Medical Malpractice Settlement Agreement (Tennessee)

CONFIDENTIAL SETTLEMENT AGREEMENT AND RELEASE

(Tennessee Health Care Liability / Medical Malpractice)

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

RELEASING PARTY (Claimant/Plaintiff): [________________________________], individually [and as next-of-kin / personal representative of the Estate of ____________] ("Releasor");

RELEASED PARTIES (Healthcare Defendants): [________________________________], [Provider Type — physician / hospital / clinic / health system], and its insurers, including [Insurer Name], Policy No. [____________] (collectively, "Releasees").

1. RECITALS

1.1 On or about [__/__/____], Releasor alleged that Releasees provided health care services that fell below the recognized standard of acceptable professional practice under T.C.A. § 29-26-115, resulting in injury (the "Incident").

1.2 ☐ Releasor served pre-suit notice on [__/__/____] in compliance with T.C.A. § 29-26-121 (60-day notice; HIPAA-compliant authorization; list of providers noticed).

1.3 ☐ Releasor filed a Complaint with Certificate of Good Faith under T.C.A. § 29-26-122 in the [Circuit / Chancery] Court of [____________] County, Tennessee, Case No. [____________] (the "Action").

1.4 Releasees deny all liability. The parties wish to resolve all disputes without admission of liability.

2. SETTLEMENT PAYMENT

2.1 Allocation. ☐ The parties allocate the settlement as follows for tax and lien purposes:

• Physical injury / physical sickness (excludable under IRC § 104(a)(2)): $[__________]
• Wrongful death (T.C.A. § 20-5-113): $[__________]
• Other (specify, taxable): $[__________]

2.2 Tennessee Damages Cap Acknowledgment. The parties acknowledge that noneconomic damages in a Tennessee health care liability action are capped under T.C.A. § 29-39-102 at $750,000 (or $1,000,000 if catastrophic injury is established, e.g., spinal cord injury resulting in paraplegia/quadriplegia, severe brain injury, two-or-more limb amputation, third-degree burns over 40% of body, or wrongful death of a parent leaving a minor surviving child). See McClay v. Airport Mgmt. Servs., LLC, 596 S.W.3d 686 (Tenn. 2020). This settlement is compromised in consideration of this cap.

3. RELEASE

3.1 General Release. Releasor releases and forever discharges Releasees from all claims, known or unknown, arising out of the Incident, including all claims under T.C.A. § 29-26-101 et seq., wrongful death under T.C.A. § 20-5-106 and § 20-5-113, loss of consortium, and any related tort or statutory claim.

3.2 Court Approval. ☐ If Releasor is a minor or incapacitated person, this Agreement is subject to court approval under T.C.A. § 34-1-121 (settlements involving minors) / T.C.A. § 29-34-105.

3.3 Wrongful Death. ☐ If applicable, the personal representative warrants authority under T.C.A. § 20-5-106 to settle on behalf of statutory beneficiaries, who are listed on Exhibit B.

4. LIEN RESOLUTION

4.1 Medicare. Releasor warrants Medicare-eligibility status: ☐ Medicare beneficiary / ☐ not eligible / ☐ reasonable expectation within 30 months. If a beneficiary, the parties shall comply with the Medicare Secondary Payer Act (42 U.S.C. § 1395y(b)(2)) and obtain a Final Conditional Payment Letter from the BCRC/CRC before disbursement. ☐ A Medicare Set-Aside (MSA) of $[__________] is established (Exhibit C).

4.2 Medicaid / TennCare. TennCare lien resolved under T.C.A. § 71-5-117 for $[__________]; satisfaction letter attached as Exhibit D.

4.3 ERISA / Private Health Plan Liens. [List plan / lien amount / status].

4.4 Hospital / Provider Liens. Tennessee Hospital Lien Act (T.C.A. § 29-22-101 et seq.) liens addressed at Exhibit E.

4.5 Indemnification. Releasor indemnifies Releasees for any unresolved liens, conditional payments, or subrogation claims arising from the Incident.

