Medical Malpractice Settlement Agreement (Rhode Island)
MEDICAL MALPRACTICE SETTLEMENT AGREEMENT AND MUTUAL RELEASE
(Rhode Island)
1. DOCUMENT HEADER
1.1 Parties
This Medical Malpractice Settlement Agreement and Mutual Release (the "Agreement") is entered into as of [EFFECTIVE DATE] by and between:
(a) [CLAIMANT FULL LEGAL NAME], an individual residing at [ADDRESS], [CITY], Rhode Island [ZIP] ("Claimant"); and
(b) [HEALTHCARE PROVIDER / FACILITY NAME], a [entity type] organized under the laws of [State] with its principal place of business at [ADDRESS], [CITY], Rhode Island [ZIP] ("Provider").
Claimant and Provider are each a "Party" and collectively the "Parties."
1.2 Recitals
A. Claimant alleges that Provider's medical services rendered on or about [DATE(S) OF CARE] caused personal injuries (the "Claim").
B. The Claim is or may be the subject of an action styled [CASE CAPTION], [Civil Action No. ____], pending in the Rhode Island Superior Court, [County] County (the "Action").
C. Provider denies all liability. The Parties wish to fully and finally resolve all Released Claims and the Action without admission of liability, consistent with Rhode Island law including R.I. Gen. Laws § 9-1-14.1 (statute of limitations), § 9-19-32 (informed consent), § 9-19-39 (qualified expert), and § 9-19-34.1 (collateral source).
In consideration of the mutual promises herein, the receipt and sufficiency of which are acknowledged, the Parties agree:
2. DEFINITIONS
"Action" — As set forth in Recital B.
"Business Day" — Any day other than Saturday, Sunday, or a Rhode Island state holiday.
"Claim" — As set forth in Recital A.
"Effective Date" — The date on the first page.
"Lienholders" — Medicare, Medicaid (Rhode Island Executive Office of Health and Human Services / EOHHS), TRICARE, ERISA plans, hospital lienholders, and any other entity holding a statutory or contractual lien or right of recovery against the Settlement Sum.
"NPDB" — The National Practitioner Data Bank established under 42 U.S.C. § 11131 et seq.
"Released Claims" — All claims, demands, actions, causes of action, damages, and liabilities of any kind, whether known or unknown, that Claimant ever had, now has, or may hereafter have arising out of or relating to the Claim or the care identified in Recital A.
"Released Parties" — Provider and Provider's past and present officers, directors, employees, agents, partners, shareholders, members, insurers (including [CARRIER]), reinsurers, attorneys, parent and affiliated entities, predecessors, successors, and assigns.
"Settlement Sum" — The total consideration set forth in Section 3.1.
3. OPERATIVE PROVISIONS
3.1 Settlement Payment
Provider (through its liability carrier [CARRIER NAME]) shall pay the total sum of $[AMOUNT] (the "Settlement Sum") as follows:
| Component | Amount | Payee | Due |
|---|---|---|---|
| Lump-sum cash | $[___] | [Claimant's counsel IOLTA / Claimant] | Within [30] days of last-to-occur of (i) full execution, (ii) court approval if required, (iii) receipt of Medicare/Medicaid conditional payment final demands |
| Structured annuity (optional) | $[___] | [Assignment Co.] | Per Schedule A |
| Medicare set-aside (if applicable) | $[___] | [MSA custodian] | At funding |
3.2 Court Approval; Minor / Incapacitated Claimant
☐ Not Applicable.
☐ Subject to approval by the Rhode Island [Superior / Probate] Court within [60] days. If approval is denied, this Agreement is void and the Parties are restored to their pre-Agreement positions.
3.3 Mutual Release
Effective upon receipt of the Settlement Sum, Claimant fully and forever releases and discharges the Released Parties from the Released Claims. Provider releases Claimant from any counterclaims arising out of the Claim.
3.4 Dismissal With Prejudice
Within [10] Business Days of receipt of the Settlement Sum and lien clearance, Claimant shall file a stipulation of dismissal with prejudice of the Action, each party to bear its own costs and fees.
