MUTUAL RELEASE AND MEDICAL MALPRACTICE SETTLEMENT AGREEMENT

(Georgia – Template)

[// GUIDANCE: This is a comprehensive template intended for use by Georgia-licensed counsel in resolving medical malpractice claims. Customize all bracketed sections, confirm factual accuracy, and ensure compliance with current Georgia law and applicable federal requirements before circulation.]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block

I. DOCUMENT HEADER

1.1 Title. Mutual Release and Medical Malpractice Settlement Agreement (the “Agreement”).

1.2 Parties.
(a) “Claimant”: [CLAIMANT FULL LEGAL NAME], [individual | personal representative | guardian ad litem], residing at [ADDRESS].
(b) “Provider”: [PHYSICIAN/ADVANCED PRACTICE PROVIDER NAME], a licensed health-care professional in the State of Georgia.
(c) “Practice Entity” (if applicable): [PRACTICE NAME], a [STATE] [corporation/LLC/LLP] with its principal place of business at [ADDRESS].
(d) “Insurer”: [INSURANCE CARRIER NAME], NAIC No. [NUMBER].

1.3 Effective Date. This Agreement is effective as of the latest date of execution indicated in Section X (the “Effective Date”).

1.4 Governing Law & Jurisdiction. This Agreement is governed by the laws of the State of Georgia, without regard to conflict-of-laws principles. Venue shall lie exclusively in the state courts located in [COUNTY], Georgia, as further detailed in Section VIII.

1.5 Recitals.
A. On or about [DATE OF ALLEGED INCIDENT] (“Incident Date”), medical services were rendered to Claimant at [LOCATION/INSTITUTION].
B. Claimant alleges that the care provided constituted medical malpractice, resulting in bodily injury and damages (the “Claims”).
C. Provider and Practice Entity deny all liability but desire to resolve the Claims to avoid the uncertainties and expenses of litigation.
D. The Parties therefore enter into this Agreement for valuable consideration, intending to be legally bound.

II. DEFINITIONS

The following capitalized terms have the meanings set forth below and apply throughout this Agreement. Defined terms appear in alphabetical order.

“Agreement” – As defined in Section 1.1.
“Claimant” – As defined in Section 1.2(a).
“Claims” – The allegations described in Recital B, including any known or unknown causes of action arising from the Incident.
“Defendant Parties” – Collectively, Provider, Practice Entity, Insurer, and their respective past and present owners, officers, directors, employees, agents, successors, and assigns.
“Effective Date” – As defined in Section 1.3.
“Medicare Secondary Payer Requirements” – The mandatory insurer reporting and conditional payment reimbursement obligations under 42 U.S.C. § 1395y(b) and implementing regulations.
“NPDB” – The National Practitioner Data Bank established under 42 U.S.C. §§ 11131-11133.
“Periodic Payments” – Any structured or annuitized settlement payments described in Section 3.3.
“Settlement Amount” – The total monetary consideration paid under Section 3.2, inclusive of Periodic Payments (if elected), costs, and attorneys’ fees.

[// GUIDANCE: Add or delete definitions to conform to the facts and settlement structure.]

III. OPERATIVE PROVISIONS

3.1 Dismissal of Actions.
(a) Within five (5) business days after receipt of the Initial Cash Payment (Section 3.2(a)), Claimant shall file with the [Court/Jurisdiction] fully executed dismissals with prejudice of any pending actions relating to the Claims.
(b) Each Party will bear its own court costs unless expressly included in the Settlement Amount.

3.2 Payment of Settlement Amount.
(a) Initial Cash Payment. Insurer shall pay Claimant $[AMOUNT] (“Initial Cash Payment”) within ten (10) business days after the later of (i) execution of this Agreement by all Parties, and (ii) receipt of a completed Form W-9 from Claimant’s counsel.
(b) Structured Component (Optional). If elected in Section 3.3, additional Periodic Payments will be funded through a qualified assignment to [ASSIGNEE COMPANY] pursuant to 26 U.S.C. § 130.
(c) Liability Cap. The Settlement Amount constitutes the maximum aggregate liability of the Defendant Parties for the Claims. No further sums shall be due.

3.3 Structured Settlement (Georgia-Specific).
[ ] Check if Not Applicable
[ ] Check if Applicable. Periodic Payments will be made in accordance with the Schedule attached as Exhibit A. The Parties agree to comply with all federal and state structured settlement requirements, including disclosure of cost, benefit, and funding source.

3.4 Liens & Reimbursement Obligations.
(a) Claimant shall satisfy or resolve all hospital, governmental, workers’ compensation, ERISA, or other liens arising from the Incident.
(b) Claimant indemnifies and holds harmless the Defendant Parties from any lien-holder claims or Medicare/Medicaid recoupment demands.
(c) The Parties shall cooperate to comply with Medicare Secondary Payer Requirements, including issuance of the required Section 111 report and conditional payment reimbursement.

3.5 Conditions Precedent.
The obligations of the Defendant Parties to pay the Settlement Amount are expressly conditioned upon:
(i) Receipt of all documents required under Section X;
(ii) Receipt of court approval if Claimant is a minor or legally incapacitated; and
(iii) Execution of releases substantially in the form attached as Exhibit B for all known and unknown claims.

IV. REPRESENTATIONS & WARRANTIES

4.1 Mutual Authority. Each Party warrants that it has full capacity, power, and authority to execute and perform this Agreement and that no additional consents are required.

4.2 No Assignment of Claims. Claimant represents that he/she has not assigned, pledged, or otherwise transferred any interest in the Claims.

4.3 Tax Advice Disclaimer. Each Party acknowledges that it has not relied on the other Party for tax advice and has been advised to seek independent tax counsel regarding the Settlement Amount and Periodic Payments.

4.4 Survival. The warranties in this Section survive the Effective Date and the dismissal of any related litigation.

V. COVENANTS & RESTRICTIONS

5.1 Mutual Release.
Effective upon receipt of the Settlement Amount, Claimant releases and forever discharges the Defendant Parties from any and all past, present, or future claims arising out of or in any way connected with the Incident, whether known or unknown, including wrongful death claims by Claimant’s heirs.

5.2 Confidentiality.
(a) Except as required by law or court order, the Parties shall keep the terms of this Agreement and the Settlement Amount confidential.
(b) Permitted disclosures include reporting to NPDB, CMS, state licensing boards, tax advisors, insurers, and as necessary to enforce this Agreement.

5.3 Non-Disparagement. Each Party agrees not to make any statement, written or oral, that would reasonably be expected to disparage or harm the reputation of another Party in relation to the Incident.

5.4 Cooperation in Reporting. Provider and Insurer shall timely comply with NPDB reporting obligations under 42 U.S.C. § 11131. Claimant shall execute all reasonably necessary documents to facilitate such reporting.

5.5 Further Assurances. The Parties agree to execute and deliver additional documents reasonably required to effectuate this Agreement.

VI. DEFAULT & REMEDIES

6.1 Events of Default.
(a) Failure of Insurer to deliver any payment when due under Section 3.2.
(b) Material breach of confidentiality or non-disparagement obligations.
(c) Any representation or warranty proving materially false or misleading.

6.2 Notice & Cure.
The non-defaulting Party shall provide written notice describing the default. The defaulting Party has seven (7) business days to cure monetary defaults and fifteen (15) calendar days to cure non-monetary defaults.

6.3 Remedies.
(a) If the default is not timely cured, the non-defaulting Party may:
(i) Accelerate any unpaid Periodic Payments;
(ii) Seek entry of judgment for the unpaid portion of the Settlement Amount plus interest at the statutory rate; and
(iii) Recover reasonable attorneys’ fees and costs incurred in enforcement.
(b) Specific performance and injunctive relief are available for breaches of Sections 5.2 or 5.3, notwithstanding Section VIII (Arbitration).

VII. RISK ALLOCATION

7.1 Indemnification – Mutual Release. Except for obligations expressly created by this Agreement, each Party waives and releases all claims against every other Party related to the Incident.

7.2 Limitations on Liability. The total liability of each Defendant Party arising out of this Agreement or the Incident shall not exceed the Settlement Amount.

7.3 Insurance. Insurer represents that the Settlement Amount is within the applicable policy limits and that no reservation of rights exists.

7.4 Force Majeure. No Party shall be liable for delays in performance caused by events beyond its reasonable control, provided that the affected Party promptly notifies the others and resumes performance as soon as practicable.

VIII. DISPUTE RESOLUTION

8.1 Governing Law. Georgia law governs all questions concerning the construction, validity, and enforcement of this Agreement.

8.2 Forum Selection. Any action arising from or relating to this Agreement shall be brought exclusively in the Superior Court of [COUNTY], Georgia.

8.3 Arbitration (Optional).
[ ] Check if Not Applicable
[ ] Check if Applicable. All disputes arising out of this Agreement shall be resolved by confidential, binding arbitration administered by the American Arbitration Association (“AAA”) under its Healthcare Claims Arbitration Rules. The arbitrator shall have authority to grant all remedies available at law or in equity. Judgment on the award may be entered in any court of competent jurisdiction.

8.4 Jury Trial Waiver (Optional).
[ ] Check if Not Applicable
[ ] Check if Applicable. EACH PARTY KNOWINGLY AND VOLUNTARILY WAIVES ITS RIGHT TO A TRIAL BY JURY FOR ANY DISPUTE ARISING OUT OF THIS AGREEMENT.

8.5 Attorneys’ Fees. The prevailing Party in any arbitration or court action to enforce this Agreement is entitled to recover its reasonable attorneys’ fees and costs.

IX. GENERAL PROVISIONS

9.1 Entire Agreement. This Agreement (including Exhibits) constitutes the entire understanding between the Parties and supersedes all prior negotiations.

9.2 Amendments & Waivers. No modification is effective unless in writing and signed by all Parties. No waiver of any breach is deemed a waiver of any other or subsequent breach.

9.3 Assignment. Except for a qualified assignment of Periodic Payments under Section 3.3, no Party may assign its rights or delegate its duties without prior written consent of the other Parties.

9.4 Successors & Assigns. This Agreement binds and benefits the Parties and their respective heirs, representatives, successors, and permitted assigns.

9.5 Severability. If any provision is held invalid or unenforceable, the remaining provisions remain effective, and the invalid provision shall be reformed to the minimum extent necessary to be valid.

9.6 Counterparts; Electronic Signatures. This Agreement may be executed in counterparts, each of which is deemed an original. Signature pages transmitted electronically (e.g., via PDF or e-signature platform) are binding.

9.7 Headings. Headings are for convenience only and do not affect interpretation.

X. EXECUTION BLOCK

IN WITNESS WHEREOF, the Parties have executed this Agreement as of the dates written below.

[// GUIDANCE: Attach notarization or witness acknowledgments if required by local rule or to bolster enforceability.]

Exhibit A – Structured Settlement Payment Schedule

[Include annuity issuer, periodic payment dates, and amounts.]

Exhibit B – Form of Release

[Attach any additional releases for spouses, parents, or derivative claimants.]

[// GUIDANCE: Georgia currently has no statutory cap on medical malpractice damages following judicial invalidation of prior legislation. Retain this placeholder for possible future legislative changes or if cap limitations apply under another jurisdiction.]