Medical Malpractice Settlement Agreement

MEDICAL MALPRACTICE SETTLEMENT AGREEMENT AND MUTUAL RELEASE

(Oklahoma)

1. PARTIES AND RECITALS

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

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

Recitals.
A. Claimant alleges that Provider's medical care rendered on or about [DATE(S) OF CARE] caused personal injury (the "Claim").
B. The Claim is or may be the subject of an action styled [CASE CAPTION], [CASE NO.], pending in the District Court of [COUNTY] County, Oklahoma (the "Action").
C. The Parties wish to resolve the Claim and the Action fully and finally, without admission of liability, in accordance with Oklahoma law, including 76 O.S. § 18.

In consideration of the mutual promises herein, the adequacy of which is acknowledged, the Parties agree:

2. DEFINITIONS

"Action" — has the meaning in Recital B.

"Claim" — has the meaning in Recital A and includes all theories pled or that could have been pled.

"CMS" — the U.S. Centers for Medicare & Medicaid Services.

"Effective Date" — the latest date this Agreement is signed by all Parties.

"NPDB" — the National Practitioner Data Bank, 45 C.F.R. Part 60.

"Released Claims" / "Released Parties" — defined in Section 6.

"Settlement Amount" — the total monetary consideration in Section 3.1.

3. SETTLEMENT CONSIDERATION

3.1 Payment. Provider (or Provider's insurer) shall pay Claimant the total Settlement Amount of $[AMOUNT], by [wire transfer / cashier's check] payable to [CLAIMANT'S COUNSEL TRUST ACCOUNT], within [thirty (30)] days after (a) full execution of this Agreement, (b) delivery of Claimant's IRS Form W-9, and (c) final lien resolution under Section 4.

3.2 Allocation.
| Component | Amount |
|---|---|
| Past and future medical expenses (economic) | $[____] |
| Lost wages / lost earning capacity (economic) | $[____] |
| Pain and suffering / noneconomic (uncapped per Beason) | $[____] |
| Loss of consortium (if applicable) | $[____] |
| Attorneys' fees and costs | $[____] |
| Total Settlement Amount | $[____] |

3.3 Structured Settlement (Optional). If elected, Provider shall fund a qualified assignment and annuity (IRC § 130) issued by a carrier rated A- or better by A.M. Best, on the periodic payment schedule attached as Schedule 3.3.

3.4 Tax Treatment. The Parties intend that the portion of the Settlement Amount attributable to physical injury or physical sickness be excluded from gross income under 26 U.S.C. § 104(a)(2). Each Party is responsible for its own tax advice; no Party makes any tax representation to the other. A Form 1099 will be issued only as required by law.

3.5 Dismissal. Within [10] business days after receipt of the Settlement Amount and lien clearance, Claimant shall file a Dismissal With Prejudice of the Action under 12 O.S. § 684, each Party bearing its own costs and fees except as set forth herein.

4. LIENS, MEDICARE/MEDICAID, AND REPORTING

4.1 Medicare Secondary Payer. Claimant represents Claimant's Medicare status as: ☐ Beneficiary ☐ Non-Beneficiary ☐ Within 30 months of ESRD/SSDI eligibility. Claimant shall provide a Conditional Payment Letter from the BCRC/CRC and shall satisfy any conditional payments before disbursement, consistent with 42 U.S.C. § 1395y(b)(2).

4.2 Medicare Set-Aside. If Medicare's future-medical interests must be protected, an MSA in the amount of $[____] shall be funded as set forth on Schedule 4.2 (or none required because [reason]).

4.3 Medicaid (SoonerCare). Claimant shall resolve any Oklahoma Health Care Authority lien under 63 O.S. § 5051.1 and 42 U.S.C. § 1396k prior to disbursement.

4.4 Other Liens. All ERISA, private health insurer, hospital, and statutory liens listed on Schedule 4.4 shall be satisfied from the Settlement Amount.

4.5 Indemnification for Liens. Claimant agrees to indemnify, defend, and hold Provider and Released Parties harmless from any lien or subrogation claim arising out of the Claim, up to the amount of the Settlement Amount.

4.6 NPDB and Board Reporting. Provider (or its insurer/entity acting on its behalf) shall make any report required by 45 C.F.R. § 60.7 to the NPDB and any report required to the Oklahoma State Board of Medical Licensure and Supervision under 59 O.S. § 509.5 within the applicable statutory window. The Parties acknowledge that such reporting is non-waivable.

5. NO ADMISSION; CONFIDENTIALITY

5.1 No Admission of Liability. This Agreement is a compromise of a disputed claim. Provider expressly denies liability. Nothing herein is an admission of fault.

