Medical Malpractice Settlement Agreement and Release (Maine)

MEDICAL MALPRACTICE SETTLEMENT AGREEMENT AND RELEASE

(Maine — Comprehensive Settlement Template)

1. PARTIES

This Settlement Agreement and Release (the "Agreement") is entered into as of [__/__/____] (the "Effective Date") by and among:

The Releasees and Carrier are collectively the "Released Parties." The parties to this Agreement are collectively the "Parties."

2. RECITALS

A. On or about [__/__/____], Claimant received medical care from the Released Parties at [FACILITY/LOCATION] (the "Care Episode").

B. Claimant alleges that the Released Parties negligently provided care during the Care Episode and caused Claimant [INJURIES / WRONGFUL DEATH OF DECEDENT] (the "Claims").

C. The Claims [☐ are pending before a Prelitigation Screening Panel pursuant to 24 M.R.S. § 2853 (Notice of Claim filed [__/__/____], Docket No. [__________]); ☐ are pending in the Maine Superior Court for [___] County, Docket No. [__________]; ☐ have not yet been filed].

D. The Released Parties deny all allegations of negligence, causation, and damages.

E. To avoid the further expense, delay, and uncertainty of the Prelitigation Screening Panel and any litigation, and without any admission of liability, the Parties wish to compromise and resolve the Claims on the terms below.

3. SETTLEMENT PAYMENT

3.1 Total Settlement Amount. In consideration of the releases herein, the Carrier shall pay or cause to be paid the total sum of $[AMOUNT] (the "Settlement Amount").

3.2 Allocation. The Parties allocate the Settlement Amount as follows:

3.3 Payment Method. ☐ Lump sum by wire transfer or bank check; ☐ Structured settlement per Schedule A; ☐ Qualified settlement fund under 26 U.S.C. § 468B.

3.4 Payment Timing. The Settlement Amount shall be paid within [thirty (30)] days following the latest of:
(a) Claimant's execution and delivery of this Agreement;
(b) Receipt of a fully executed IRS Form W-9 from Claimant and Claimant's counsel;
(c) Probate court approval (if required under Section 6);
(d) Resolution of all Medicare, Medicaid (MaineCare), ERISA, and other liens per Section 7; and
(e) Dismissal of any pending action per Section 8.

4. RELEASE

4.1 General Release. Claimant, on behalf of Claimant and Claimant's heirs, executors, administrators, successors, and assigns, fully and forever releases, acquits, and discharges the Released Parties from any and all claims, demands, actions, causes of action, damages, costs, expenses, and liabilities of every kind, known or unknown, arising out of or in any way related to the Care Episode and the Claims.

4.2 Scope. The release expressly includes, without limitation:
(a) Claims for professional negligence, medical malpractice, lack of informed consent, and corporate negligence;
(b) Claims for wrongful death and survival under 18-C M.R.S. § 2-807;
(c) Claims for loss of consortium, loss of services, and emotional distress;
(d) Statutory claims under the Maine Health Security Act, 24 M.R.S. ch. 21;
(e) EMTALA, HIPAA, and any other federal claim arising from the Care Episode;
(f) Claims for punitive or exemplary damages;
(g) All claims for attorney's fees, costs, and interest.

4.3 Unknown Claims. Claimant expressly waives any and all claims arising out of the Care Episode that are presently unknown or unsuspected, and acknowledges that this Agreement extends to all such claims. Maine common law does not include a Cal. Civ. Code § 1542-style mandatory waiver, but Claimant nonetheless intends a comprehensive release.

4.4 Covenant Not to Sue. Claimant covenants not to file, prosecute, or join any action, claim, or proceeding against any Released Party arising out of the Care Episode.

4.5 Carve-Outs. This release does NOT release:
(a) The Parties' obligations under this Agreement;
(b) Future, unrelated medical care provided after the Effective Date;
(c) Worker's compensation rights (if any); or
(d) Vested benefits under any employee benefit plan.

5. NO ADMISSION OF LIABILITY

This Agreement is a compromise of a disputed claim. The Released Parties expressly deny any negligence, fault, or wrongdoing. Nothing herein shall be construed as an admission of liability, and this Agreement shall not be admissible in any other proceeding except as necessary to enforce its terms.

