Medical Malpractice Settlement Agreement and Release (North Dakota)

CONFIDENTIAL SETTLEMENT AGREEMENT, RELEASE, AND INDEMNIFICATION

(North Dakota Medical Malpractice)

1. PARTIES

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

(a) [CLAIMANT/PLAINTIFF NAME], residing at [ADDRESS] ("Releasor");

(b) [PROVIDER / FACILITY NAME], a [ND professional corporation / hospital / health system] ("Provider Releasee");

(c) [INSURER NAME], professional liability insurer for Provider Releasee ("Insurer"); and

(d) [OTHER RELEASED PARTIES, if any] (collectively with Provider Releasee, the "Releasees").

2. RECITALS

A. Releasor asserted claims of medical negligence, lack of informed consent, and related theories against Releasees arising out of care rendered on or about [__/__/____] at [FACILITY, ND] (the "Incident").

B. ☐ Suit was filed as [Case Caption], [County] County District Court, [Judicial District], Case No. [__________] (the "Action"); OR ☐ no suit has been filed.

C. Releasor served (or would serve) an expert affidavit under N.D.C.C. § 28-01-46 dated [__/__/____].

D. Releasees deny all liability. The Parties wish to resolve all disputes without admission of fault and without further litigation.

3. CONSIDERATION

3.1 Settlement Payment. In full and final settlement, Insurer/Releasees shall pay Releasor the gross sum of $[__________] ("Settlement Amount"), payable within [thirty (30)] days after the latest of: (a) full execution; (b) court approval (if required under Section 6); and (c) receipt of completed IRS Forms W-9 and any Medicare/Medicaid lien clearance.

3.2 Allocation. The Parties allocate the Settlement Amount as follows, consistent with N.D.C.C. § 32-42-02 and IRC § 104(a)(2):

3.3 Form of Payment. ☐ Lump sum to Releasor's counsel's IOLTA trust account; ☐ Structured settlement annuity per Exhibit A; ☐ Combination.

3.4 Tax Treatment. The Parties intend that payments allocated to physical-injury-based damages be excludable from gross income under IRC § 104(a)(2). Releasor acknowledges that Releasees and Insurer make no representation regarding tax treatment and that Releasor has had the opportunity to obtain independent tax advice.

4. RELEASE

4.1 General Release. Releasor, on behalf of Releasor and Releasor's heirs, executors, administrators, successors, assigns, spouses, beneficiaries, and personal representatives, fully and forever releases and discharges Releasees and their parents, subsidiaries, affiliates, partners, officers, directors, employees, agents, insurers, reinsurers, attorneys, and successors from any and all claims, demands, causes of action, damages, costs, attorneys' fees, and liabilities of every kind, known or unknown, arising out of or relating to the Incident or the Action, including but not limited to claims for medical negligence, lack of informed consent, EMTALA violations, vicarious liability, loss of consortium, wrongful death, and any derivative claims.

4.2 Unknown Claims. Releasor expressly waives any rights or benefits otherwise conferred by any statute or common-law rule providing that a general release does not extend to claims unknown at the time of execution.

4.3 Scope. This release does NOT extend to (a) enforcement of this Agreement; (b) future medical care not arising from the Incident; or (c) workers' compensation or first-party benefits not subject of the Action.

5. LIENS, SUBROGATION, AND COLLATERAL SOURCES

5.1 Medicare / Medicaid. Releasor represents that Releasor ☐ is / ☐ is not a Medicare beneficiary. Releasor shall obtain a Medicare Final Conditional Payment letter and, if applicable, a Medicare Set-Aside, and shall satisfy all obligations under the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)(2). Releasor shall similarly resolve any ND Medicaid lien under N.D.C.C. § 50-24.1-02.1.

5.2 Other Liens. Releasor shall satisfy or hold harmless Releasees from all liens, including ERISA plan, TRICARE, VA, hospital, and provider liens.

5.3 Indemnification. Releasor shall indemnify, defend, and hold harmless Releasees and Insurer from any claim for reimbursement, subrogation, or contribution asserted by any lienholder, government payor, health plan, or third party arising from the Incident or this settlement.

6. COURT APPROVAL AND SPECIAL APPROVALS

6.1 ☐ Minor / Incapacitated Claimant. If Releasor is a minor or incapacitated adult, this Agreement is contingent on approval by the [__________] County District Court under N.D.C.C. ch. 30.1-26 / ch. 30.1-29 and applicable Rules of Court.

6.2 ☐ Wrongful Death. If a wrongful-death claim, this Agreement is contingent on probate-court approval under N.D.C.C. ch. 32-21 and any required allocation among statutory beneficiaries.

6.3 ☐ Dismissal. Within [fourteen (14)] days of funding, the Parties shall file a Stipulation of Dismissal With Prejudice in the Action, each Party bearing its own costs.

7. NPDB AND REGULATORY REPORTING

7.1 The Parties acknowledge that Insurer or Releasees (as applicable) may be required to report this settlement to the National Practitioner Data Bank under 42 U.S.C. § 11131 and 45 C.F.R. Part 60 if payment is made for the benefit of a licensed practitioner.

7.2 Nothing in this Agreement prevents or restricts any Party from (a) making any required NPDB report; (b) responding truthfully to any inquiry from the ND Board of Medicine, ND Board of Nursing, CMS, OIG, or any other regulator; or (c) complying with a subpoena or court order.

7.3 Releasees and Insurer make no representation regarding the content of any NPDB report.

8. CONFIDENTIALITY AND NON-DISPARAGEMENT

8.1 The terms and amount of this Agreement are confidential. Releasor and Releasor's counsel shall not disclose them except to: (a) immediate family; (b) tax, legal, or financial advisors; (c) lienholders; (d) as required by law, regulator, or court order; or (e) as required for NPDB reporting.

8.2 Mutual non-disparagement: no Party shall make false statements about another Party regarding the Incident or this settlement. This Section does not restrict truthful statements to regulators, in legal proceedings, or to treating providers.

9. NO ADMISSION OF LIABILITY

This Agreement is a compromise of disputed claims. Releasees expressly deny liability, fault, and wrongdoing. This Agreement is not, and shall not be construed as, an admission of liability by any Party and is inadmissible under N.D.R.Ev. 408 except to enforce its terms.

10. REPRESENTATIONS AND WARRANTIES

10.1 Releasor represents that: (a) Releasor is the sole owner of all released claims; (b) no claim has been assigned; (c) Releasor has had the opportunity to consult with independent counsel; (d) Releasor has not relied on any representation outside this Agreement; (e) Releasor is competent and authorized to execute this Agreement; and (f) Releasor has disclosed all known lienholders.

10.2 Each Party has authority to enter into and perform this Agreement.

11. GENERAL PROVISIONS

11.1 Governing Law. North Dakota law governs, without regard to conflicts principles.

11.2 Venue. Exclusive venue for enforcement lies in the [__________] County District Court, North Dakota.

11.3 Entire Agreement. This Agreement and its Exhibits are the entire agreement and supersede all prior writings and discussions.

11.4 Amendments. Only by writing signed by all Parties.

11.5 Severability. If any provision is invalid, the remainder remains enforceable.

11.6 Counterparts; E-Signatures. Permitted under N.D.C.C. ch. 9-16.

11.7 Construction. No Party is deemed the drafter; ambiguities are construed neutrally.

11.8 Notices. Personal delivery, overnight courier, or certified mail to the addresses set forth in the Action caption or as later designated.

12. EXECUTION

Approved as to form:

13. EXHIBITS

• Exhibit A — Structured Settlement / Annuity Terms (if applicable)
• Exhibit B — Stipulation of Dismissal With Prejudice
• Exhibit C — Medicare Conditional Payment Letter / Final Demand
• Exhibit D — Medicaid Lien Resolution
• Exhibit E — Court Approval Order (minor/incapacitated/wrongful death)

SOURCES AND REFERENCES

• N.D.C.C. § 32-42-02 (noneconomic damages cap — $500,000)
• Condon v. St. Alexius Medical Center, 2019 ND 113 (cap upheld against equal-protection challenge)
• N.D.C.C. § 28-01-46 (expert affidavit within 3 months of complaint)
• N.D.C.C. § 28-01-18(3) (2-year statute of limitations); § 28-01-25.1 (6-year repose)
• N.D.C.C. ch. 32-03.2 (modified comparative fault; damages)
• N.D.C.C. § 50-24.1-02.1 (ND Medicaid lien)
• 42 U.S.C. § 11131 et seq.; 45 C.F.R. Part 60 (NPDB reporting)
• 42 U.S.C. § 1395y(b)(2) (Medicare Secondary Payer)
• IRC § 104(a)(2) (exclusion of physical-injury damages from gross income)