Medical Malpractice Settlement Agreement and Mutual Release (Mississippi)

MEDICAL MALPRACTICE SETTLEMENT AGREEMENT AND MUTUAL RELEASE

State of Mississippi

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions (Payment, Liens, Dismissal)
4. Pre-Suit Compliance Acknowledgments
5. Representations & Warranties
6. Covenants & Restrictions
7. Default & Remedies
8. Risk Allocation; Mutual Release
9. Tax, NPDB, and Reporting
10. Dispute Resolution
11. General Provisions
12. Execution Block

1. DOCUMENT HEADER

1.1 Parties

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

(a) [CLAIMANT FULL LEGAL NAME], an individual residing at [ADDRESS] ("Claimant"); and

(b) [HEALTHCARE PROVIDER FULL LEGAL NAME], a [LEGAL ENTITY TYPE] organized under the laws of [Mississippi / OTHER] with its principal place of business at [ADDRESS] ("Provider").

Claimant and Provider are each a "Party" and collectively the "Parties."

1.2 Recitals

A. Claimant alleges that Provider's medical care rendered on or about [DATE(S) OF CARE] at [FACILITY] caused personal injuries (the "Claim").
B. The Claim is or may be the subject of an action styled [CASE CAPTION], Cause No. [____], pending in the Circuit Court of [COUNTY] County, Mississippi (the "Action").
C. The Parties wish to resolve the Claim and the Action fully and finally, without admission of liability, consistent with Mississippi law, including Miss. Code Ann. §§ 11-1-58, 11-1-60, 11-1-65, and 15-1-36.

NOW, THEREFORE, in consideration of the mutual promises and recitals herein, the adequacy of which is acknowledged, the Parties agree as follows.

2. DEFINITIONS

"Action" — As defined in Recital B.

"Claim" — As defined in Recital A.

"CMS" — The Centers for Medicare & Medicaid Services.

"Effective Date" — As stated in Section 1.1.

"Noneconomic Damages Cap" — The $500,000 limit on noneconomic damages in medical malpractice actions under Miss. Code Ann. § 11-1-60(2)(b).

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

"Released Claims" — As defined in Section 8.2.

"Released Parties" — As defined in Section 8.2.

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

3. OPERATIVE PROVISIONS

3.1 Payment of Settlement Amount

(a) Provider (or its insurer) shall pay to Claimant the total Settlement Amount of $[SETTLEMENT_AMOUNT] on or before [SETTLEMENT_PAYMENT_DATE] by [WIRE TRANSFER / CASHIER'S CHECK] payable to [PAYEE — typically "[Law Firm] Trust Account FBO Claimant"].

(b) The Settlement Amount fully encompasses:
i. All economic damages (medical expenses, lost earnings, future care);
ii. All noneconomic damages, subject to the Noneconomic Damages Cap under Miss. Code Ann. § 11-1-60;
iii. Attorneys' fees and costs;
iv. All statutory liens, subrogation, and reimbursement obligations (Medicare, Medicaid, ERISA, hospital, workers' comp).

(c) Allocation (Optional). If allocation is desired for tax or lien purposes, attach Schedule 3.1(c) identifying portions allocated to economic versus noneconomic damages.

3.2 Structured Settlement (Optional)

If a Structured Settlement is elected:
(a) Provider (or its insurer) shall purchase a qualified assignment and annuity contract from a life insurer rated not less than A- by A.M. Best;
(b) Periodic payments per Schedule 3.2 (Periodic Payment Schedule);
(c) The annuity issuer and assignee shall be jointly and severally liable for periodic payments; no acceleration or commutation absent mutual written consent.

3.3 Medicare / Medicaid and Other Liens

(a) Medicare. Claimant shall, prior to disbursement, obtain a final demand from CMS in compliance with the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)(2), and shall satisfy any conditional payment obligation. The Parties acknowledge Medicare's interests have been considered and reasonably protected.
(b) Medicaid. Claimant shall resolve any Mississippi Division of Medicaid lien under 42 U.S.C. § 1396k and applicable Mississippi law before disbursement.
(c) Other Liens. Claimant shall satisfy or hold harmless Provider from all other known liens, including ERISA plan reimbursement, hospital liens, and workers' compensation liens. Known liens are itemized on Schedule 3.3.
(d) Lien Indemnity. Claimant indemnifies and holds Provider and Released Parties harmless from any claim by any lienholder seeking recovery from the Settlement Amount.

