Personal Injury Settlement Agreement - Alaska

PERSONAL INJURY SETTLEMENT AGREEMENT AND RELEASE

(Alaska)

1. Parties, Incident, and Purpose

This Personal Injury Settlement Agreement and Release (the “Agreement”) is entered into by:

• Claimant / Releasor: [FULL LEGAL NAME AND ADDRESS]
• Defendant / Releasee: [FULL LEGAL NAME, ENTITY TYPE, AND ADDRESS]
• Insurer or other funding person, if a party: [NAME, CAPACITY, AND ADDRESS]

The disputed claim arises from an incident on [DATE] at [LOCATION] (the “Incident”). Claimant asserts injury and damages; Defendant denies liability. The Parties wish to resolve only the claims and parties identified in this Agreement, subject to the completed funding, approval, recovery-interest, and dismissal schedules.

2. Defined Settlement Scope

“Approval Order” means any court or administrative order identified in Exhibit D as a condition of this settlement.

“Effective Date” means the last completed event selected in Section 4.

“Released Claims” means only the claims described in Exhibit A through the stated Release Date. It excludes every reserved claim, later event, and enforcement right listed there.

“Released Parties” means only the persons and entities individually named in Exhibit A. Category labels must be reviewed deliberately and do not replace a complete list.

“Settlement Amount” means the total consideration stated in Section 3.

3. Settlement Funding

3.1 Total consideration: $[AMOUNT].

3.2 Funding method:

• ☐ Lump sum of $[AMOUNT] due [NUMBER] calendar days after all funding conditions occur.
• ☐ Periodic payments described completely in Exhibit B.
• ☐ Other consideration: [DESCRIPTION].

3.3 Exhibit C states every payee, amount or reserve, payment method, deadline, escrow condition, recovery-interest holdback, attorney fee and cost, and any court-directed account or fiduciary arrangement.

3.4 No receipt is acknowledged until the promised funds or funding instruments are actually delivered.

3.5 This form does not determine tax characterization, reporting, public-benefit eligibility, special-needs planning, annuity security, assignment treatment, or professional-responsibility duties. Any negotiated position must be documented in the completed exhibits after advisor review.

4. Conditions and Effective Date

Select every applicable condition:

• ☐ Signature by all Parties and required representatives
• ☐ Entry of the Approval Order in Exhibit D
• ☐ Delivery of dismissal papers to escrow
• ☐ Final recovery-interest figures or agreed holdbacks under Exhibit C
• ☐ Delivery of periodic-payment funding documents
• ☐ Other: [DESCRIPTION]

The Effective Date occurs upon: [IDENTIFY THE LAST REQUIRED EVENT].

If required approval is denied, Exhibit D states what happens to signatures, escrowed documents, funds, deadlines, and pending claims. No release on behalf of a minor becomes effective contrary to Civil Rule 90.2 or the Approval Order.

5. Alaska Minor-Settlement Gate

Complete this section and Exhibit D when a claimant is a minor.

5.1 Approval. Civil Rule 90.2(a)(1) requires court approval, upon a petition or motion, before a parent's or guardian's release, covenant not to sue, or stipulation for judgment on a minor's claim becomes effective.

5.2 Petition or motion. Confirm that the filing states:

• the minor's date of birth;
• the moving person's relationship to the minor;
• the circumstances giving rise to the claim;
• the amount of applicable liability insurance;
• the basis for finding the settlement fair and reasonable; and
• for the minor's personal injury, the extent of injury, treatment provided, and probable future course of treatment.

5.3 Fees, costs, and hearing. The Approval Order must address attorney fees and costs paid from the minor's proceeds. The rule permits approval without a hearing when net proceeds after attorney fees and costs do not exceed $25,000; it does not guarantee that a hearing will be waived.

5.4 Funding and release sequence. No instrument under Rule 90.2 terminates the minor's interests until funds are paid as the court directs. Funding, escrow, release, and dismissal instructions must follow the Approval Order.

