Medical Malpractice Settlement Agreement (Iowa)

comments; delete before execution.
3. Have document reviewed by Iowa counsel and a Medicare Set-Aside specialist if Medicare/Medicaid liens are involved.

JURISDICTION: IA
LAST UPDATED: 2026-05-11
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CONFIDENTIAL SETTLEMENT AGREEMENT AND RELEASE

(Iowa Medical Malpractice — Comprehensive Template)

TABLE OF CONTENTS

1. Parties and Recitals
2. Definitions
3. Settlement Consideration
4. Releases
5. Liens, Subrogation, and Medicare/Medicaid Compliance
6. NPDB and Board Reporting
7. Confidentiality and Non-Disparagement
8. Tax Treatment
9. No Admission of Liability
10. Representations and Warranties
11. Dispute Resolution
12. General Provisions
13. Execution Block

1. PARTIES AND RECITALS

1.1 Parties

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

Claimant, Provider, Facility, and Insurer are collectively the "Parties."

1.2 Recitals

A. On or about [DATE OF INCIDENT], Claimant received medical care from Provider at Facility (the "Subject Care").
B. Claimant asserts that Provider and/or Facility deviated from the applicable standard of care, causing personal injury (the "Claim").
C. Claimant [filed / threatened to file] an action styled [CASE CAPTION], Case No. [____], in the Iowa District Court for [COUNTY] County (the "Action").
D. A Certificate of Merit Affidavit under Iowa Code § 147.140 [has been / has not been] served.
E. The Parties wish to fully and finally compromise the Claim without admission of liability, recognizing that litigation would involve disputed issues under Iowa Code ch. 668 (comparative fault), Iowa Code § 147.136A (noneconomic damages caps), and Iowa Code § 614.1(9) (limitations and repose).

NOW, THEREFORE, in consideration of the mutual promises herein, the Parties agree as follows.

2. DEFINITIONS

"Claim" — Any and all claims, demands, causes of action, suits, or proceedings of any kind, known or unknown, arising out of or relating to the Subject Care.

"Effective Date" — The date last signed by all Parties.

"Lien Holders" — Medicare, Medicaid, ERISA plans, private health insurers, and any other entities asserting a subrogation, reimbursement, or statutory lien against the Settlement Amount.

"NPDB" — The National Practitioner Data Bank established under 42 U.S.C. § 11131 et seq.

"Released Parties" — Provider, Facility, Insurer, and each of their respective predecessors, successors, parents, subsidiaries, affiliates, officers, directors, employees, agents, attorneys, insurers, and reinsurers.

"Settlement Amount" — The total consideration set forth in Section 3.1.

3. SETTLEMENT CONSIDERATION

3.1 Total Amount. Insurer, on behalf of Provider and Facility, shall pay Claimant the gross sum of $[____] (the "Settlement Amount"), allocated as follows:

3.2 Payment Terms. The Settlement Amount shall be paid by check or wire transfer payable to "[CLAIMANT NAME] and [LAW FIRM NAME] as Attorneys" within [30] days after the latest of: (a) Effective Date; (b) receipt of a fully executed W-9 and dismissal documents; and (c) resolution of all known liens per Section 5.

3.3 Structured Settlement (Optional).

☐ A portion of the Settlement Amount, equal to $[____], shall be paid through a structured settlement annuity issued by [INSURER] under the terms set forth in Schedule A.

3.4 Attorneys' Fees and Costs. Each Party shall bear its own attorneys' fees and costs except as otherwise provided in the fee agreement between Claimant and Claimant's counsel.

4. RELEASES

4.1 General Release by Claimant. In consideration of the Settlement Amount, Claimant, on behalf of Claimant and Claimant's heirs, executors, administrators, successors, assigns, and any person claiming by, through, or under Claimant, hereby fully and forever releases, acquits, and discharges the Released Parties from any and all Claims arising out of or in any way connected with the Subject Care.

4.2 Scope. This release extends to all Claims, whether known or unknown, suspected or unsuspected, foreseen or unforeseen, including any claim that may later be discovered.

