Settlement Agreement and Release
This Settlement Agreement and Release (the "Settlement Agreement") is made and
entered into this ____________day of____________________, 19 ____, by and
between [among]:
"Claimant"
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["Defendant" ]
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"Insurer"
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Recitals
A. On or about ______________ , 19 ______, Claimant [name person who suffered
physical injury if other than Claimant] was injured in an accident
occurring at____________(place)_______________. Claimant alleges that the
accident and resulting physical and personal injuries arose out of certain
alleged negligent acts or omissions of Defendant, and has made a claim
seeking monetary damages on account of those injuries.
B. Insurer is the liability insurer of the Defendant, and as such, would be
obligated to pay any claim made or judgement obtained against Defendant
which is covered by its policy with Defendant.
C. The parties desire to enter into this Settlement Agreement in order to
provide for certain payments in full settlement and discharge of all claims
which have, or might be made, by reason of the incident described in
Recital A above, upon the terms and conditions set forth below.
Agreement
The parties agree as follows:
1.0 Release and Discharge
1.1 In consideration of payments set forth in Section 2, Claimant
hereby completely releases and forever discharge Defendant and Insurer
from any and all past, present or future claims, demands, obligations,
actions, causes of action, wrongful death claims, rights, damages,
costs, losses of services, expenses and compensation of any nature
whatsoever, whether based on a tort, contract or other theory of
recovery, which the Claimant now has, or which may hereafter accrue or
otherwise be acquired, on account of, or may in any way grow out of the
incident described in Recital A above, including, without limitation,
any and all known or unknown claims for bodily and personal injuries to
Claimant, or any future wrongful death claim of Claimant's
representatives or heirs, which have resulted or may result from the
alleged acts or omissions of the Defendant.
1.2 This release and discharge shall also apply to Defendant's and
Insurer's past, present and future officers, directors, stockholders,
attorneys, agents, servants, representatives, employees, subsidiaries,
affiliates, partners, predecessors and successors in interest, and
assigns and all other persons, firms or corporations with whom any of
the former have been, are now, or may hereafter be affiliated.
1.3 This release, on the part of the Claimant, shall be a fully binding
and complete settlement among the Claimant, the Defendant and the
Insurer, and their heirs, assigns and successors.
1.4 Claimant acknowledges and agrees that the release and discharge set
forth above is a general release. Claimant expressly waives and assumes
the risk of any and all claims for damages which exist as of this date,
but of which the Claimant does not know or suspect to exist, whether
through ignorance, oversight, error, negligence, or otherwise, and
which, if known, would materially affect Claimant's decision to enter
into this Settlement Agreement. The Claimant further agrees that
Claimant has accepted payment of the sums specified herein as a
complete compromise of matters involving disputed issues of law and
fact. Claimant assumes the risk that the facts or law may be other than
Claimant believes. It is understood and agreed to by the parties that
this settlement is a compromise of a doubtful and disputed claim, and
the payments are not to be construed as an admission of liability on
the part of the Defendant, by whom liability is expressly denied.
2.0 Payments
In consideration of the release set forth above, the Insurer on
behalf of the Defendant agrees to pay to the individual(s) named
below ("Payee(s)") the sums outlined in this Section 2 below:
2.1 Payments due at the time of settlement as follows:
(insert Payees and lump sum cash payments)
2.2 Periodic payments made according to the schedule as follows (the
"Periodic Payments"):
(insert Payees and Periodic Payments)
[2.3 Payments to (attorney(s) and his/her/their successors
and assigns, for and on behalf of Claimant in discharge
of Claimant's obligation to pay attorney fees:
(insert attorney fees if part of the settlement)]
All sums set forth herein constitute damages on account of personal injuries and
sickness, within the meaning of Section 104(a)(2) of the Internal Revenue Code
of 1986, as amended.
3.0 Claimant's Rights to Payments
Claimant acknowledges that the Periodic Payments cannot be
accelerated, deferred, increased or decreased by the Claimant; nor
shall the Claimant have the power to sell, mortgage, encumber, or
anticipate the Periodic Payments, or any part thereof, by
assignment or otherwise.
4.0 Claimant's Beneficiary
Any payments to be made after the death of any Payee pursuant to
the terms of this Settlement Agreement shall be made to such
person or entity as shall be designated in writing by Claimant to
the Insurer or the Insurer's Assignee. If no person or entity is
so designated by Claimant, or if the person designated is not
living at the time of the Payee's death, such payments shall be
made to the estate of the Payee. No such designation, nor any
revocation thereof, shall be effective unless it is in writing and
delivered to the Insurer or the Insurer's Assignee. The
designation must be in a form acceptable to the Insurer or the
Insurer's Assignee before such payments are made.
5.0 Consent to Qualified Assignment
5.1 Claimant acknowledges and agrees that the Defendant and/or the
Insurer may [will] make a "qualified assignment", within the meaning of
Section 130(C) of the Internal Revenue Code of 1986, as amended, of the
Defendant's and/or the Insurer's liability to make the Periodic
Payments set forth in Section 2.2 to ____(assignment company)______
("the Assignee"). The Assignee's obligation for payment of the Periodic
Payments shall be no greater than that of Defendant and/or the Insurer
(whether by judgement or agreement) immediately preceding the
assignment of the Periodic Payments obligation.
5.2 Any such assignment, if made, shall be accepted by the
Claimant without right of rejection and shall completely release and
discharge the Defendant and the Insurer from the Periodic Payments
obligation assigned to the Assignee. The Claimant recognizes that, in
the event of such an assignment, the Assignee shall be the sole obligor
with respect to the Periodic Payments obligation, and that all other
releases with respect to the Periodic Payments obligation that pertain
to the liability of the Defendant and the insurer shall thereupon
become final, irrevocable and absolute.
6.0 Right to Purchase an Annuity
The Defendant and/or the Insurer, itself or through its
Assignee, reserve the right to fund the liability to make the
Periodic Payments through the purchase of an annuity policy
from __________(annuity issuer)_________. The Defendant, the
Insurer or the Assignee shall be the sole owner of the annuity
policy and shall have all rights of ownership. The Defendant,
the Insurer or the Assignee may have _______(annuity
issuer)________ mail payments directly to the Payee(s). The
Claimant shall be responsible for maintaining a current
mailing address for Payee(s) with _______(annuity
issuer)_______.
7.0 Discharge of Obligation
The obligation of the Defendant, the Insurer and/or Assignee
to make each Periodic Payment shall be discharged upon the
mailing of a valid check in the amount of such payment to the
designated address of the Payee(s) named in Section 2 of this
Settlement Agreement.
[8.0 Attorney's Fees (If attorney fees are not part of the
settlement)
Each party hereto shall bear all attorney's fees and costs
arising from the actions of its own counsel in connection with
this Settlement Agreement, the matters and documents referred
to herein, and all related matters.]
9.0 Representation of Comprehension of Document
In entering into this Settlement Agreement the Claimant
represents that Claimant has relied upon the advice of his/her
attorneys, who are the attorneys of his/her own choice, concerning
the legal and income tax consequences of this Settlement
Agreement; that the terms of this Settlement Agreement have been
completely read and explained to Claimant by his/her attorneys;
and that the terms of this Settlement Agreement are fully
understood and voluntarily accepted by Claimant.
10.0 Warranty of Capacity to Execute Agreement
Claimant represents and warrants that no other person or
entity has, or had, any interest in the claims, demands,
obligations, or causes of action referred to in this Settlement
Agreement, except as otherwise set forth herein; that Claimant has
the sole right and exclusive authority to execute this Settlement
Agreement and receive the sums specified in it; and that Claimant
has
not sold, assigned, transferred, conveyed or otherwise disposed
of any of the claims, demands, obligations or causes of action
referred to in this Settlement Agreement.
11.0 Confidentiality
The parties agree that neither they nor their attorneys nor
representatives shall reveal to anyone, other than as may be
mutually agreed to in writing, any of the terms of this
Settlement Agreement or any of the amounts, numbers or terms
and conditions of any sums payable to Payee(s) hereunder.
12.0 Governing Law
This Settlement Agreement shall be construed and interpreted
in accordance with the laws of the State of
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[(insert additional language as required by state law)]
13.0 Additional Documents
All parties agree to cooperate fully and execute any
and all supplementary documents and to take all additional actions
which may be necessary or appropriate to give full force and
effect to the basic terms and intent of this Settlement Agreement.
14.0 Entire Agreement and Successors in Interest
This Settlement Agreement contains the entire agreement
between the Claimant, [the Defendant] and the Insurer with regard
to the matters set forth in it and shall be binding upon and enure
to the benefit of the executors, administrators, personal
representatives, heirs, successors and assigns of each.
15.0 Effectiveness
This Settlement Agreement shall become effective immediately
following execution of the parties.
Claimant
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By:
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Date:
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Claimant's Attorney
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By:
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Date:
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Insurer
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By:
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Title
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Date:
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[Defendant
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By:
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Title
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Date: ]
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