5.2 Confidentiality. Except as required by law, court order, regulatory or NPDB reporting, tax filings, lien resolution, or disclosure to spouses, accountants, attorneys, insurers, or auditors under a duty of confidence, the Parties shall keep the existence and terms of this Agreement confidential. Either Party may confirm that the Action has been "resolved" without further detail.

5.3 Non-Disparagement. Each Party agrees not to make any public statement intended to disparage the other concerning the Claim or care at issue. This Section does not prohibit truthful statements in legal, regulatory, or NPDB processes.

5.4 Apology / Sympathetic Communications. Pursuant to 63 O.S. § 1-1708.1A et seq., any prior sympathetic communications or apologies are inadmissible and shall not be construed as admissions.

6. RELEASE

6.1 Released Parties. "Released Parties" means Provider, Provider's insurers, reinsurers, parents, subsidiaries, affiliates, partners, members, shareholders, officers, directors, employees, agents, attorneys, successors, and assigns.

6.2 Released Claims. Claimant fully and forever releases the Released Parties from any and all claims, demands, causes of action, damages, costs, expenses, attorneys' fees, and liabilities of every kind, whether known or unknown, arising out of or related to the Claim, the medical care at issue, and the Action.

6.3 Unknown Claims. This release expressly extends to claims unknown or unsuspected as of the Effective Date that, if known, would have materially affected the decision to settle.

6.4 Carve-Outs. This release does not extend to (a) obligations created by this Agreement; (b) claims arising from medical care not at issue in the Action; or (c) rights to indemnification under any insurance policy held by Claimant.

7. REPRESENTATIONS AND WARRANTIES

7.1 Each Party has full authority to enter into this Agreement.

7.2 Claimant represents that no Released Claim has been assigned, pledged, or transferred to any third party.

7.3 Claimant has had the opportunity to consult independent counsel and enters this Agreement knowingly and voluntarily.

7.4 All liens are disclosed on Schedule 4.4 to Claimant's knowledge after diligent inquiry.

8. DEFAULT; REMEDIES

8.1 Provider Default. If Provider fails to deliver the Settlement Amount when due and fails to cure within [10] business days of written notice, Claimant may move to enter a stipulated judgment in the Action for the unpaid balance plus interest at the statutory rate under 12 O.S. § 727.1, plus attorneys' fees and costs.

8.2 Claimant Default. If Claimant fails to perform any obligation (including dismissal or lien resolution) and fails to cure within [10] business days of written notice, Provider may withhold funds, seek specific performance, and recover reasonable attorneys' fees and costs.

8.3 Cumulative Remedies. All remedies are cumulative.

9. DISPUTE RESOLUTION

9.1 Governing Law. Oklahoma law governs, without regard to conflicts of law.

9.2 Forum. The District Court of [COUNTY] County, Oklahoma, shall have exclusive jurisdiction; the court retains jurisdiction to enforce this Agreement under 12 O.S. § 1031.

9.3 Arbitration (Optional). The Parties may, by mutual written election, submit any dispute to confidential binding arbitration under the Oklahoma Uniform Arbitration Act, 12 O.S. § 1851 et seq., before a single neutral in [CITY], Oklahoma.

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

10. GENERAL PROVISIONS

10.1 Entire Agreement. This Agreement (with Schedules) is the entire agreement and supersedes all prior negotiations.

10.2 Amendments. Only in a writing signed by both Parties.

10.3 Severability. If any provision is invalid, the remainder remains enforceable; the release in Section 6 is essential and non-severable.

10.4 Successors and Assigns. Binds heirs, executors, administrators, successors, and assigns.

10.5 Counterparts; Electronic Signatures. Permitted under Oklahoma UETA, 12A O.S. § 15-101 et seq.

10.6 Construction. Drafted jointly; no presumption against drafter.

11. EXECUTION

Acknowledgment of Counsel (Claimant): I have advised my client concerning the terms, the release of unknown claims, and lien obligations.

____________________________
[CLAIMANT'S COUNSEL], OBA No. [____]
Date: ______________________

SCHEDULES

• Schedule 3.3 — Periodic Payment Schedule (if Structured Settlement)
• Schedule 4.2 — Medicare Set-Aside
• Schedule 4.4 — Lien Schedule (Medicare, Medicaid/SoonerCare, ERISA, private health insurer, hospital, attorney lien)
• Schedule 6 — IRS Form W-9 of payee

This template is provided for informational purposes and must be reviewed by competent Oklahoma counsel before use.