4.3 Carve-Outs. Notwithstanding the foregoing, this release does NOT release:
(a) Any obligation of the Parties arising under this Agreement;
(b) Claims for separate care or treatment not at issue in the Action; or
(c) Claims expressly preserved in Schedule B.

4.4 Dismissal. Within [10] business days after receipt of the Settlement Amount and confirmation of lien resolution, Claimant shall execute and file a Stipulation of Dismissal With Prejudice of the Action under Iowa R. Civ. P. 1.943.

5. LIENS, SUBROGATION, AND MEDICARE/MEDICAID COMPLIANCE

5.1 Lien Identification and Discharge. Claimant represents that all known Lien Holders are listed on Schedule C. Claimant shall satisfy or otherwise resolve all known liens from the Settlement Amount.

5.2 Medicare Compliance.
(a) Claimant represents Claimant [is / is not] a Medicare beneficiary and [does / does not] have a reasonable expectation of becoming a Medicare beneficiary within 30 months.
(b) Pursuant to the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)(2), Claimant shall obtain a Conditional Payment Letter from CMS/BCRC and resolve any Medicare conditional payments prior to disbursement.
(c) Medicare Set-Aside (MSA). ☐ A Medicare Set-Aside in the amount of $[____] [shall / shall not] be established per Schedule D, with consideration of CMS thresholds and review criteria.

5.3 Medicaid Compliance. Pursuant to 42 U.S.C. § 1396a(a)(25)(H) and Iowa Code § 249A.6, Claimant shall resolve any Iowa Medicaid (HHS/IME) recovery claim before disbursement.

5.4 Section 111 Reporting. Insurer shall comply with its Section 111 mandatory reporting obligations under 42 U.S.C. § 1395y(b)(8).

5.5 Indemnification (Liens). Claimant shall indemnify and hold harmless the Released Parties from any claim by a Lien Holder for amounts up to the Settlement Amount.

6. NPDB AND BOARD REPORTING

6.1 NPDB Acknowledgment. The Parties acknowledge that, under 42 U.S.C. § 11131 and 45 C.F.R. Part 60, payment by an insurer on behalf of an individual practitioner in resolution of a written claim or judgment must be reported to the NPDB. This Agreement does not, and cannot, waive that mandatory reporting obligation.

6.2 Iowa Board of Medicine Reporting. Nothing herein restricts any reporting obligation to the Iowa Board of Medicine under Iowa Code ch. 272C or related rules.

6.3 No Restraint on Reporting. Consistent with 42 U.S.C. § 11131(d) and applicable Iowa law, no provision of this Agreement shall be construed to restrict any Party from making truthful statements or disclosures to any federal or state regulator, the NPDB, or any licensing board.

7. CONFIDENTIALITY AND NON-DISPARAGEMENT

7.1 Confidentiality. The Parties agree that the terms of this Agreement, including the Settlement Amount, are confidential and shall not be disclosed to any third party except:
(a) As required by law, including NPDB and Board reporting and tax filings;
(b) To attorneys, accountants, tax advisors, lien holders, and insurers on a need-to-know basis;
(c) To immediate family on a need-to-know basis subject to confidentiality;
(d) In response to lawful subpoena, after notice to opposing counsel; or
(e) To enforce this Agreement.

7.2 Authorized Statement. If asked publicly about the Action, a Party may state only: "The matter has been resolved to the satisfaction of the Parties."

7.3 Non-Disparagement. No Party shall make any public statement disparaging the professional or personal reputation of another Party, except that nothing herein shall preclude truthful testimony under oath or truthful disclosures to regulators.

8. TAX TREATMENT

8.1 IRC § 104(a)(2). The Parties intend that payments allocated to personal physical injury in Section 3.1 be excludable from Claimant's gross income under 26 U.S.C. § 104(a)(2).

8.2 No Tax Advice. The Released Parties have made no representation regarding the tax treatment of any payment. Claimant is solely responsible for the tax consequences of the Settlement Amount and shall obtain independent tax advice.

