Hold Harmless Agreement and Letter


This is a standard sample hold harmless agreement with an insurance company for a tort case. Hold harmless agreements are used in several contexts. The most common use of hold harmless agreements is as a limit or waiver of liability.

Another type of simple hold harmless agreement that is common in accident cases is where insurance companies will often ask for a hold harmless agreement to protect them in the event that medical liens are paid off after settlement.

On this page are three sample hold harmless forms: (1) a hold harmless agreement limiting liability; (2) a hold harmless agreement for medical liens in personal injury cases; and (3) a hold harmless letter notifying an insurance company that a medical lien is being resolved.

Sample Hold Harmless Agreement
(Waiver of Liability)

I hereby acknowledge that the participation in is a benefit offered to me as a part of my membership.   I further acknowledge that I have read, understood and I voluntarily agree to abide by all of the rules appearing above and/or rules as posted in the and registration area.   In consideration for this service, I, individually and on behalf of my child, do hereby waive, release and forever discharge , its subsidiaries and affiliates and their respective agents, employees, officers, directors, shareholders, successors and assigns from any and all claims and causes of action of any kind or nature which are in any way related, directly or indirectly, to the use of which I may have or that hereafter may accrue including any such claims or causes of action caused in whole or in part by the negligence of , its subsidiaries and affiliates, and their respective agents, employees, officers, directors, successors and assigns.  

I understand that my child is here at my own risk and expense and agree that neither I nor my child will bring any claim or cause of action of any kind or nature against its subsidiaries and affiliates and their respective agents, employees, officers, directors, successors and assigns.  

I further agree to indemnify, defend and hold harmless , its subsidiaries and affiliates and their respective agents, employees, officers, directors, successors and assigns from any claims or causes of action of any kind arising from my or my child’s use of . .   By placing my signature below, I acknowledge and agree that I have read this agreement, understood all of the terms and conditions contained herein, and that this agreement will be in full force and effect during each of my or my child’s visit to . This agreement shall remain in full force and effect at all times whether my child is dropped off at the by me or anyone else.

Sample Hold Harmless Agreement
(Medical Liens in Accident Case)

JANE DOE, Plaintiff

v. Case No.: 19-C-0968957


In consideration of any settlement amounts paid in the above-captioned case, the undersigned hereby agree(s) to resolve the full amount of any and all liens (including Medicare, Medicaid, Tricare, or Health Insurance Liens) which have been, or which may be presented for benefits paid to JANE DOE as a result of injuries sustained in the auto accident which occurred on August 1, 2021. The undersigned further agree(s) to save and forever hold harmless _____________________ Insurance Company from any and all liability from the aforementioned liens.


_____________________________ (date) _______________________________ (date)

Hold Harmless Letter

February 11, 2021

VIA FAX:  866-496-3545

USAA – Auto Injury Solutions

P.O. Box 26001

Daphne, Alabama 36526

Attn:  Mark Young

Our Client:                 Melissa Client
Your Insured:             Jack Badriver
Date of Loss:             December 10, 2020
Claim No.:                 0561685454

Dear Mark:

Miller & Zois has been advised that Medicaid is asserting a lien against any recovery made by our client in the amount of $111,360.66.  We intend to satisfy the lien and will reimburse this lien out of any recovery made by our client.  

Please do not hesitate to contact me if you have any questions regarding this matter.

Very truly yours,

Maryland Car Accident Lawyer

FAQs – Hold Harmless Agreements

What is a hold harmless agreement?

A hold harmless agreement or clause is a contract in which one party assumes liability or risk that relieves the other party of a responsibility they might otherwise have.

What is the purpose of a simple hold harmless agreement?

The purpose of any hold harmless agreement is to transfer legal risk or liability from one party to another. For example, A and B can enter into a hold harmless agreement to transfer A’s legal obligation and risk to B.

Is there a difference between “indemnify” and “hold harmless”?

Most courts – including Maryland – do not draw a distinction between “indemnify” and “hold harmless.”

But in an indemnity agreement, risk or liability is not actually transferred from party 1 to party 2. Instead, party 1 continues to assume the liability and party 2 agrees to pay for or cover any loss eventually incurred as a result. By contrast, in a hold harmless agreement liability is transferred or assumed directly.

What is the HMO hold harmless statute?

The Maryland HMO Act, Md. Code Ann., Health General §19-701 et seq., contains a statutory “hold harmless” clause. This is not the same type of hold harmless you see discussed in the rest of this discussion. 

This statute prevents health care providers from billing the patient for services covered under the terms of their HMO policy unless the bill is contractually permitted or specifically excluded.   

What Is a Medical Lien Release Letter?

A medical lien release letter is a promise to pay out of your settlement your medical bill or lien. A medical lien release template letter is provided above.