Medical Malpractice Settlement Agreement (District of Columbia)

MEDICAL MALPRACTICE SETTLEMENT AGREEMENT AND RELEASE

District of Columbia

1. PARTIES

This Medical Malpractice Settlement Agreement and Release (the "Agreement") is entered into as of [EFFECTIVE DATE] by and among:

Provider, Entity, and Insurer are collectively the "Released Parties."

2. RECITALS

A. On or about [INCIDENT DATE], Claimant alleges that Provider rendered medical care at [LOCATION] that resulted in injuries described as [BRIEF DESCRIPTION OF INJURY] (the "Incident").

B. Claimant served a Notice of Intention to File Suit under D.C. Code § 16-2802 on [NOTICE DATE], satisfying the 90-day pre-suit notice requirement.

C. [If suit filed:] On [FILING DATE], Claimant filed Civil Action No. [CASE NO.] in the Superior Court of the District of Columbia (the "Action"). The parties participated in early mediation pursuant to D.C. Code § 16-2821 on [MEDIATION DATE].

D. The Released Parties deny all liability, fault, and wrongdoing. This Agreement is a compromise of disputed claims and is not, and shall not be construed as, an admission of liability.

E. The Parties wish to settle all claims arising from the Incident on the terms below.

3. SETTLEMENT CONSIDERATION

3.1 Total Settlement Amount

In consideration of the releases and covenants below, Insurer shall pay, on behalf of the Released Parties, the total gross sum of $[AMOUNT] (the "Settlement Amount").

3.2 Allocation

3.3 Payment Terms

☐ Lump sum within [30] days of (i) full execution, (ii) lien resolution per Section 5, and (iii) entry of any required court approval order.
☐ Structured settlement per Schedule A (annuity issuer, periodic payments).
☐ Qualified Settlement Fund under 26 C.F.R. § 1.468B-1.

3.4 Payee and Form

Payment to be made by check or wire to "[CLAIMANT'S COUNSEL] IOLTA Trust Account FBO [CLAIMANT]" unless otherwise directed in writing.

3.5 Attorney's Fees and Costs

Attorney's fees and costs shall be paid from the Settlement Amount in accordance with the retainer agreement between Claimant and counsel. The Released Parties take no position on the reasonableness of fees.

4. COURT APPROVAL (If Required)

☐ Minor or Incapacitated Claimant. This Agreement is contingent on approval by the Superior Court of the District of Columbia, Probate Division, under D.C. Code § 21-120, and appointment of a [conservator / guardian ad litem] as needed.

☐ Wrongful Death / Survival. Approval by the Probate Division and any required allocation between wrongful death (D.C. Code § 16-2701) and survival (D.C. Code § 12-101) claims is documented in Schedule B.

☐ Adult Competent Claimant. No court approval required.

5. LIENS, SUBROGATION, AND HOLDBACKS

5.1 Medicare

Claimant represents and warrants that Claimant [is / is not] a Medicare beneficiary. Claimant shall:

☐ Provide a Conditional Payment Letter / Final Demand from CMS / BCRC
☐ Reimburse any Medicare conditional payments per 42 U.S.C. § 1395y(b)(2) and 42 C.F.R. § 411.24
☐ Consider Medicare's future interest (Medicare Set-Aside) where appropriate

5.2 Medicaid

If Claimant is a DC Medicaid recipient, Claimant shall satisfy any Medicaid lien per 42 U.S.C. § 1396k and D.C. Code § 4-602 before disbursement.

5.3 ERISA / Private Health Insurance

Claimant is responsible for resolving any ERISA plan or private health insurer subrogation interest.

5.4 Holdback

Claimant's counsel shall hold $[HOLDBACK AMOUNT] in trust pending final lien resolution.

5.5 Indemnification of Released Parties

Claimant agrees to indemnify and hold the Released Parties harmless from any lien, subrogation, or reimbursement claim of Medicare, Medicaid, ERISA plans, health insurers, or healthcare providers arising from treatment for the Incident.

6. RELEASE

6.1 General Release

In exchange for the Settlement Amount, Claimant fully releases, acquits, and forever discharges the Released Parties — together with their officers, directors, employees, agents, partners, successors, assigns, parents, subsidiaries, affiliates, reinsurers, and attorneys — from any and all claims, demands, causes of action, damages, costs, expenses, and liabilities of every kind, known or unknown, arising out of or relating to the Incident, including without limitation claims for negligence, gross negligence, medical malpractice, lack of informed consent, vicarious liability, agency, apparent agency, corporate negligence, intentional tort, EMTALA, wrongful death, survival, loss of consortium, and any DC consumer protection or statutory claim.

6.2 Unknown Claims

Claimant expressly waives any and all rights to assert claims that Claimant does not know or suspect to exist at the time of execution, arising from the Incident.

6.3 Survivors

The release binds Claimant's heirs, executors, administrators, personal representatives, successors, and assigns.

7. NPDB AND REGULATORY REPORTING

7.1 Acknowledgement

Claimant acknowledges that the Released Parties or Insurer may be required to report this settlement to the National Practitioner Data Bank under 42 U.S.C. § 11131 and 42 C.F.R. Part 60, and to other regulatory authorities including the D.C. Board of Medicine. Nothing in this Agreement waives or limits any such reporting obligation.

