Can a NEMT company make riders sign a liability waiver? What courts and Medicaid allow

A NEMT company can hand riders a liability waiver, but a court is unlikely to enforce one that is signed at the curb as a condition of a medical ride. The leading case involves a wheelchair van, and the Tennessee Supreme Court found the release unenforceable on every ground it weighed. On Medicaid and broker trips, the broker’s rules decide when you may refuse a member, and the broker manuals that list refusal grounds do not include an unsigned release.

What actually limits a company’s exposure is covered in our guide to NEMT liability: insurance, broker contract terms, and records. This page covers the waiver question itself. When a rider declines one specific safety step, a rider refusal form records it, and private-pay terms belong in a private-pay rider agreement.

The wheelchair van case: Copeland v. HealthSouth/Methodist

In Copeland v. HealthSouth/Methodist Rehabilitation Hospital, decided December 20, 2018, the Tennessee Supreme Court refused to enforce a medical transportation company’s pre-ride release. The facts will look familiar to any operator.

Frederick Copeland, 77, was recovering from a knee replacement at a rehabilitation hospital in Memphis. The hospital contracted with MedicOne, a medical transportation company, to take him to his orthopedic surgeon on December 2, 2014. The driver brought a wheelchair van with a lift and no rear seats, so Mr. Copeland walked to the van with his walker and climbed into the front passenger seat.

Before leaving, the driver gave him a two-sided preprinted sheet: a run report on one side and a “Wheelchair Van Transportation Agreement” on the other. The agreement had nine single-spaced paragraphs, three of them releasing MedicOne from claims. After the appointment, getting back into the van, he lost his footing on the running board, fell, and was hurt. He sued. The trial court and the Court of Appeals both enforced the release. The Supreme Court reversed.

The court restated Tennessee’s test as three factors, weighed on all the circumstances: the parties’ relative bargaining power, how clear the release language is, and public policy and the public interest. MedicOne lost on all three.

Why the release failed on all three counts

Each factor turned on a detail a NEMT company controls.

• Bargaining power. The hospital chose and paid MedicOne, not the rider. The driver spent 19 minutes at the hospital in total, including pushing him from his room, loading the walker, and getting both forms signed. He did not understand the agreement, could not have explained it, had no authority to change it, and would not have driven Mr. Copeland without a signature. The rider’s choice was to sign or delay his medical care that day.
• Clarity. One paragraph released MedicOne from “any and all claims” related “in any way” to its transportation. A later carve-out for gross negligence began with the words “without limitation of the foregoing,” which undercut it, and another paragraph had no carve-out at all. The court called the language overly broad and ambiguous, and a severability clause did not save it.
• Public interest. A doctor’s appointment is a medical necessity, unlike the recreational activities where releases are usually upheld. The court said the company took on greater responsibility when it agreed to transport a patient, and it was not reasonable to expect him to call a taxi or reschedule.

The court still described releases of negligence as generally enforceable in Tennessee. That makes the result more pointed: a release handed over by a driver, on a medical trip, by a company the rider did not choose, is the kind it refused to enforce.

Rules that hold in most states

Some limits apply almost everywhere, and a few states go further. In Copeland, the court summarized principles courts across the country share:

1. No one can release themselves in advance from liability for gross negligence, reckless conduct, or intentional wrongdoing.
2. Releases in contracts with common carriers are unenforceable, because of public policy and the carrier’s advantage over the public.
3. Most courts require the release to say clearly and specifically that it covers the company’s own negligence.

State law decides whether your service is a common carrier and how far the rules reach. Two examples show the range:

• California. Anyone who offers to the public to carry persons is a common carrier (Civil Code 2168). A carrier of persons for reward must use “the utmost care and diligence” for their safe carriage (2100), and no agreement made in advance can exonerate a common carrier from liability for its gross negligence, fraud, or willful wrong (2175). A private-pay service that offers rides to the public can fit that definition.
• Louisiana. Civil Code article 2004 makes null any clause that, in advance, excludes or limits liability for causing physical injury to the other party, along with any clause covering intentional or gross fault. A pre-ride injury release has nothing to stand on there.