3.5 Statute of Limitations Acknowledgment
The Parties acknowledge that R.I. Gen. Laws § 9-1-14.1 imposes a three (3) year statute of limitations for medical malpractice, subject to the statutory discovery rule. This Agreement is entered without admission as to timeliness or merit.
3.6 Liens; Set-Asides; Subrogation
(a) Medicare. Claimant has reported (or shall report) this settlement to CMS and shall satisfy any Medicare conditional payments under 42 U.S.C. § 1395y(b) and 42 C.F.R. Part 411 prior to disbursement.
(b) Medicaid. Claimant shall satisfy any Rhode Island Medicaid lien (R.I. EOHHS, R.I. Gen. Laws § 40-6-9 / 42 U.S.C. § 1396p(a)(1)) prior to disbursement.
(c) Other Liens. ERISA plan, hospital, workers' compensation, and TRICARE recoveries shall be resolved by Claimant's counsel from the Settlement Sum.
(d) Indemnity for Liens. Claimant shall indemnify and hold the Released Parties harmless from any Lienholder claim arising out of the Released Claims, up to the Settlement Sum received by Claimant.
3.7 Allocation
The Settlement Sum is allocated as follows for purposes of 26 U.S.C. § 104(a)(2) and Medicare reporting:
| Allocation | Amount |
|---|---|
| Personal physical injury and physical sickness (excludable under IRC § 104(a)(2)) | $[___] |
| Past medical expenses | $[___] |
| Future medical expenses (MSA, if any) | $[___] |
| Lost wages / loss of earning capacity | $[___] |
| Noneconomic damages (no RI cap) | $[___] |
| Total | $[AMOUNT] |
3.8 No Admission of Liability
This Agreement is a compromise of disputed claims. The Released Parties expressly deny liability, negligence, breach of standard of care, and any violation of R.I. Gen. Laws § 9-19-32 (informed consent).
4. REPRESENTATIONS & WARRANTIES
4.1 Authority. Each Party has full authority to enter into this Agreement.
4.2 No Assignment of Claims. Claimant has not assigned or transferred any Released Claim.
4.3 Lien Disclosure. Claimant has disclosed all known Lienholders and beneficiaries with recovery rights.
4.4 Medicare/Medicaid Status. Claimant has disclosed Medicare/Medicaid enrollment status and any conditional-payment correspondence.
4.5 Capacity & Independent Counsel. Each Party has consulted independent counsel or knowingly waived such consultation.
5. COVENANTS & RESTRICTIONS
5.1 Confidentiality.
Except as required by law, court order, or NPDB reporting obligations, the Parties shall keep the terms of this Agreement (including the Settlement Sum) confidential. Permitted disclosures: tax preparers, attorneys, lienholders, regulators, NPDB, immediate family, and as needed to enforce this Agreement.
5.2 Non-Disparagement. Each Party shall refrain from publicly disparaging the other regarding the Claim. This Section does not restrict truthful testimony, regulatory complaints, or peer-review participation.
5.3 NPDB Reporting Acknowledgment. Claimant acknowledges that Provider's insurer is required to report this settlement to the NPDB and the Rhode Island Department of Health / Board of Medical Licensure and Discipline as required by law. Failure to report is unlawful and cannot be waived by this Agreement.
5.4 Cooperation. The Parties shall cooperate in executing additional documents reasonably necessary to effectuate this Agreement (e.g., W-9, structured-settlement documentation, MSA submissions, dismissal papers).
6. DEFAULT & REMEDIES
6.1 Default. Failure to pay the Settlement Sum within [30] days of all conditions precedent; material breach of confidentiality; breach of lien indemnity.
6.2 Notice & Cure. Written notice; [10] Business Days to cure monetary default; [30] days otherwise.
6.3 Remedies. Specific performance, damages, attorneys' fees to prevailing party in any enforcement action, plus prejudgment interest under R.I. Gen. Laws § 9-21-10.
