Medical Malpractice Settlement Agreement

MEDICAL MALPRACTICE SETTLEMENT AGREEMENT AND MUTUAL RELEASE

(Minnesota)

1. PARTIES AND RECITALS

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

Recitals.
A. Claimant alleges that on or about [DATE OF CARE], Provider negligently rendered medical care, causing personal injuries (the "Claim").
B. The Claim is or could be the subject of an action styled [CASE CAPTION], [pending / threatened] in the [COURT], [COUNTY] County, Minnesota (the "Action"), filed (if applicable) within Minn. Stat. § 541.076.
C. Pursuant to Minn. Stat. § 145.682, Claimant has [served the required affidavit of expert review / would be required to serve such affidavit].
D. The Parties wish to resolve the Claim fully and finally without admission of liability, in accordance with Minnesota law.

2. SETTLEMENT PAYMENT

2.1 Total Settlement Amount. Provider/Carrier shall pay $[AMOUNT] (the "Settlement Amount") in full and final resolution of all Released Claims.

2.2 Payment Mechanics.
(a) Lump Sum. $[AMOUNT] by wire transfer or certified funds to "[CLAIMANT COUNSEL] IOLTA Trust Account" within [30] days after the latest of: (i) full execution; (ii) Provider's receipt of an executed W-9; (iii) Court approval (if required for a minor, incapacitated person, or wrongful-death claim under Minn. Stat. § 573.02); and (iv) confirmation of Medicare/Medicaid lien resolution per Section 5.

(b) Structured Settlement (optional). ☐ Periodic payments per the annuity schedule in Schedule A, funded through [ANNUITY ISSUER] (qualified under 26 U.S.C. § 130).

2.3 Allocation.
| Component | Amount | Tax Treatment |
|---|---|---|
| Physical injury / illness damages | $[__________] | Excluded under 26 U.S.C. § 104(a)(2) |
| Lost wages (if any) | $[__________] | Taxable |
| Emotional distress (origin in physical injury) | $[__________] | Excluded under § 104(a)(2) |
| Punitive damages (if any) | $[__________] | Taxable |
| Attorneys' fees / costs | $[__________] | Per IRC and engagement |

3. NO ADMISSION OF LIABILITY

This Agreement is a compromise of disputed claims. Provider expressly denies liability, fault, or wrongdoing. Nothing herein shall be construed as an admission of negligence, malpractice, or breach of the standard of care.

4. RELEASE AND DISMISSAL

4.1 General Release. Claimant, on behalf of Claimant and Claimant's heirs, executors, administrators, successors, and assigns, fully and forever releases and discharges Provider, Carrier, and their respective parents, subsidiaries, affiliates, officers, directors, partners, members, employees, agents, attorneys, insurers, reinsurers, and successors (collectively, "Released Parties") from any and all claims, demands, damages, actions, causes of action, suits, costs, expenses, and liabilities, known or unknown, accrued or unaccrued, arising out of or related to the Claim or the medical care rendered to [Claimant/Injured Party] by Provider (collectively, the "Released Claims").

4.2 Unknown Claims. Claimant expressly waives any benefit of any statute or rule that would limit the effect of this release as to unknown or unsuspected claims. Claimant acknowledges that Claimant may later discover facts different from those now known or believed, and assumes that risk.

4.3 Dismissal With Prejudice. Within [10] Business Days after receipt of the Settlement Amount, Claimant's counsel shall file a Stipulation of Dismissal With Prejudice under Minn. R. Civ. P. 41.01(a), each Party to bear its own costs and attorneys' fees except as set forth herein.

4.4 Court Approval (if required). Where the injured party is a minor or incapacitated person, the Parties shall jointly petition for court approval pursuant to Minn. Stat. § 540.08 / § 573.02 and Minn. Gen. R. Prac. 145 (minor settlements). Settlement is contingent on approval.

5. MEDICARE, MEDICAID, AND OTHER LIEN RESOLUTION

5.1 Medicare (MSP). Claimant represents (☐ is / ☐ is not) a Medicare beneficiary. Claimant shall (a) report this settlement to CMS as required by 42 U.S.C. § 1395y(b)(2) and Section 111 of the MMSEA; (b) obtain a final Conditional Payment Letter; and (c) satisfy all Medicare conditional payments from the Settlement Amount before disbursement.

5.2 Medicare Set-Aside (MSA). ☐ The Parties have considered Medicare's future-interest under 42 C.F.R. § 411.46. An MSA in the amount of $[AMOUNT] is funded per Schedule B, OR ☐ No MSA is required based on [reason].

5.3 Medicaid (MA / MinnesotaCare). Claimant shall notify the Minnesota Department of Human Services per Minn. Stat. § 256B.056, subd. 6, and § 256B.37, and satisfy any DHS subrogation lien from the Settlement Amount.

