Settlement Agreement (Personal Injury) Template

Settlement Agreement (Personal Injury) Template

This Settlement Agreement and Release (“Agreement”) is entered into by and between:

Injured Party / Claimant:
[Full Name of Injured Party]
[Street Address]
[City, State/Province, ZIP/Postal Code]

and

Released Party / Defendant / Insured:
[Full Name of Released Party or Name of Company / Insured]
[Street Address]
[City, State/Province, ZIP/Postal Code]

Together, the Injured Party and Released Party may be referred to as the “Parties.”

1. Background and Purpose

1.1 Incident Description.
On or about [Date of Incident], the Injured Party alleges that he/she/they suffered injuries and damages in an incident that occurred at or near [Location, City, State/Province], involving:

[Brief description of incident – for example, “a motor vehicle collision,” “a slip-and-fall on the premises,” “a product-related injury,” etc.]

1.2 Claims.
The Injured Party has asserted, or may assert, personal injury claims and related demands for damages against the Released Party and related persons or entities arising out of the Incident described above, including but not limited to claims for bodily injury, pain and suffering, medical expenses, lost income, and other alleged losses (collectively, the “Claims”).

1.3 Purpose of Agreement.
The Parties desire to fully and finally resolve all Claims arising from or related to the Incident, without further litigation or dispute, by entering into this Agreement.

2. Settlement Payment

2.1 Settlement Amount.
In consideration of the release and other promises in this Agreement, the Released Party (or its insurer) agrees to pay the total sum of $[Settlement Amount in Numbers] (U.S. dollars) ([Settlement Amount in Words] U.S. dollars) (the “Settlement Amount”) to the Injured Party.

2.2 Payment Timing and Method.
The Settlement Amount will be paid as follows (check or describe):

• Lump-sum payment of $[Amount] within [__] days after full execution of this Agreement and receipt of any required documents (such as a W-9, court approval, or lien information).

• Structured payments according to the attached schedule (Exhibit A), funded by [Insurer/Annuity Company Name].

Payment shall be made by [check / electronic transfer / other method] payable to:
[Payee Name – e.g., “Law Firm Trust Account for [Injured Party]” or Injured Party directly]

3. Full and Final Release of Claims

3.1 Release by Injured Party.
In exchange for the Settlement Amount and other consideration, the Injured Party, on behalf of him/her/themself and his/her/their heirs, beneficiaries, executors, administrators, successors, and assigns, hereby fully and forever releases and discharges the Released Party and all of its/their past, present, and future parents, subsidiaries, affiliates, insurers, reinsurers, officers, directors, employees, agents, representatives, attorneys, and assigns (collectively, the “Released Persons”) from any and all Claims, demands, actions, causes of action, suits, damages, losses, costs, and expenses of any kind — known or unknown — arising from or in any way related to the Incident.

3.2 Known and Unknown Claims.
This Release is intended to cover all Claims arising from the Incident, whether the Injured Party is currently aware of them or not, including unknown or unanticipated injuries or consequences that may develop in the future, to the fullest extent permitted by applicable law. If local law restricts the release of unknown claims, the scope of this Section 3.2 shall be interpreted consistently with that law.

3.3 No Further Recovery.
The Injured Party agrees not to file, pursue, or maintain any lawsuit, claim, or other proceeding against any of the Released Persons based on the Incident or the Claims, and agrees that this Agreement may be raised as a full and complete defense to any such proceeding.

4. No Admission of Liability

4.1 Disputed Liability.
The Released Party and Released Persons expressly deny any wrongdoing, fault, or liability in connection with the Incident and the Claims.

4.2 Compromise Only.
The Parties acknowledge that the Settlement Amount is paid solely to compromise disputed Claims and to avoid the cost, inconvenience, and uncertainty of litigation. This Agreement is not to be construed as an admission of liability or fault by any Released Person.

5. Liens, Medical Bills, and Indemnification

5.1 Responsibility for Liens and Bills.
Unless otherwise stated below, the Injured Party is responsible for satisfying any valid liens, subrogation interests, or outstanding medical bills arising from the Incident, including but not limited to those claimed by medical providers, health insurers, government programs (such as Medicare, Medicaid, or similar), workers’ compensation carriers, or others.

5.2 Use of Settlement Funds.
The Injured Party understands that some or all of the Settlement Amount may need to be used to resolve such liens or bills and that no Released Person is responsible for paying them beyond the Settlement Amount, unless expressly agreed in writing.

