PERSONAL INJURY SETTLEMENT AND MUTUAL RELEASE AGREEMENT
(Arkansas)
[// GUIDANCE: This template is designed for Arkansas-based personal injury matters. It assumes no arbitration, no jury waiver, and exclusive state-court jurisdiction, per the user’s metadata. Please tailor bracketed items and optional clauses to the facts of your case and obtain court approval whenever a minor or incapacitated person is involved.*
TABLE OF CONTENTS
- Document Header & Recitals
- Article I – Definitions
- Article II – Settlement Payment & Consideration
- Article III – Mutual Release of Claims
- Article IV – Representations & Warranties
- Article V – Covenants & Restrictions
- Article VI – Default & Remedies
- Article VII – Risk Allocation
- Article VIII – Dispute Resolution
- Article IX – General Provisions
- Execution Block
DOCUMENT HEADER & RECITALS
This Personal Injury Settlement and Mutual Release Agreement (this “Agreement”) is entered into effective as of [EFFECTIVE DATE] (the “Effective Date”) by and between:
• [CLAIMANT FULL LEGAL NAME], an individual [and, if applicable, guardian ad litem for [MINOR NAME]] (“Claimant”); and
• [DEFENDANT/RELEASED PARTY FULL LEGAL NAME], a [STATE OF FORMATION] [ENTITY TYPE] with principal place of business at [ADDRESS] (“Released Party,” and together with Claimant, the “Parties,” and each, a “Party”).
WHEREAS, Claimant alleges that on or about [DATE OF INCIDENT] (the “Incident”) Claimant sustained personal injuries and damages allegedly caused by Released Party;
WHEREAS, Claimant has asserted or may assert claims, causes of action, or demands (collectively, the “Action”) arising out of the Incident in [COURT NAME / CASE NO.] or any other forum;
WHEREAS, without admitting liability, the Parties desire to fully and finally settle all disputes, claims, and potential claims relating to the Incident upon the terms set forth herein;
NOW, THEREFORE, for good and valuable consideration, the sufficiency of which is acknowledged, the Parties agree as follows:
ARTICLE I – DEFINITIONS
For purposes of this Agreement, capitalized terms have the meanings set forth below:
1.1 “Claims” means any and all past, present, or future claims, demands, causes of action, liabilities, obligations, damages, losses, costs, expenses, liens, and attorneys’ fees of every kind or nature, whether known or unknown, fixed or contingent, asserted or unasserted, including without limitation those arising under tort, contract, statute, or common law and relating in any manner to the Incident.
1.2 “Court Approval” means entry of a valid order by a court of competent jurisdiction approving this Agreement pursuant to applicable Arkansas law governing settlements involving minors or incapacitated persons.
1.3 “Medicare Secondary Payer Laws” means 42 U.S.C. § 1395y(b) and related regulations concerning Medicare’s secondary payer status.
1.4 “Released Parties” means Released Party and its past, present, and future parents, subsidiaries, affiliates, shareholders, officers, directors, managers, employees, agents, insurers, reinsurers, successors, and assigns.
1.5 “Settlement Amount” means [USD $__] to be paid by or on behalf of Released Party pursuant to Article II.
1.6 “Structured Settlement” means the periodic payment arrangement, if any, set forth in Section 2.3.
ARTICLE II – SETTLEMENT PAYMENT & CONSIDERATION
2.1 Settlement Payment. Released Party shall pay or cause to be paid the Settlement Amount to Claimant as follows:
(a) Lump-Sum Option: [USD $__] payable within [___] business days after (i) execution of this Agreement by all Parties, (ii) receipt of any required Court Approval, and (iii) receipt of all dismissals or releases specified in Section 3.4.
(b) Structured Option: See Section 2.3.
[// GUIDANCE: Select lump-sum or insert structured details. Do not include both unless intentionally combined.]
2.2 Form of Payment. Payment shall be made by [wire transfer / cashier’s check] to the trust account of Claimant’s counsel, [LAW FIRM NAME, IOLTA ACCOUNT NO.], to be disbursed pursuant to Arkansas Rule of Professional Conduct 1.15.
