Medical Malpractice Settlement

MEDICAL MALPRACTICE SETTLEMENT AGREEMENT AND MUTUAL RELEASE

(Vermont)

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
4. Representations & Warranties
5. Covenants & Restrictions
6. Default & Remedies
7. Risk Allocation
8. Dispute Resolution
9. General Provisions
10. Execution Block

1. DOCUMENT HEADER

1.1 Title; Parties
This Medical Malpractice Settlement Agreement and Mutual Release (the "Agreement") is entered into as of [EFFECTIVE DATE] (the "Effective Date") by and between:

a. [CLAIMANT FULL LEGAL NAME], an individual residing at [ADDRESS] ("Claimant"); and
b. [HEALTHCARE PROVIDER FULL LEGAL NAME], a [LEGAL ENTITY TYPE] organized under the laws of Vermont with its principal place of business at [ADDRESS] ("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)] caused personal injuries (the "Claim").
B. The Claim is or may be the subject of an action styled [CASE CAPTION], pending in the Vermont Superior Court, Civil Division, [COUNTY] Unit (the "Action").
C. Claimant filed (or would have filed) a Certificate of Merit pursuant to 12 V.S.A. § 1042 in connection with the Action.
D. The Parties wish to fully and finally resolve the Claim, all Released Claims, and the Action, without admission of liability, and in compliance with Vermont law, including 12 V.S.A. § 1908 (burden of proof), § 1909 (informed-consent limitation), and applicable federal reporting obligations including the National Practitioner Data Bank ("NPDB"), 42 U.S.C. § 11131 et seq.

NOTE: Vermont law imposes NO statutory cap on noneconomic damages in medical malpractice actions.

In consideration of the mutual promises herein, the Parties agree as follows:

2. DEFINITIONS

"Action" – has the meaning set forth in Recital B.

"Agreement" – means this Medical Malpractice Settlement Agreement and Mutual Release.

"Business Day" – any day other than a Saturday, Sunday, or Vermont state holiday.

"Certificate of Merit" – the attorney/party certification required by 12 V.S.A. § 1042.

"Claim" – has the meaning set forth in Recital A.

"Confidential Information" – has the meaning set forth in Section 5.2.

"Court" – the Vermont Superior Court, Civil Division, [COUNTY] Unit.

"Effective Date" – has the meaning set forth in Section 1.1.

"NPDB" – the National Practitioner Data Bank established under 42 U.S.C. § 11131 et seq.

"Released Claims" – has the meaning set forth in Section 7.2.

"Released Parties" – has the meaning set forth in Section 7.2.

"Settlement Amount" – the total monetary consideration payable pursuant to Section 3.1.

"Settlement Payment Date" – the date on which any lump-sum (or first periodic installment) is required to be delivered under Section 3.1.

"Structured Settlement" – has the meaning set forth in Section 3.2.

"Survival Period" – has the meaning set forth in Section 4.4.

3. OPERATIVE PROVISIONS

3.1 Payment of Settlement Amount

(a) Provider shall pay (or cause to be paid) to Claimant the total Settlement Amount of $[SETTLEMENT_AMOUNT] on or before the Settlement Payment Date of [DATE] by [WIRE TRANSFER / CASHIER'S CHECK] payable to [PAYEE INFORMATION].

(b) The Settlement Amount fully encompasses:
☐ Economic damages (medical expenses, lost earnings, future care);
☐ Noneconomic damages (pain and suffering, loss of consortium, etc.) — Vermont imposes NO statutory cap;
☐ Attorneys' fees and costs;
☐ Resolution of statutory liens and subrogation (Medicare, Medicaid, ERISA, private insurer).

3.2 Structured Settlement (Optional)

If the Parties elect a Structured Settlement:

(a) Election. Claimant elects to receive periodic payments. Provider (or its insurer) shall purchase a qualified assignment and annuity contract from a licensed annuity provider rated not less than A- by A.M. Best.

(b) Periodic Payment Schedule. Payments shall be made as follows:
• $[AMOUNT] annually, beginning [DATE], for [TERM] years; and
• One balloon payment of $[AMOUNT] on [DATE].

(c) Present Value. The actuarially-determined present value of the Periodic Payment Schedule equals the Settlement Amount.

(d) Tax Treatment. The Parties intend that all damages constituting compensation for personal physical injury or physical sickness be excluded from Claimant's gross income under IRC § 104(a)(2). Periodic payments are intended to qualify under IRC § 130.