5.5 Disposition. Exhibit D must state the court-directed payment of expenses, costs, and fees and the disposition of the remaining balance and future payments for the minor's best interests. It must identify any parent or guardian arrangement, trust, conservatorship, restricted account, custodianship, or other disposition actually authorized by the order.

5.6 Other capacity. If a claimant is an adult who may lack capacity, an estate, or a person acting through another fiduciary, counsel must identify the separate governing authority and approval process in Exhibit D. Civil Rule 90.2 should not be extended beyond its terms by assumption.

6. Dismissal and Funding Sequence

• ☐ No action is pending.
• ☐ A claimant-signed dismissal is delivered to [ESCROW / COUNSEL] and may be filed only after written confirmation that all funding and approval conditions are satisfied.
• ☐ Funding is delivered to escrow and released only after [EVENT].
• ☐ Other sequence: [TERMS].

Any dismissal is with prejudice only as to the Released Claims against the Released Parties unless Exhibit A expressly and validly states otherwise. Litigation costs and fees are allocated as follows: [TERMS].

7. Recovery Interests, Expenses, and Holdbacks

7.1 Exhibit C must inventory every known or potential medical-provider claim, Medicare or Medicaid recovery interest, benefit-plan or insurer reimbursement claim, workers' compensation interest, child-support claim, attorney lien, funding-company interest, assignment, subrogation claim, or other demand against the recovery.

7.2 Exhibit C assigns responsibility for investigation, notices, records, negotiation, payment, escrow, and holdback. It must not state that no interest exists unless the signer has a documented basis for that statement.

7.3 No blanket claimant indemnity or general mutual indemnity is included. Any claim-specific indemnity must identify the indemnifying person, protected person, precise third-party claim, notice, defense control, settlement consent, exclusions, and liability measure.

7.4 For a minor settlement, Exhibit C and the Approval Order must be consistent with Civil Rule 90.2's treatment of reasonable expenses, costs, attorney fees, and the remaining balance.

8. Release and Reserved Claims

8.1 Claimant release. On the Effective Date and subject to actual funding and any Approval Order, Claimant releases the Released Parties from the Released Claims identified in Exhibit A.

8.2 Known and unknown claims. Select and describe the intended result:

• ☐ Only known claims listed in Exhibit A are released.
• ☐ Defined unknown consequences of the Incident are included after counsel review: [TERMS].
• ☐ The following claims, parties, benefits, enforcement rights, later conduct, or time periods are reserved: [TERMS].

8.3 Defendant release:

• ☐ No reciprocal release.
• ☐ Defendant releases Claimant from only these claims: [TERMS].

8.4 Other alleged responsible persons. Exhibit A states whether claims against each nonsettling person are reserved and how any settlement credit, contribution, indemnity, or allocation issue is addressed after counsel review.

8.5 No admission. This Agreement compromises disputed claims and is not an admission of liability.

9. Optional Conduct Terms

9.1 Confidentiality:

• ☐ None.
• ☐ Limited to: [INFORMATION / PERSONS / DURATION].

Permitted disclosures must cover required approval, legal process, tax and benefit reporting, recovery-interest resolution, insurance administration, medical care, government communications, and confidential professional advice.

9.2 Non-disparagement:

• ☐ None.
• ☐ Narrow restriction: [TERMS].

The clause does not prohibit truthful testimony, legal process, protected government communications, medical care, insurance or benefit administration, or confidential advice.

9.3 Cooperation. Further documents may implement the completed exhibits but may not expand the Released Claims, Released Parties, or payment duties without a signed amendment and any required approval.

10. Default and Remedies

10.1 A material failure to perform an express obligation after its conditions occur is a default. A disputed recovery interest, approval condition, or escrow instruction is not automatically a default unless this Agreement allocates that risk.

10.2 Cure:

• ☐ No contractual cure period.
• ☐ Written notice and [NUMBER] calendar days to cure, except [EXCEPTIONS].