2.3 Structured Settlement Terms (Optional).
(a) Annuity: Released Party shall purchase an annuity contract issued by [ANNUITY COMPANY] rated at least A- (A.M. Best) providing for periodic payments as follows:
• [AMOUNT] on [DATE];
• [AMOUNT] annually for [NUMBER] years beginning [DATE]; and
• [AMOUNT] lump-sum on [DATE].
(b) Qualified Assignment: Payments shall be made pursuant to a qualified assignment under 26 U.S.C. § 130; Claimant shall have no right to accelerate, defer, increase, or assign the Structured Settlement except as permitted by Arkansas Structured Settlement Protection Act and applicable federal law.
(c) No Constructive Receipt: The Parties intend to avoid constructive receipt by Claimant within the meaning of Internal Revenue Code § 104(a)(2).
2.4 Lien Resolution. Claimant is solely responsible for satisfaction and release of all medical, Medicaid, Medicare, workers’ compensation, veterans’ administration, child-support, and any other liens or subrogation claims.
2.5 Tax Treatment. The Parties intend that amounts paid hereunder for personal physical injuries are excludable from Claimant’s gross income under 26 U.S.C. § 104(a)(2); however, Claimant acknowledges that Released Party makes no warranty regarding tax consequences. Claimant shall obtain independent tax advice.
ARTICLE III – MUTUAL RELEASE OF CLAIMS
3.1 Release by Claimant. Upon receipt of the Settlement Amount, Claimant, on behalf of self and any heirs, executors, administrators, successors, and assigns, irrevocably and unconditionally releases and forever discharges the Released Parties from any and all Claims.
3.2 Release by Released Party. Upon the Effective Date, Released Party releases Claimant from any claims arising out of the Incident, including contribution, indemnity, or subrogation, except obligations created by this Agreement.
3.3 Waiver of Unknown Claims. The Parties expressly waive and relinquish all rights under any applicable law that would otherwise limit the release of unknown or unsuspected claims.
3.4 Dismissal of Action. Within [___] business days after receipt of the Settlement Amount and, if applicable, Court Approval, Claimant shall file (and, where necessary, join with Released Party in filing) a [WITH PREJUDICE] dismissal of the Action, each party to bear its own costs and fees unless otherwise set forth herein.
3.5 No Admission of Liability. This Agreement is a compromise of disputed claims and shall not be construed as an admission of liability by any Party.
ARTICLE IV – REPRESENTATIONS & WARRANTIES
4.1 Authority. Each Party represents that it has full power, legal right, and authority to enter into and perform this Agreement, and that no additional consents are required, other than Court Approval where applicable.
4.2 No Assignment. Claimant represents that no Claims have been assigned, pledged, or otherwise transferred to any third party.
4.3 Independent Counsel. Each Party acknowledges that it has consulted with, or had the opportunity to consult with, independent legal counsel and is entering this Agreement voluntarily.
4.4 Reliance. Each Party acknowledges that it is not relying on any representation or statement not expressly set forth herein.
ARTICLE V – COVENANTS & RESTRICTIONS
5.1 Confidentiality (Optional). Except as required by law or Court Approval, the Parties shall keep the terms and amount of this settlement confidential.
5.2 Non-Disparagement (Optional). Each Party agrees not to make statements intended to defame or disparage the other concerning matters released herein.
5.3 Cooperation. The Parties shall execute and deliver such further documents as may be reasonably necessary to effectuate this Agreement.
5.4 Court Approval for Minors. If Claimant or any beneficiary is a minor or incapacitated person, this Agreement is contingent upon Court Approval under applicable Arkansas statutes and local rules. The Parties shall cooperate in filing a petition for approval.
[// GUIDANCE: Arkansas circuit courts typically require (i) verified petition, (ii) medical evidence, (iii) proposed order, and (iv) disclosure of attorney’s fees when approving settlements ≥ $10,000 for minors.]