3.4 Dismissal of Action

Within [FIVE (5)] Business Days after Provider's full delivery of the Settlement Amount (or proof of fully funded Structured Settlement), Claimant shall file a Stipulation of Dismissal with Prejudice of the Action, each Party to bear its own costs except as otherwise provided herein.

3.5 Conditions Precedent

Provider's payment obligation is conditioned upon:
(a) Execution of this Agreement by all Parties;
(b) Delivery of executed IRS Form W-9 by Claimant's counsel;
(c) Receipt of executed dismissal documents held in escrow with [ESCROW AGENT]; and
(d) Court approval if required (e.g., minor's claim, wrongful-death distribution, conservatorship).

4. PRE-SUIT COMPLIANCE ACKNOWLEDGMENTS

4.1 60-Day Pre-Suit Notice (Miss. Code Ann. § 15-1-36(15)). The Parties acknowledge that Claimant served (or was excused from serving) the statutory 60-day pre-suit written notice of intention to sue identifying the legal basis and nature of the injuries.

4.2 Certificate of Expert Consultation (Miss. Code Ann. § 11-1-58). The Parties acknowledge that Claimant's counsel complied with the consultation requirements of Miss. Code Ann. § 11-1-58 (consultation with a qualified expert or applicability of an exception such as res ipsa loquitur or informed consent).

4.3 Statute of Limitations. The Parties acknowledge the applicable Mississippi medical-malpractice statute of limitations under Miss. Code Ann. § 15-1-36 has been considered and is not a barrier to this settlement.

5. REPRESENTATIONS & WARRANTIES

5.1 Authority. Each Party represents it has full power and authority to enter into and perform this Agreement.

5.2 No Assignment of Claims. Claimant represents that no part of the Claim or any Released Claim has been assigned to any third party.

5.3 Capacity. Claimant represents Claimant is of legal age, of sound mind, and has had the opportunity to consult with independent counsel.

5.4 Lien Disclosure. Claimant has disclosed all known liens on Schedule 3.3.

5.5 Survival. Representations survive the Effective Date for [eighteen (18) months], except those concerning lien indemnity (Section 3.3(d)) and assignment (Section 5.2), which survive indefinitely.

6. COVENANTS & RESTRICTIONS

6.1 Confidentiality.

Except as required by law (including NPDB and Mississippi State Board of Medical Licensure reporting), the Parties shall keep the terms and amount of this Agreement confidential. Permitted disclosures: tax advisors, insurers, lienholders, immediate family, counsel, and the court.

6.2 Non-Disparagement. Neither Party shall make any statement intended to defame or disparage the other concerning the Claim, the Action, or the underlying care.

6.3 No Admission of Liability. This Agreement is a compromise of disputed claims. Provider expressly denies liability, fault, or wrongdoing.

6.4 Cooperation. The Parties shall execute such further documents as reasonably necessary to effectuate this Agreement (lien releases, dismissal papers, W-9s).

6.5 Notice & Cure. A Party alleging breach shall provide written notice and a [ten (10) Business Day] cure period before exercising remedies.

7. DEFAULT & REMEDIES

7.1 Events of Default.
(a) Provider fails to deliver any payment when due;
(b) Claimant fails to file the dismissal within the timeframe in Section 3.4;
(c) Either Party materially breaches Section 6.1 or 6.2.

7.2 Remedies.
(a) Provider Default. Claimant may move for entry of a stipulated judgment in the Action for the unpaid balance plus statutory interest under Miss. Code Ann. § 75-17-7, attorneys' fees, and costs.
(b) Claimant Default. Provider may seek specific performance, dismissal of the Action with prejudice, and recovery of reasonable attorneys' fees.

7.3 Attorneys' Fees. The prevailing Party in any action to enforce this Agreement is entitled to recover reasonable attorneys' fees and costs.

8. RISK ALLOCATION; MUTUAL RELEASE

8.1 Limitation of Liability. Provider's aggregate liability arising from or related to the Claim is limited to the Settlement Amount.

8.2 Mutual Release.
(a) Released Claims. "Released Claims" means any and all past, present, or future claims, demands, causes of action, damages, or liabilities of every kind, known or unknown, arising out of or related to the Claim, the medical care at issue, or the Action.
(b) Released Parties. "Released Parties" includes the Parties and their respective parents, subsidiaries, affiliates, insurers, reinsurers, officers, directors, agents, employees, partners, successors, and assigns.
(c) General Release. Each Party fully and forever releases the other Party and all Released Parties from the Released Claims.
(d) Unknown Claims. The Parties expressly intend this Release to extend to claims that are presently unknown or unsuspected.