6. PROBATE / COURT APPROVAL

6.1 Minor or Incapacitated Claimant. ☐ If Claimant is a minor or incapacitated, this Agreement is contingent on approval by the Probate Court for [___] County, Maine, including any required guardian ad litem report.

6.2 Wrongful Death. ☐ If Claimant is the Personal Representative of a decedent's estate, this Agreement is contingent on approval by the Probate Court under 18-C M.R.S. § 2-807 and notice to and distribution among the statutory beneficiaries.

6.3 Court-Ordered Allocation. Allocation among statutory beneficiaries and between survival and wrongful-death components shall be determined by the Probate Court.

7. LIENS, SUBROGATION, AND MEDICARE / MEDICAID COMPLIANCE

7.1 Lien Identification and Resolution. Claimant represents and warrants that the following liens and reimbursement rights have been identified, and shall be fully satisfied or otherwise resolved by Claimant from the Settlement Amount before disbursement to Claimant:

7.2 Medicare Set-Aside. ☐ Not required (Claimant not Medicare-eligible and no reasonable expectation of eligibility within 30 months); ☐ A Liability Medicare Set-Aside Arrangement ("LMSA") in the amount of $[AMOUNT] is established per Schedule B.

7.3 Section 111 Reporting. Carrier shall report this settlement as required by 42 U.S.C. § 1395y(b)(8) (MMSEA Section 111). Claimant shall promptly provide all information needed (HICN/MBI, DOB, SSN, ICD codes).

7.4 Indemnity. Claimant shall indemnify, defend, and hold harmless the Released Parties from any claim asserted by any lienholder, subrogee, or governmental payer arising out of the Care Episode, including penalties under the Medicare Secondary Payer Act.

8. DISMISSAL AND PANEL WITHDRAWAL

8.1 Prelitigation Screening Panel. ☐ Within ten (10) days of receipt of the Settlement Amount, the Parties shall file a joint notice of resolution with the panel chair and request dismissal of the panel proceedings under 24 M.R.S. § 2853 and M.R. Civ. P. 80M.

8.2 Pending Civil Action. ☐ Within ten (10) days of receipt of the Settlement Amount, the Parties shall file a Stipulation of Dismissal with prejudice under M.R. Civ. P. 41(a)(1)(ii).

8.3 Pre-suit Settlement. ☐ Not applicable; no action pending.

9. NPDB AND BOARD REPORTING

9.1 NPDB Reporting. Claimant acknowledges that the Carrier or its agent is required by 45 C.F.R. Part 60 to report any payment made for the benefit of an individual practitioner to the National Practitioner Data Bank. Reporting in compliance with federal law is not a breach of confidentiality under this Agreement.

9.2 Allocation to Practitioner. The Released Parties may, in their discretion, allocate the Settlement Amount among practitioners and the Entity Releasee for NPDB-reporting purposes consistent with HCQIA.

9.3 Maine Board Reporting. Reporting to the Maine Board of Licensure in Medicine, Board of Osteopathic Licensure, or Board of Nursing required by statute or rule shall not be a breach.

10. CONFIDENTIALITY

10.1 Confidential Terms. The terms of this Agreement, including the Settlement Amount, are confidential. Claimant, Claimant's counsel, and the Released Parties shall not disclose them except:
(a) To attorneys, accountants, tax preparers, and financial advisors bound by confidentiality;
(b) To insurers, reinsurers, and risk managers;
(c) To Medicare, MaineCare, the IRS, the NPDB, the Maine Bureau of Insurance, and other regulators with reporting authority;
(d) To immediate family members bound to confidentiality;
(e) In response to a lawfully issued subpoena, with prompt notice to the other Parties; and
(f) As necessary to enforce this Agreement.

10.2 Non-Disparagement. Each Party agrees not to disparage the other in any public forum, including social media. This clause does not prohibit truthful statements to regulators, in litigation, or as otherwise required by law.

10.3 Remedy. Material breach of this Section 10 entitles the non-breaching Party to injunctive relief and actual damages.