ARTICLE VI – DEFAULT & REMEDIES
6.1 Events of Default. Failure of Released Party to timely deliver the Settlement Amount, or failure of Claimant to timely file dismissal documents, constitutes an “Event of Default.”
6.2 Cure Period. The breaching Party shall have [10] business days after written notice to cure an Event of Default.
6.3 Remedies. If not cured, the non-breaching Party may:
(a) Seek specific performance of this Agreement;
(b) Recover the Settlement Amount plus interest at the Arkansas statutory rate from the due date; and
(c) Recover reasonable attorneys’ fees and costs incurred in enforcement.
6.4 Limitation. Except for obligations arising under Sections 3 and 6, each Party’s aggregate liability under this Agreement shall not exceed the Settlement Amount.
ARTICLE VII – RISK ALLOCATION
7.1 Indemnification for Liens. Claimant shall indemnify, defend, and hold harmless Released Parties from any lienholder claims or governmental recovery actions relating to payments made hereunder.
7.2 Force Majeure. No Party shall be liable for delay caused by events beyond its reasonable control (e.g., natural disasters, war, governmental orders), provided it gives prompt notice and resumes performance as soon as practicable.
7.3 Insurance. Released Party represents it maintains liability insurance sufficient to fund the Settlement Amount; Claimant acknowledges reliance on this representation.
ARTICLE VIII – DISPUTE RESOLUTION
8.1 Governing Law. This Agreement shall be governed by, and construed in accordance with, the laws of the State of Arkansas, without regard to conflict-of-laws principles.
8.2 Exclusive Forum. The Parties submit to the exclusive jurisdiction of the state courts located in [COUNTY], Arkansas, and waive any objection based on forum non conveniens. Removal to federal court is expressly waived to the fullest extent permitted by law.
8.3 No Arbitration; No Jury Waiver. The Parties acknowledge that arbitration and jury-trial waiver provisions are intentionally omitted.
ARTICLE IX – GENERAL PROVISIONS
9.1 Entire Agreement. This Agreement constitutes the entire understanding of the Parties and supersedes all prior negotiations and agreements concerning its subject matter.
9.2 Amendments; Waivers. No amendment or waiver is effective unless in writing and signed by all Parties. A waiver on one occasion is not a waiver on any other occasion.
9.3 Assignment. No Party may assign or delegate its rights or obligations without prior written consent of the other Parties, except that Released Party may assign its payment obligations to an approved qualified assignee pursuant to Section 2.3.
9.4 Severability. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force, and the invalid provision shall be reformed to the minimum extent necessary to achieve its intent.
9.5 Successors & Assigns. This Agreement binds and benefits the Parties and their respective successors and permitted assigns.
9.6 Counterparts; Electronic Signatures. This Agreement may be executed in counterparts, each of which is deemed an original. Signatures delivered via facsimile, PDF, or secure electronic signature platform constitute originals.
9.7 Headings. Headings are for convenience only and do not affect interpretation.
9.8 Construction. The Parties acknowledge equal drafting responsibility; hence, ambiguities shall not be construed against any Party.
EXECUTION BLOCK
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.
| Claimant | Released Party |
|---|---|
| [CLAIMANT NAME] | [RELEASED PARTY NAME] |
| Signature: ______ | Signature: ______ |
| Printed Name: ____ | Printed Name: ____ |
| Date: _____ | Title: _____ |
| Date: _____ |
[OPTIONAL NOTARY ACKNOWLEDGMENT—Arkansas]
State of Arkansas )
County of [__] )
Subscribed and sworn before me on [DATE] by [NAME], proved to me on the basis of satisfactory evidence to be the person who appeared before me.
Notary Public
My Commission Expires: ___
[// GUIDANCE: Arkansas law does not universally require notarization of settlement agreements, but some insurers and courts prefer it. Attach notarization if court approval is sought or if any Party requests heightened enforceability.]
END OF DOCUMENT