5.4 ERISA / Private Health Plan Liens. Claimant shall identify and resolve any ERISA, hospital, or workers' compensation liens.

5.5 Indemnification of Released Parties. Claimant shall indemnify, defend, and hold the Released Parties harmless from any lien, subrogation claim, or reimbursement demand asserted against the Settlement Amount.

6. NPDB AND REGULATORY REPORTING

6.1 NPDB. Provider/Carrier shall report this settlement to the National Practitioner Data Bank as and to the extent required by 42 U.S.C. § 11131 and 45 C.F.R. Part 60 within 30 days of payment. Provider may include a contemporaneous narrative under 45 C.F.R. § 60.6.

6.2 Minnesota Board Reporting. Carrier shall report to the Minnesota Board of Medical Practice (or applicable licensing board) as required by Minn. Stat. § 147.111 / § 60A.052.

6.3 No Restriction on Mandatory Reporting. Nothing in this Agreement restricts any Party's ability to comply with mandatory reporting obligations, respond to a subpoena, or cooperate with a government investigation.

7. CONFIDENTIALITY AND NON-DISPARAGEMENT

7.1 Confidentiality. The terms and amount of this Agreement are confidential. Disclosure is permitted only to: (a) the Parties' attorneys, accountants, tax advisors, lien holders, and insurers; (b) immediate family; (c) as required by NPDB / licensing-board reporting; (d) as required by law, court order, or valid subpoena (with prior notice to the non-disclosing Party where lawful); and (e) as required for tax filings or Medicare/Medicaid lien resolution.

7.2 No Gag on Patient Safety.

Nothing in this Section restricts Claimant from (a) reporting to the Minnesota Board of Medical Practice or any other licensing or regulatory body, (b) cooperating with a government investigation, or (c) discussing the underlying medical facts (as distinct from the settlement terms).

7.3 Non-Disparagement. Neither Party shall make public statements disparaging the other concerning the Claim or the underlying medical care, except as protected by law.

7.4 Liquidated Damages. Material breach of Section 7.1 entitles the non-breaching Party to actual damages or, at its election, liquidated damages of $[AMOUNT] per breach, the Parties agreeing that actual damages are difficult to ascertain.

8. REPRESENTATIONS AND WARRANTIES

8.1 Authority. Each Party represents it has full authority to enter into and perform this Agreement.
8.2 No Assignment of Claims. Claimant represents Claimant has not assigned or transferred any Released Claim.
8.3 Capacity; Independent Counsel. Claimant represents Claimant has read this Agreement, understands its terms, and has had the opportunity to consult independent counsel.
8.4 Tax Advice. No Released Party has provided tax advice; Claimant relies solely on Claimant's own advisors regarding 26 U.S.C. § 104(a)(2) and other tax issues.

9. GENERAL PROVISIONS

9.1 Governing Law; Venue. Minnesota law governs. Venue for any enforcement action lies in [COUNTY] County District Court, Minnesota.
9.2 Entire Agreement. This Agreement, with Schedules, is the entire agreement and supersedes all prior negotiations.
9.3 Amendment. Only by written instrument signed by both Parties.
9.4 Severability. If any provision is held unenforceable, the remainder remains in force; the Court may reform the provision to the minimum extent necessary.
9.5 Counterparts; E-Signatures. This Agreement may be executed in counterparts; electronic signatures are valid under Minn. Stat. § 325L.07.
9.6 Notices. All notices shall be in writing to the addresses set forth in Section 1.
9.7 Construction. No presumption against the drafter; the Parties have jointly drafted this Agreement with counsel.

10. EXECUTION

IN WITNESS WHEREOF, the Parties execute this Agreement as of the Effective Date.

Approved as to Form:

SCHEDULES

• Schedule A — Structured Settlement Annuity Schedule (if applicable)
• Schedule B — Medicare Set-Aside Allocation (if applicable)
• Schedule C — Lien Payoff Schedule (Medicare, Medicaid, ERISA, hospital)
• Schedule D — Stipulation of Dismissal With Prejudice (Minn. R. Civ. P. 41.01)

SOURCES AND REFERENCES

• Minn. Stat. § 145.682 — Certification of Expert Review; 60-day safe harbor (mandatory dismissal for non-compliance)
• Minn. Stat. § 541.076 — 4-year SOL for health-care-provider actions
• Minn. Stat. § 549.20 — Punitive damages procedure (motion to amend; clear-and-convincing standard)
• Minnesota has no statutory cap on noneconomic damages in medical malpractice
• Minn. Stat. § 573.02 / Gen. R. Prac. 145 — Wrongful-death and minor settlement approval
• 42 U.S.C. § 1395y(b)(2); 42 C.F.R. § 411.46 — Medicare Secondary Payer / MSA
• 42 U.S.C. § 11131; 45 C.F.R. Part 60 — NPDB reporting
• 26 U.S.C. § 104(a)(2) — Tax treatment of physical-injury recoveries