(e) Security. The annuity issuer and assignee shall be jointly and severally liable for all periodic payments; no acceleration or commutation absent mutual written consent.

3.3 Dismissal of Action

Within five (5) Business Days after Provider's full delivery of the Settlement Amount (or proof of funded Structured Settlement), Claimant shall file a Stipulation of Dismissal with prejudice of the Action under V.R.C.P. 41(a)(1)(ii), each Party to bear its own fees and costs except as otherwise provided.

3.4 Conditions Precedent

Provider's obligation to pay is conditioned upon:
a. Execution of this Agreement by all Parties (and, if applicable, court approval if Claimant is a minor or incapacitated person under V.R.C.P. 17);
b. Delivery of an executed IRS Form W-9 by Claimant's counsel;
c. Receipt of executed dismissal documents in escrow with [ESCROW AGENT] pending funding;
d. Provider's confirmation of lien resolution status under Section 5.4.

3.5 Tax Allocation and Reporting

The Parties intend the Settlement Amount (other than amounts allocated to interest, lost wages, or punitive damages) to be excluded from gross income under IRC § 104(a)(2) as damages on account of personal physical injuries or physical sickness. Each Party shall report consistently with this allocation. Provider makes no representation regarding the tax treatment of any payment; Claimant has been advised to consult independent tax counsel.

4. REPRESENTATIONS & WARRANTIES

4.1 Mutual Authority. Each Party represents that it has full power and authority to enter into and perform this Agreement.

4.2 No Assignment of Claims. Claimant represents that no part of the Claim or any Released Claim has been assigned, pledged, or otherwise conveyed to any third party.

4.3 Liens & Reimbursement Obligations. Claimant represents that all known liens (governmental, ERISA, or private) are listed on Schedule 4.3 and will be satisfied from the Settlement Amount. Claimant shall indemnify Provider against any unlisted lien (including Medicare conditional payment recovery under 42 U.S.C. § 1395y(b) and Vermont Medicaid recovery under 33 V.S.A. § 1910).

4.4 Survival. The representations in Sections 4.1–4.3 shall survive the Effective Date for eighteen (18) months (the "Survival Period"), except that Section 4.3 (lien indemnification) shall survive indefinitely.

5. COVENANTS & RESTRICTIONS

5.1 NPDB & Statutory Reporting. Provider (and/or its insurer) shall make any payment-related report required under 42 U.S.C. § 11131 et seq. (NPDB) and any applicable Vermont reporting (including reports to the Vermont Board of Medical Practice under 26 V.S.A. § 1317 and to insurers). Claimant acknowledges that NPDB reporting is mandatory and not subject to waiver.

5.2 Confidentiality. Except as required by law (including NPDB reporting and required disclosures to the Vermont Board of Medical Practice), or as needed for tax, accounting, insurance, or legal advice, the Parties shall keep the terms of this Agreement and the negotiations leading to it confidential. Permitted disclosures include tax advisors, insurers, immediate family, the Court, lienholders, and as required by subpoena or court order.

5.3 Non-Disparagement. Each Party agrees not to make any public statement intended to defame or disparage the other Party concerning the Claim or the Action. Truthful statements compelled by law or required for medical record completeness are not breaches.

5.4 Lien Satisfaction. Prior to disbursement of net proceeds to Claimant, Claimant's counsel shall (i) obtain a Medicare Final Demand Letter (if applicable) and remit payment; (ii) satisfy Vermont Medicaid recovery claims under 33 V.S.A. § 1910; and (iii) resolve all ERISA, hospital, and private-insurer liens.

5.5 Cooperation. The Parties shall reasonably cooperate in executing additional documents necessary to effectuate this Agreement, including IRS Forms W-9 and 1099 where applicable.

5.6 Notice & Cure. A Party alleging breach shall provide written notice and a ten (10) Business Day cure period before exercising any remedy under Section 6.

6. DEFAULT & REMEDIES

6.1 Events of Default.
a. Provider fails to deliver any payment when due;
b. Claimant fails to file the dismissal within the timeframe in Section 3.3;
c. Either Party breaches Section 5.2 (Confidentiality).

6.2 Remedies.
a. Provider Default. Upon uncured default, Claimant may seek entry of a stipulated judgment for the unpaid Settlement Amount plus pre-judgment interest at the rate set by 12 V.S.A. § 2903 (currently 12% per annum), reasonable attorneys' fees, and costs.
b. Claimant Default. Upon uncured default, Provider may seek dismissal with prejudice and recover reasonable attorneys' fees incurred to enforce this Agreement.

6.3 Attorneys' Fees. The prevailing Party in any action to enforce this Agreement is entitled to recover its reasonable attorneys' fees and costs.

7. RISK ALLOCATION

7.1 Limitation of Liability. Provider's aggregate liability arising from or related to the Claim shall not exceed the Settlement Amount.

7.2 Mutual Release.
(a) Released Claims. Any and all past, present, or future claims, demands, causes of action, damages, or liabilities, whether known or unknown, suspected or unsuspected, arising out of or related to the Claim, the medical care at issue, or the Action.

(b) Released Parties. The Parties and their respective parents, subsidiaries, affiliates, insurers, reinsurers, officers, directors, agents, employees, successors, and assigns.

(c) Release. Each Party fully and forever releases the other Party and all Released Parties from the Released Claims.

(d) Unknown Claims Waiver. Each Party expressly assumes the risk of any unknown or undiscovered facts and waives any rule of construction limiting general releases to known claims. The release is intended to be construed as a general release to the maximum extent permitted under Vermont law.

7.3 No Indemnification. Except as set forth in Section 4.3 (lien indemnification), this Agreement provides for mutual releases only and no separate indemnification obligations survive.

7.4 Force Majeure. No Party shall be liable for delays caused by events beyond reasonable control, provided prompt notice is given and performance resumes as soon as practicable. Payment obligations are not excused.

8. DISPUTE RESOLUTION

8.1 Governing Law. This Agreement is governed by Vermont law without regard to conflict-of-law principles.

8.2 Forum Selection. Any civil action arising under this Agreement shall be brought exclusively in the Vermont Superior Court, Civil Division, [COUNTY] Unit. Each Party irrevocably submits to that court's jurisdiction.

8.3 Arbitration (Optional).
At the election of either Party by written notice delivered within ten (10) Business Days of the Effective Date, all disputes arising from this Agreement shall be submitted to binding arbitration under the Vermont Arbitration Act, 12 V.S.A. ch. 192, before a single retired Vermont judge under JAMS or AAA rules. Judgment on the award may be entered in any court of competent jurisdiction.

8.4 Jury Trial Waiver (Optional). The Parties knowingly and voluntarily waive the right to jury trial in any proceeding arising from this Agreement.

9. GENERAL PROVISIONS

9.1 Amendments; Waivers. No amendment or waiver is effective unless in writing and signed by both Parties.

9.2 Assignment. No Party may assign without prior written consent, except that Provider may assign to its insurer for payment purposes.

9.3 Successors & Assigns. This Agreement binds and benefits the Parties and their respective successors and permitted assigns.

9.4 Severability. If any provision is invalid, it shall be narrowly construed, and the remainder shall remain in effect.

9.5 Entire Agreement. This Agreement constitutes the entire understanding between the Parties.

9.6 Counterparts; Electronic Signatures. This Agreement may be executed in counterparts. Electronic signatures (consistent with 9 V.S.A. ch. 20, Vermont UETA) are deemed original.

9.7 Court Approval (If Applicable). If Claimant is a minor or incapacitated person, this Agreement is contingent on court approval under V.R.C.P. 17 and applicable Vermont probate procedure.

10. EXECUTION BLOCK

IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.

[Optional Notary Acknowledgment – Vermont Jurat under 24 V.S.A. § 441]

Sources and References

• 12 V.S.A. § 1042 (Certificate of Merit): https://legislature.vermont.gov/statutes/section/12/027/01042
• 12 V.S.A. § 1908 (Burden of proof, malpractice): https://legislature.vermont.gov/statutes/section/12/081/01908
• 12 V.S.A. § 1909 (Informed-consent limitation): https://legislature.vermont.gov/statutes/section/12/081/01909
• 12 V.S.A. § 521 (Statute of limitations – 3 years)
• 42 U.S.C. § 11131 et seq. (NPDB)
• IRC § 104(a)(2); IRC § 130 (qualified assignments)
• 42 U.S.C. § 1395y(b); 42 C.F.R. Part 411 (Medicare Secondary Payer)
• 33 V.S.A. § 1910 (Vermont Medicaid recovery)

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