8.3 Force Majeure. No Party shall be liable for delays caused by events beyond its reasonable control, provided the affected Party gives prompt notice.

9. TAX, NPDB, AND REPORTING

9.1 Tax Treatment — IRC § 104(a)(2).

The Parties intend that the Settlement Amount be treated, to the extent applicable, as damages received on account of personal physical injuries or physical sickness excludable from gross income under 26 U.S.C. § 104(a)(2). No Party makes any representation or warranty as to tax consequences; Claimant is responsible for Claimant's own tax obligations.

9.2 No 1099 for Excludable Damages. Provider's insurer shall not issue Form 1099 for payments that are excludable under IRC § 104(a)(2), except where required by law (e.g., punitive damages, interest, attorneys' fees payable directly).

9.3 NPDB Reporting. Provider's insurer shall report this settlement to the National Practitioner Data Bank as required by 42 U.S.C. § 11131 and 45 C.F.R. Part 60. Provider shall furnish Claimant a copy of the NPDB report upon request as permitted by law.

9.4 Mississippi State Board of Medical Licensure. Insurer shall comply with any reporting required to the Mississippi State Board of Medical Licensure.

10. DISPUTE RESOLUTION

10.1 Governing Law. Mississippi law governs, without regard to conflict-of-laws principles.

10.2 Forum Selection. Exclusive venue in the Circuit Court of [COUNTY] County, Mississippi, which retains jurisdiction to enforce this Agreement.

10.3 Arbitration (Optional).

Upon written mutual election within ten (10) Business Days of the Effective Date, disputes shall be resolved by confidential binding arbitration before a single retired Mississippi judge under JAMS or AAA rules, seated in [CITY], Mississippi.

10.4 Jury Trial Waiver (Optional). EACH PARTY KNOWINGLY AND VOLUNTARILY WAIVES TRIAL BY JURY IN ANY PROCEEDING ARISING UNDER THIS AGREEMENT.

11. GENERAL PROVISIONS

11.1 Amendments; Waivers. Effective only in a writing signed by both Parties.

11.2 Assignment. No Party may assign without prior written consent, except Provider may assign to its insurer for payment purposes.

11.3 Successors & Assigns. Binds and benefits the Parties and their respective successors and permitted assigns.

11.4 Severability. Invalid provisions are narrowly construed; the remainder remains in effect.

11.5 Entire Agreement. This Agreement, with Schedules, is the entire understanding and supersedes all prior negotiations.

11.6 Counterparts; Electronic Signatures. Permitted; electronic signatures deemed original.

11.7 Voluntary Execution. Each Party acknowledges (a) it has read this Agreement; (b) had opportunity to consult counsel; (c) understands its terms; and (d) executes it voluntarily.

11.8 Court Approval (If Required). If Claimant is a minor, ward, or decedent's estate, this Agreement is contingent on entry of a Mississippi court order approving the settlement under applicable Mississippi law.

12. EXECUTION BLOCK

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

APPROVED AS TO FORM:

13. SCHEDULES

• Schedule 3.1(c) — Damages Allocation (Economic vs. Noneconomic)
• Schedule 3.2 — Periodic Payment Schedule (if Structured Settlement)
• Schedule 3.3 — Known Liens (Medicare / Medicaid / ERISA / Hospital / Workers' Comp)
• Exhibit A — IRS Form W-9
• Exhibit B — Stipulation of Dismissal with Prejudice (for filing)

Sources and References

• Miss. Code Ann. § 11-1-60 (noneconomic damages cap — $500,000 in medical malpractice)
• Miss. Code Ann. § 11-1-58 (Certificate of Expert Consultation)
• Miss. Code Ann. § 15-1-36 and § 15-1-36(15) (statute of limitations; 60-day pre-suit notice)
• Miss. Code Ann. § 11-1-65 (punitive damages; sliding-scale cap by defendant net worth)
• Miss. Code Ann. § 75-17-7 (post-judgment interest)
• 42 U.S.C. §§ 11131–11137 (NPDB); 45 C.F.R. Part 60 (NPDB regulations)
• 42 U.S.C. § 1395y(b)(2) (Medicare Secondary Payer)
• 42 U.S.C. § 1396k (Medicaid third-party liability)
• 26 U.S.C. § 104(a)(2) (tax exclusion for physical injury damages)