7. RISK ALLOCATION
7.1 Mutual Release. As set forth in Section 3.3.
7.2 Lien Indemnity. As set forth in Section 3.6(d).
7.3 No Reliance. Each Party relies only on the representations in this Agreement.
7.4 Tax Consequences. Each Party is solely responsible for its own tax consequences and has consulted independent tax counsel. Provider makes no representation regarding the tax treatment of the Settlement Sum.
8. DISPUTE RESOLUTION
8.1 Governing Law. Rhode Island law governs without regard to conflicts.
8.2 Forum. Exclusive jurisdiction in the Rhode Island Superior Court, [County] County, or the U.S. District Court for the District of Rhode Island.
8.3 Arbitration (Optional). ☐ The Parties elect binding arbitration under R.I. Gen. Laws § 10-3-1 et seq. (RI Arbitration Act) administered by [AAA] in [Providence], Rhode Island.
8.4 Jury Waiver. ☐ Each Party knowingly and voluntarily waives the right to jury trial in any action to enforce this Agreement.
8.5 Attorneys' Fees. Prevailing party in any enforcement action shall recover reasonable attorneys' fees and costs.
9. GENERAL PROVISIONS
9.1 Entire Agreement. This Agreement constitutes the entire agreement and supersedes all prior negotiations.
9.2 Amendments. In writing signed by both Parties.
9.3 Severability. If any provision is invalid, the remainder remains enforceable.
9.4 Counterparts; Electronic Signatures. Permitted under R.I. Gen. Laws § 42-127.1 (RI UETA).
9.5 Notices. By personal delivery, overnight courier, or certified mail to the addresses in Section 1.1.
9.6 Construction. Drafter rule waived.
9.7 Successors and Assigns. Binding on heirs, executors, administrators, successors, and assigns.
9.8 Acknowledgment of Voluntary Execution. Each Party acknowledges having read this Agreement, understood its terms, had opportunity to consult counsel, and signed voluntarily.
10. EXECUTION BLOCK
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.
| Claimant | Provider |
|---|---|
| [CLAIMANT NAME] | [PROVIDER NAME] |
| ____________________ | By: ____________________ |
| Date: ______________ | Name: __________________ |
| Title: _________________ | |
| Date: __________________ |
Approved as to Form:
| Counsel for Claimant | Counsel for Provider |
|---|---|
| [ATTORNEY NAME] (RI Bar No. ____) | [ATTORNEY NAME] (RI Bar No. ____) |
| ____________________ | ____________________ |
| Date: ______________ | Date: ______________ |
11. EXHIBITS & SCHEDULES
- Schedule A — Structured Settlement Terms (if applicable)
- Exhibit 1 — Medicare Conditional Payment Final Demand / Clearance
- Exhibit 2 — Rhode Island Medicaid (EOHHS) Lien Resolution
- Exhibit 3 — Court Approval Order (minor / incapacitated / wrongful death)
- Exhibit 4 — W-9 / IRS Form 1099 acknowledgments
- Exhibit 5 — NPDB Report Acknowledgment
Sources and References
- R.I. Gen. Laws § 9-1-14.1 (SOL — medical malpractice): https://webserver.rilegislature.gov/Statutes/TITLE9/9-1/9-1-14.1.htm
- R.I. Gen. Laws § 9-19-32 (informed consent — procedural): https://webserver.rilegislature.gov/Statutes/TITLE9/9-19/9-19-32.htm
- R.I. Gen. Laws § 9-19-39 (qualified expert): https://webserver.rilegislature.gov/Statutes/TITLE9/9-19/9-19-39.htm
- NPDB Guidebook (HRSA): https://www.npdb.hrsa.gov/resources/aboutGuidebooks.jsp
- Medicare Secondary Payer (CMS): https://www.cms.gov/medicare/coordination-of-benefits-and-recovery
About This Template
These templates cover the everyday paperwork that happens between patients, providers, and health plans: consent forms, medical record authorizations, directives for end-of-life care, and requests to approve or deny treatment. Getting them right matters because they document medical decisions, release sensitive health information, and often have to meet both federal privacy rules and state-specific requirements. A form that is missing a required disclosure can be rejected by a provider or challenged later in court.
Important Notice
This template is provided for informational purposes. It is not legal advice. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Last updated: May 2026