5. CONFIDENTIALITY

5.1 The terms of this Agreement, including the settlement amount, are confidential. Permitted disclosures: (a) counsel, accountants, tax advisors; (b) court order; (c) disclosure required by law including NPDB and Tennessee Board of Medical Examiners reporting; (d) Medicare/Medicaid/insurer lien resolution; (e) immediate family members of Releasor under obligation of confidentiality.

5.2 Liquidated Damages. ☐ Breach of confidentiality by Releasor results in liquidated damages of $[__________].

6. NPDB AND REGULATORY REPORTING

6.1 Releasees acknowledge that payment of this settlement for the benefit of a licensed practitioner may trigger reporting to the National Practitioner Data Bank (NPDB) under 42 U.S.C. § 11131 et seq. and 45 C.F.R. Part 60 within 30 days of payment, and may trigger reporting to the Tennessee Board of Medical Examiners under T.C.A. § 56-7-115 (insurer reporting of medical malpractice claims) and T.C.A. § 63-6-214.

6.2 Nothing in Section 5 prohibits Releasees, their insurers, or counsel from making any disclosure required by NPDB, Tennessee Department of Commerce and Insurance, the Tennessee Board of Medical Examiners, or any other regulatory body.

7. NO ADMISSION OF LIABILITY

7.1 This Agreement is a compromise of disputed claims. Releasees expressly deny liability and any negligent act, error, or omission.

8. TAX TREATMENT

8.1 Amounts allocated to compensation for personal physical injury or physical sickness are intended to be excludable from gross income under IRC § 104(a)(2). Releasees make no representations regarding tax consequences. Releasor is advised to consult a tax professional. Form 1099 reporting will be made consistent with the allocation in Section 2.1.

9. DISMISSAL OF ACTION

9.1 Within [10] business days of receipt of the Settlement Payment, Releasor's counsel shall file a Stipulation of Dismissal with Prejudice in the Action under Tenn. R. Civ. P. 41.01, with each party to bear its own costs and attorney fees.

10. GENERAL PROVISIONS

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

10.2 Venue / Jurisdiction. Exclusive venue in the [Circuit / Chancery] Court of [____________] County, Tennessee.

10.3 Entire Agreement. This Agreement, with Exhibits, is the complete agreement and supersedes all prior negotiations.

10.4 Modification. Only by writing signed by all parties.

10.5 Severability. Invalid provisions severed; remainder enforceable.

10.6 Counterparts / Electronic Signature. Permitted under T.C.A. § 47-10-101 et seq.

10.7 Voluntary Execution. Each party acknowledges (a) reading the Agreement, (b) consulting counsel, and (c) signing voluntarily.

SIGNATURES

Notary (Releasor): State of Tennessee, County of [____________]. Subscribed and sworn before me this [__/__/____]. ____________________ Notary Public. My commission expires: [__/__/____].

EXHIBITS

• Exhibit A — Structured Settlement Annuity Schedule
• Exhibit B — Wrongful Death Beneficiaries (T.C.A. § 20-5-106)
• Exhibit C — Medicare Set-Aside Allocation / Final Conditional Payment Letter
• Exhibit D — TennCare / Medicaid Lien Satisfaction
• Exhibit E — Hospital / Provider Lien Resolution (T.C.A. § 29-22-101 et seq.)
• Exhibit F — Court Approval Order (Minor / Wrongful Death) — if applicable

SOURCES & REFERENCES

• T.C.A. § 29-26-115 (standard of care, expert testimony)
• T.C.A. § 29-26-121 (60-day pre-suit notice)
• T.C.A. § 29-26-122 (certificate of good faith)
• T.C.A. § 29-39-102 (noneconomic damages cap)
• T.C.A. § 20-5-106, § 20-5-113 (wrongful death)
• T.C.A. § 71-5-117 (TennCare subrogation)
• T.C.A. § 29-22-101 et seq. (Hospital Lien Act)
• McClay v. Airport Mgmt. Servs., LLC, 596 S.W.3d 686 (Tenn. 2020)
• Myers v. AMISUB (SFH), Inc., 382 S.W.3d 300 (Tenn. 2012)
• 42 U.S.C. § 11131 et seq.; 45 C.F.R. Part 60 (NPDB)
• 42 U.S.C. § 1395y(b)(2) (Medicare Secondary Payer)
• IRC § 104(a)(2) (federal tax exclusion)