7.2 No Contractual Suppression

The Parties agree that this Agreement does not, and may not be construed to, prevent any required NPDB or licensing-board report.

8. CONFIDENTIALITY

8.1 Scope

The Parties agree to keep the existence, terms, and amount of this settlement confidential, except for disclosure: (a) to immediate family, attorneys, accountants, tax advisors, and lienholders bound by confidentiality; (b) as required by law, court order, subpoena, or regulatory authority; (c) to NPDB and licensing boards; (d) to enforce this Agreement; (e) for tax filings; or (f) as required for any audit.

8.2 Public-Record Carve-Out

If pleadings or settlement filings have become part of the public court record, the public information is outside the scope of this confidentiality clause.

8.3 Harassment / Discrimination Carve-Out

To the extent any factual allegation underlying the claim involves conduct prohibited by the D.C. Human Rights Act, nothing in this Agreement shall be construed to prohibit Claimant from speaking about such conduct.

8.4 Non-Disparagement

Each Party agrees not to make any false or defamatory statement about the other. Truthful statements to regulators, in court, or under subpoena are not violations.

8.5 Liquidated Damages

[Optional — Strike if not negotiated.] Any material breach of Section 8.1 shall give rise to liquidated damages of $[____], reflecting the difficulty of quantifying actual damages.

9. DISMISSAL AND COVENANTS

9.1 Dismissal

Within [10] business days of receipt of the Settlement Amount and execution by all Parties, Claimant shall file a Stipulation of Dismissal With Prejudice in the Action, each side to bear its own costs.

9.2 Covenant Not to Sue

Claimant covenants not to file, prosecute, or assist any further claim against the Released Parties arising from the Incident.

9.3 No Future Care Commitment

This Agreement does not obligate Provider or Entity to provide future medical care to Claimant.

10. REPRESENTATIONS AND WARRANTIES

Claimant represents and warrants that: (a) Claimant has full authority to enter this Agreement; (b) no claims relating to the Incident have been assigned to any third party; (c) all material liens have been disclosed; (d) Claimant has had the opportunity to consult independent counsel and tax advisors; and (e) Claimant signs voluntarily after full review.

11. TAX MATTERS

The Released Parties make no representation regarding tax treatment. Claimant is solely responsible for any tax consequences. The Parties intend the allocation in Section 3.2 to reflect compensation for personal physical injuries within the meaning of 26 U.S.C. § 104(a)(2), to the extent supported by the record. Insurer shall issue any required IRS Forms 1099 consistent with the allocation.

12. GENERAL PROVISIONS

12.1 Governing Law and Forum

This Agreement is governed by the laws of the District of Columbia. Exclusive jurisdiction and venue for any enforcement action lies in the Superior Court of the District of Columbia.

12.2 Entire Agreement

This Agreement, with its Schedules, is the entire agreement between the Parties regarding the Incident and supersedes all prior negotiations and writings.

12.3 Amendment

Amendable only by a writing signed by all Parties.

12.4 Severability

If any provision is held unenforceable, the remainder shall remain in full force, and the unenforceable provision shall be reformed to the minimum extent necessary.

12.5 Construction

The Agreement was jointly drafted; ambiguities shall not be construed against any Party.

12.6 Counterparts / Electronic Signature

May be executed in counterparts and by electronic signature (DC Uniform Electronic Transactions Act, D.C. Code § 28-4901 et seq.).

12.7 No Admission

This Agreement is a compromise of disputed claims. Nothing herein constitutes an admission of liability or wrongdoing.

13. EXECUTION

Notarization (Optional)

District of Columbia, SS:
Subscribed and sworn before me this [__/__/____].
Notary Public: __________________________ My commission expires: [__/__/____]

SCHEDULES

• Schedule A — Structured Settlement Terms (if applicable)
• Schedule B — Wrongful Death / Survival Allocation (if applicable)
• Schedule C — Medicare Conditional Payment / MSA Documentation
• Schedule D — Medicaid / ERISA / Health-Plan Lien Resolution
• Schedule E — Stipulation of Dismissal With Prejudice
• Schedule F — NPDB Report (informational copy)

SOURCES AND REFERENCES

• D.C. Code § 16-2802 (Notice of Intention to File Suit): https://code.dccouncil.gov/us/dc/council/code/sections/16-2802
• D.C. Code § 16-2803 (Extension of statute of limitations): https://code.dccouncil.gov/us/dc/council/code/sections/16-2803
• D.C. Code § 16-2821 (Mediation requirement): https://code.dccouncil.gov/us/dc/council/code/sections/16-2821
• DC Courts Medical Malpractice Mediation: https://www.dccourts.gov/services/mediation-matters/medical-malpractice
• 42 U.S.C. § 11131 et seq. (NPDB); 42 C.F.R. Part 60
• 42 U.S.C. § 1395y(b)(2) (Medicare Secondary Payer); 42 U.S.C. § 1396k (Medicaid)
• 26 U.S.C. § 104(a)(2) (tax treatment of personal physical injury damages)

Disclaimer: This template is for informational use only and is not legal advice. Medical malpractice settlements involve complex lien, tax, NPDB, and confidentiality issues. Have this reviewed and customized by DC-licensed counsel and lien-resolution specialists before use.