Utah Medical Malpractice Settlement Agreement and Release

Medical Malpractice Settlement Agreement and General Release (Utah)

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

1. Recitals

A. Claimant alleges that on or about [__/__/____], at [FACILITY], Released Party rendered care that caused [DESCRIPTION OF INJURY].

B. Claimant served a Notice of Intent to Commence Action pursuant to Utah Code § 78B-3-412 on [__/__/____].

C. The parties participated in Prelitigation Panel Review under Utah Code § 78B-3-416, concluded on [__/__/____].

D. ☐ Litigation was filed as [CASE CAPTION], [____] Judicial District Court, [____] County, Utah, Case No. [______]; ☐ No litigation has been filed.

E. The parties wish to resolve all disputes without admission of liability.

2. Settlement Payment

☐ Total Settlement Amount. $[__________] ("Settlement Amount"), allocated as follows:

☐ Form of Payment. ☐ Lump sum; ☐ Structured settlement via [ASSIGNEE/ANNUITY ISSUER] per IRC §§ 104(a)(2), 130; ☐ Periodic payments per schedule attached.

☐ Funding Deadline. Within [__] days of Effective Date and satisfaction of lien conditions in Section 4.

3. Statutory Cap Acknowledgment

☐ The parties acknowledge that under Utah Code § 78B-3-410, noneconomic damages in medical malpractice actions are capped at $450,000 for injuries occurring on or after May 15, 2010 (subject to any statutory inflation adjustment certified by the State Treasurer to the Administrative Office of the Courts).

☐ The allocation in Section 2 is intended to comply with the statutory cap and shall not be construed as an admission that damages would have exceeded the cap.

4. Liens, Subrogation, and Set-Asides

☐ Medicare. Claimant warrants disclosure of Medicare entitlement under Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b). Conditional payments shall be resolved with CMS/BCRC prior to disbursement. ☐ Medicare Set-Aside (MSA) of $[________] established per CMS guidance.

☐ Medicaid (Utah). Utah Department of Health and Human Services lien under Utah Code § 26B-3-101 et seq. resolved per attached payoff letter.

☐ ERISA / Private Health Plan. Plan liens resolved per [PAYOFF LETTER / SUBROGATION RELEASE].

☐ Hospital / Provider Liens. Utah Hospital Lien Act, Utah Code § 38-7-1 et seq. — payoff confirmation attached.

☐ Workers' Compensation Lien. ☐ N/A ☐ Resolved per Utah Code § 34A-2-106.

☐ Indemnity. Claimant indemnifies Released Party and Payor against any unresolved lien up to the Settlement Amount.

5. Release

☐ General Release. Claimant releases Released Party and its insurers, employees, agents, successors, and assigns from all claims arising from or related to the care described in Section 1, known or unknown.

☐ Heirs/Estate. Release binds Claimant's heirs, executors, administrators, successors, and assigns.

☐ Reservation. ☐ None; ☐ Claims against non-settling parties [____________] are expressly reserved.

6. No Admission of Liability

☐ This Agreement is a compromise of disputed claims. Released Party expressly denies liability. Nothing herein shall be admissible as an admission in any forum except to enforce this Agreement.

7. NPDB and Regulatory Reporting

☐ The parties acknowledge that Payor shall report this settlement to the National Practitioner Data Bank as required by 42 U.S.C. § 11131 if payment is made for the benefit of an individually named practitioner. NPDB reporting cannot be contractually waived.

☐ Reportable subject practitioner(s): [____________].

☐ Utah DPL reporting per Utah Code § 58-67-304 / § 58-31b-307 as applicable.

8. Confidentiality

☐ Mutual Confidentiality. Terms (including Settlement Amount) are confidential except as required for:

• NPDB and regulatory reporting
• Tax, accounting, and lien resolution
• Court approval (if minor/incapacitated/wrongful death)
• Disclosure to spouse, attorneys, accountants, and financial advisors under like obligation
• Compelled disclosure by law or subpoena (with prompt notice)

☐ Liquidated Damages for Breach. $[________] per breach, or actual damages, at the non-breaching party's election.

☐ No Disparagement. Mutual non-disparagement.

9. Court Approval (If Applicable)

☐ Minor/Incapacitated Claimant. Subject to court approval per Utah Rule of Civil Procedure 17(b) and Utah Code § 75-5-101 et seq.

☐ Wrongful Death/Survival. Subject to approval per Utah Code § 78B-3-106 (wrongful death — adult) / § 78B-3-107 (survival) and probate court oversight.

10. Tax Treatment

☐ The parties intend the allocation in Section 2 to reflect the actual nature of the claims and shall report consistently for federal and state tax purposes. Each party shall obtain independent tax advice. No party warrants tax treatment. IRC § 104(a)(2) excludes damages received "on account of personal physical injuries or physical sickness."

11. Dispute Resolution

☐ Governing Law. Utah law.
☐ Venue. [____] County District Court, State of Utah.
☐ Enforcement. Prevailing party entitled to reasonable attorney fees and costs.

12. Miscellaneous

☐ Entire agreement; written amendments only.
☐ Severability; if cap allocation is invalidated, the parties shall reform to nearest enforceable allocation.
☐ Counterparts and electronic signatures permitted (Utah Code § 46-4-101 et seq.).
☐ Each party represents independent legal counsel and voluntary execution.

Signatures

Notary (Utah)

State of Utah, County of [____________]. Subscribed and sworn to before me on [__/__/____] by [____________].

_______________________
Notary Public

Sources and References

• Utah Code § 78B-3-410: https://le.utah.gov/xcode/Title78B/Chapter3/78B-3-S410.html
• Utah Health Care Malpractice Act (Part 4): https://le.utah.gov/xcode/Title78B/Chapter3/
• Utah Code § 78B-3-416 (Prelitigation Panel): https://codes.findlaw.com/ut/title-78b-judicial-code/ut-code-sect-78b-3-416/
• Utah Code § 78B-3-423 (Affidavit of Merit — held unconstitutional, Vega v. Jordan Valley Med. Ctr., 2019 UT 40)
• Utah Courts — Cap on Damages: https://www.utcourts.gov/en/court-records-publications/resources/other-resources/damage-cap.html
• NPDB Guidebook: https://www.npdb.hrsa.gov/
• CMS Medicare Secondary Payer: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery