Sample Hold Harmless Agreement    

 

ANA MAJANO- Plaintiff

v

MILES DIXON- Defendant,

 * * * * *
         CASE NO. 05-C-05-095553
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Practice Tip: Insurance companies often want language protecting them from lien holders claiming the insurance company should have protected their lien.  In some states, they are entitled to a hold harmless agreement. Either way, in most cases lawyers should make sure that the medical liens are being properly resolved.  Here is some sample language you can use (because, incredibly, the insurance companies never seem to have anything like this handy).

     It is expressly understood and agreed, that in consideration of all bills paid to  _______________ which sum includes any and all MEDICARE/MEDICAID/TRICARE/Health Insurance lien(s) which have been, or which may be, presented for benefits paid to _________________________ as a result of physical, emotional or other injuries sustained in the automobile accident dated _____________________ which in connection with Claim Number ________________, the undersigned agree(s) to resolve the full amount of any and all liens, by accord and satisfaction or otherwise, and further agree(s) to save and forever hold harmless _____________________ Insurance Company from any and all liability therefrom.

 

_______________________________                                  ______________________________
(Client)                                                                         (Date)

 

_______________________________                                  ______________________________
(Attorney)                                                                     (Date)