11. TAX MATTERS

11.1 IRC § 104(a)(2). The Parties intend that amounts allocated to personal physical injuries or physical sickness be excludable from gross income under 26 U.S.C. § 104(a)(2). Punitive damages and pre/post-judgment interest are taxable.

11.2 No Tax Advice. No Released Party has given Claimant any tax advice. Claimant is solely responsible for the tax consequences of the Settlement Amount and shall consult independent tax counsel.

11.3 Reporting. The Carrier shall issue any required IRS Forms 1099 consistent with the allocation in Section 3.2.

12. REPRESENTATIONS AND WARRANTIES

12.1 Claimant represents and warrants that:
(a) Claimant has full authority to settle and release the Claims;
(b) Claimant has not assigned, transferred, or pledged any portion of the Claims;
(c) Claimant has identified all known lienholders and subrogees;
(d) Claimant has had a full and fair opportunity to consult with independent counsel; and
(e) Claimant enters this Agreement knowingly, voluntarily, and free of duress or undue influence.

12.2 Released Parties represent that they have authority to bind their respective insureds and to perform under this Agreement.

13. GENERAL PROVISIONS

13.1 Governing Law. Maine law governs, without regard to conflict-of-laws principles.

13.2 Forum. Exclusive jurisdiction in the Maine Superior Court for [___] County or the U.S. District Court for the District of Maine.

13.3 Entire Agreement. This Agreement, including Schedules, is the entire agreement and supersedes all prior negotiations.

13.4 Amendment. Only in a writing signed by all Parties.

13.5 Severability. Invalid provisions are reformed or severed; the remainder remains in force. The releases in Section 4 are non-severable consideration.

13.6 Counterparts; Electronic Signatures. Permitted under Maine UETA, 10 M.R.S. ch. 1051.

13.7 Attorneys' Fees. Each Party bears its own fees and costs in the underlying matter and in negotiating this Agreement. In any action to enforce this Agreement, the prevailing Party recovers reasonable fees and costs.

14. ACKNOWLEDGMENTS AND SIGNATURES

Claimant acknowledges:

☐ Claimant has read this Agreement in full;
☐ Claimant has had the opportunity to consult independent counsel;
☐ Claimant understands that this is a full and final release of all claims arising out of the Care Episode;
☐ Claimant has been informed of lien obligations and Medicare/MaineCare reporting; and
☐ Claimant signs voluntarily.

Approved as to form:

NOTARIZATION (Optional / Recommended for Wrongful Death and Minor Settlements)

State of Maine, County of [__________], ss.

On this [__] day of [__________], 20[__], before me personally appeared [CLAIMANT NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing instrument, who acknowledged that he/she executed the same for the purposes therein contained.

____________________________
Notary Public / Attorney-at-Law
My commission expires: [__/__/____]

SCHEDULES

• Schedule A — Structured Settlement Annuity Terms (if applicable)
• Schedule B — Liability Medicare Set-Aside Allocation (if applicable)
• Schedule C — Final Lien Resolution Documentation
• Schedule D — Probate Court Approval Order (if applicable)

SOURCES AND REFERENCES

• 24 M.R.S. ch. 21 — Maine Health Security Act
• 24 M.R.S. § 2853 — Submission of claims; Prelitigation Screening Panel: https://legislature.maine.gov/statutes/24/title24sec2853.html
• 18-C M.R.S. § 2-807 — Wrongful death damages (inflation-adjusted cap, 2024+): https://legislature.maine.gov/statutes/18-C/title18-Csec2-807.html
• 24 M.R.S. § 2931 — No claim for wrongful birth of healthy child
• M.R. Civ. P. 80M — Medical malpractice procedure
• 42 U.S.C. § 1395y(b) — Medicare Secondary Payer
• 42 U.S.C. § 1396k; 22 M.R.S. § 14 — MaineCare lien
• 45 C.F.R. Part 60 — NPDB reporting
• 26 U.S.C. § 104(a)(2) — Tax exclusion for physical injury damages

This template requires customization by a Maine-licensed attorney before execution. Verify the current inflation-adjusted wrongful death cap with the Maine Judicial Branch before allocating to wrongful-death components.