8.3 Form 1099. Insurer shall issue any required IRS Form 1099 consistent with the allocation in Section 3.1.

9. NO ADMISSION OF LIABILITY

9.1 This Agreement is a compromise of a disputed claim. Provider, Facility, and Insurer expressly deny any liability or wrongdoing. Nothing in this Agreement, nor the negotiations leading to it, shall be construed as an admission of liability, fault, or wrongdoing by any Party.

9.2 This Agreement is inadmissible as evidence of liability under Iowa R. Evid. 5.408 and Fed. R. Evid. 408.

10. REPRESENTATIONS AND WARRANTIES

10.1 Capacity. Each Party warrants that the individual signing has full authority to do so on behalf of that Party.

10.2 No Assignment of Claim. Claimant warrants that the Claim has not been assigned, transferred, or hypothecated.

10.3 Court Approval (If Applicable). ☐ If Claimant is a minor or under legal disability, this Agreement is conditioned on Iowa District Court approval of the settlement under applicable Iowa probate and minor settlement rules, including approval of a conservatorship if required.

10.4 Informed and Voluntary. Each Party warrants that it has read this Agreement, has consulted with counsel of its choice, and enters into this Agreement knowingly and voluntarily.

11. DISPUTE RESOLUTION

11.1 Governing Law. This Agreement is governed by Iowa law without regard to conflict-of-laws principles.

11.2 Forum. Any action to enforce or interpret this Agreement shall be brought exclusively in the Iowa District Court for [COUNTY] County.

11.3 Attorneys' Fees on Enforcement. The prevailing Party in any enforcement action shall recover reasonable attorneys' fees and costs.

12. GENERAL PROVISIONS

12.1 Entire Agreement. This Agreement, with Schedules, constitutes the entire agreement and supersedes all prior negotiations.

12.2 Amendments. Only effective in writing signed by all Parties.

12.3 Severability. If any provision is unenforceable, the remainder remains in force; the court shall reform the provision to the minimum extent necessary.

12.4 Counterparts; Electronic Signatures. Counterparts permitted; electronic signatures (DocuSign, PDF) deemed original per Iowa Code ch. 554D.

12.5 Construction. Drafter rule waived; headings for convenience only.

12.6 Notices. All notices in writing, delivered personally, by overnight courier, or by certified mail to the addresses listed.

13. EXECUTION BLOCK

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

Notary Acknowledgment

State of Iowa, County of [____], ss:
On [DATE], before me, the undersigned Notary Public, personally appeared [NAME], proved to me on the basis of satisfactory evidence to be the person who executed the foregoing instrument, and acknowledged executing it as a voluntary act.
_____________________________
Notary Public, State of Iowa
My commission expires: [__/__/____]

SCHEDULES

• Schedule A — Structured Settlement / Annuity Terms (if applicable)
• Schedule B — Carved-Out Claims (if any)
• Schedule C — Known Lien Holders (Medicare, Medicaid, ERISA, private)
• Schedule D — Medicare Set-Aside Allocation (if applicable)

Sources and References

• Iowa Code § 147.136A (Noneconomic damages cap; HF 161, eff. Feb. 16, 2023): https://www.legis.iowa.gov/docs/code/147.136A.pdf
• Iowa Code § 147.140 (Certificate of merit affidavit): https://www.legis.iowa.gov/docs/code/147.140.pdf
• Iowa Code § 614.1(9) (Statute of limitations / repose for medical malpractice)
• Iowa Code ch. 668 (Comparative fault)
• 42 U.S.C. § 11131 et seq. (NPDB)
• 42 U.S.C. § 1395y(b)(2), (b)(8) (Medicare Secondary Payer; Section 111 reporting)
• 26 U.S.C. § 104(a)(2) (Federal tax exclusion)
• Iowa R. Evid. 5.408; Fed. R. Evid. 408 (Inadmissibility of settlement negotiations)

This template is provided for informational purposes only and should be reviewed by competent Iowa counsel before use. Tax allocations should be reviewed by a qualified tax professional.