5.3 Indemnification (Optional – tailor to jurisdiction).
To the extent permitted by law, the Injured Party agrees to indemnify and hold harmless the Released Persons from any future claims or demands made by lienholders or others seeking payment of charges arising out of the Incident, except as otherwise required by applicable law or written agreement.

6. Taxes and Financial Consequences

6.1 No Tax Advice.
The Parties acknowledge that no Released Person, attorney, or representative in this matter has provided tax or financial advice regarding the Settlement Amount.

6.2 Responsibility for Taxes.
The Injured Party is solely responsible for any tax consequences that may arise from receipt of the Settlement Amount and is encouraged to consult a qualified tax professional for advice.

7. Confidentiality and Non-Disparagement (Optional)

Note: These provisions are optional and may be modified, limited, or removed, depending on local law and the Parties’ preferences.

7.1 Confidentiality of Settlement Terms (Optional).

• Not Applicable (no confidentiality required).

• Applicable: The Parties agree to keep the terms and amount of this settlement confidential, except as required by law, necessary for tax or legal advice, or to immediate family members, insurers, or financial advisors who agree to maintain confidentiality.

7.2 Non-Disparagement (Optional).

• Not Applicable.

• Applicable: The Parties agree not to make false, malicious, or intentionally disparaging public statements about each other concerning the Incident or the Claims, subject to any rights or obligations under law.

8. Representations and Acknowledgments

8.1 Capacity and Authority.
Each Party represents that they have the full legal capacity and authority to enter into this Agreement. If a Party is signing on behalf of another person or entity (such as a minor, estate, or organization), they represent that they have the proper legal authority to do so.

8.2 No Other Promises.
The Injured Party acknowledges that no promises, statements, or representations about the Incident, the Claims, or this Agreement have been made by any Released Person other than those expressly stated in this written Agreement.

8.3 Understanding of Agreement.
The Injured Party acknowledges that:

• They have read this entire Agreement (or had it read and explained);

• They understand its contents and the effect of releasing their Claims;

• They have had the opportunity to ask questions; and

• They have had the opportunity to consult with an attorney of their choice before signing.

9. Governing Law and Dispute Resolution

9.1 Governing Law.
This Agreement shall be governed by and construed in accordance with the laws of the State/Province of [Governing Law State/Province], without regard to its conflict-of-law principles, unless applicable law requires otherwise.

9.2 Dispute Resolution (Optional).
Any dispute arising out of or relating to this Agreement that cannot be resolved informally may be addressed as follows (select or modify as appropriate):

• Through the courts of [County, State/Province], which shall have exclusive jurisdiction; or

• Through mediation and/or arbitration pursuant to [mediation/arbitration rules], if the Parties so agree in writing.

10. Entire Agreement and Amendments

10.1 Entire Agreement.
This Agreement constitutes the entire understanding between the Parties regarding the settlement of the Claims and supersedes all prior oral or written negotiations, agreements, or understandings concerning the same subject matter.

10.2 Amendments.
Any changes or amendments to this Agreement must be in writing and signed by all Parties (or their authorized representatives).

11. Severability

If any provision of this Agreement is found to be invalid or unenforceable under applicable law, that provision shall be enforced to the maximum extent permissible, and the remaining provisions shall continue in full force and effect.

12. Execution and Counterparts

12.1 Execution.
The Parties may sign this Agreement in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

12.2 Electronic Signatures.
Signatures delivered by electronic means (such as scanned or digitally signed copies) shall be deemed as effective as original signatures, to the extent permitted by applicable law.

13. Signatures

Injured Party / Claimant

Name (print): _______________________________

Signature: __________________________________

Date Signed: ________________________________

Released Party / Defendant / Insured

Name (print): _______________________________

Title (if signing on behalf of a company or insurer): _______________________________

Entity (if applicable): ________________________

Signature: __________________________________

Date Signed: ________________________________

[Optional – Additional Released Party or Insurer Signature Block]

Name (print): _______________________________

Title / Role: ________________________________

Entity (if applicable): ________________________

Signature: __________________________________

Date Signed: ________________________________

[Optional – Attorney Acknowledgments]

Attorney for Injured Party (if any):

Name (print): _______________________________
Law Firm: _________________________________

Signature (acknowledging review only): ___________________________
Date: ________________________

Attorney for Released Party (if any):

Name (print): _______________________________
Law Firm: _________________________________

Signature (acknowledging review only): ___________________________
Date: ________________________