Before you rely on any release in your state, have a lawyer who handles personal injury defense read it against your state’s cases.

Medicaid and broker trips: the broker owns the paperwork

On broker trips, the broker decides when a member may be refused, which leaves no room to make your own release a condition of the ride. Mississippi’s Modivcare manual (February 2024) allows a refusal only after the provider consults Modivcare and the member is found to be a threat to the health and safety of staff, other members, or escorts, or a threat to safe operation of the vehicle. CareOregon’s February 2024 manual tells providers to complete rides unless an accident has made the vehicle inoperable, or the member is threatening or endangering the driver, themselves, or others. A member who declines to sign your form meets neither test. The full list of lawful refusals is in when a NEMT provider can refuse a ride.

Releases do appear in Medicaid transportation, but as the program’s own forms for one situation, and one state has just turned its release into a plain consent:

• Securement refusals. Modivcare’s Mississippi manual includes a “Securement Waiver” among its operations forms. The member acknowledges that standard wheelchair securement is the safest way to ride, then states that they choose not to follow it: moving the assigned seat, adding cushions or blankets that interfere with securement, riding in a chair that is not in good working order, or refusing belts and straps. The release runs to both the provider and Modivcare and has a line for a legal guardian.
• Minors riding alone, and a release that became a consent. Virginia’s June 2025 member handbook let riders 17 and under travel alone to certain after-school Medicaid programs only with a “Consent and Release of Liability Form” on file with Modivcare, carrying a parent’s or guardian’s signature. The June 2026 manual replaced that rule. Every rider under 18 now needs a parent’s or legal guardian’s written consent. Teens of 13 to 17 may then travel on their own, and a child of 12 or younger rides with an adult (the provider arranges an attendant at no cost if the parent cannot come), and the manual says the consent form “is not a release of liability.”

If your broker has a form, use it, for the purpose it names. Some refusals end the trip instead of producing a form: a rider who refuses to buckle up does not ride under some broker rules, as the seat belt guide explains.

Private-pay riders: paperwork that holds up better

For private-pay work, the documents that help most record facts and choices rather than ask the rider to give up a claim. Each one answers a point the Copeland court weighed.

• Agree on terms before the trip day. Send the service terms when the ride is booked, in plain language, so the rider or family can read them without a driver waiting. A private-pay rider agreement covers fares, cancellations, and card authorization.
• Describe the service you provide. Say whether a ride is curb-to-curb or door-to-door, and what drivers will not do, such as carrying a rider up stairs. A clear scope of service sets expectations in a way a blanket release does not.
• Get accurate rider information. Weight with the chair, the chair type, oxygen, and steps at the home decide which van and crew you send. A rider profile form captures them once.
• Record a specific refusal when it happens. When a rider declines a named safety step after hearing the risk, a signed refusal form with a witness and the time is evidence of what was offered and chosen.

If you still want a release in a private-pay agreement, the Copeland opinion shows what a court will look for: time to read it, wording a layperson understands, a scope narrower than “any and all claims,” and no reach into gross negligence.

Insurance does the work a waiver cannot

The protection that pays claims is insurance, and broker agreements set its floor. In the version of its agreement dated October 16, 2025, WellTrans, an Indiana broker, requires wheelchair vans to carry no less than $1,500,000 per accident in vehicle coverage. It also requires a $1,000,000 general liability policy that covers abuse and molestation, and a $1,000,000 professional liability policy for any company operating wheelchair vehicles.

Buying that coverage is covered in how to buy NEMT insurance, and how a rider’s injury claim proceeds is in the passenger injury claim guide.

Records that matter more than a signature

When a rider is hurt, the questions are what happened and whether your driver did it right, and records answer them. In the HealthRide driver app, signatures are captured on screen, and every ride keeps its pickup and drop-off times and GPS-recorded miles. Those records show when the rider boarded, where the van went, and how long each step took.