10.3 Select negotiated remedies after counsel review:

• ☐ Action to enforce the Agreement
• ☐ Judgment for an unpaid liquidated amount, if authorized by the governing procedure
• ☐ Contract interest at [RATE] beginning [DATE], supported by [CONTRACT / AUTHORITY]
• ☐ Agreed dismissal or restoration procedure: [TERMS]
• ☐ Other: [TERMS]

10.4 Fees:

• ☐ Each Party bears its own enforcement fees and costs except as a court otherwise awards under governing law.
• ☐ Claim-specific fee provision: [TERMS AND AUTHORITY].

No automatic interest, specific performance, fee shifting, fixed cure period, or presumption of irreparable harm is created by this form.

11. Risk Allocation

The Settlement Amount is consideration for the Released Claims, not a cap on liability for breach of this Agreement. No force-majeure term excuses funding, approval, escrow, recovery-interest, dismissal, or confidentiality duties unless the Parties insert a specific counsel-reviewed clause here: [TERMS].

No waiver, release, severability clause, or remedy may override the Approval Order or reduce a minor's protection under Civil Rule 90.2.

12. Governing Law and Disputes

Alaska substantive law governs this Agreement, subject to any valid choice-of-law analysis counsel records here: [TERMS].

Any filing must be made in a court with subject-matter jurisdiction and proper venue. Proposed Alaska court and trial location: [COURT / LOCATION], subject to governing law and any Approval Order.

Select one:

• ☐ Court proceedings; no contractual arbitration requirement
• ☐ Mediation before a non-emergency enforcement filing
• ☐ Arbitration under the attached counsel-completed rider

No jury waiver is included. Any proposed waiver requires a separate conspicuous, claim-specific provision reviewed under current law.

13. General Terms

13.1 Entire agreement. This Agreement and completed exhibits contain the settlement terms.

13.2 Amendments. An amendment or waiver must be in a record signed by every affected Party and approved through any process required by the Approval Order or governing law.

13.3 Assignment. No assignment or delegation is permitted except as expressly stated in Exhibit B or D or later approved in a signed record and any required order.

13.4 Severability. A provision may be severed only if permitted by governing law and any Approval Order and doing so does not materially alter the settlement exchange or release scope.

13.5 Persons bound. Only a signatory and persons or entities that signatory has authority to bind are bound. Exhibit A must identify every intended beneficiary or bound representative, estate, insurer, successor, or assignee.

13.6 Counterparts and signatures. The Parties select:

• ☐ Counterpart and electronic signatures under the completed signing protocol: [TERMS].
• ☐ Wet-ink originals required for: [DOCUMENTS].

13.7 Notices. Required notices are sent by [METHOD] to [ADDRESSES] and become effective upon [DELIVERY EVENT].

14. Signatures

CLAIMANT / RELEASOR

Signature: ______________________________

Name: [NAME]

Date: [DATE]

Representative capacity and authority document, if any: [DETAILS]

DEFENDANT / RELEASEE

Signature: ______________________________

Name and title: [NAME / TITLE]

Date: [DATE]

OTHER REQUIRED PARTY

Signature: ______________________________

Name, capacity, and authority: [DETAILS]

Date: [DATE]

Use a notarial certificate only if counsel, the Approval Order, escrow, or another applicable requirement calls for one.

15. Exhibits

• Exhibit A — Released Parties, Released Claims, Reserved Claims, Other Alleged Responsible Persons
• Exhibit B — Funding, Periodic Payments, Assignment, Annuity, and Beneficiary Terms
• Exhibit C — Payment Allocation, Fees, Costs, Recovery Interests, Holdbacks, and Any Claim-Specific Indemnity
• Exhibit D — Capacity, Fiduciary Authority, Civil Rule 90.2 Approval, Court-Directed Funds, and Distribution Terms
• Exhibit E — Dismissal and Escrow Documents

Sources and References

• Alaska Court System — current Alaska Rules of Court and recent rule changes
• Alaska Rules of Civil Procedure — Civil Rule 90.2