), (b)(3), (b)(8) (Medicare Secondary Payer; Section 111)
• 42 U.S.C. § 11131 et seq. (NPDB Reporting)
• 26 U.S.C. § 104(a)(2) (Tax Treatment of Personal Injury Damages)
• Connecticut Practice Book §§ 14-1, 32 (Withdrawal; Minors' Settlements)

Note on Damages Cap: Connecticut does not impose a statutory cap on noneconomic damages in medical malpractice actions. Allocation in Section 3.4 is for tax and lien purposes only.