Personal Injury Settlement Agreement - Colorado

PERSONAL INJURY SETTLEMENT AND RELEASE AGREEMENT

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
4. Representations & Warranties
5. Covenants & Restrictions
6. Default & Remedies
7. Risk Allocation
8. Dispute Resolution
9. General Provisions
10. Execution Block

1. DOCUMENT HEADER

This Personal Injury Settlement and Release Agreement (this “Agreement”) is entered into and made effective as of [EFFECTIVE DATE] (the “Effective Date”) by and between:

a. [CLAIMANT NAME], [an individual/a minor acting through [GUARDIAN NAME]/a legal entity] with an address at [CLAIMANT ADDRESS] (“Claimant”); and
b. [DEFENDANT NAME], a [corporation/limited liability company/individual] with an address at [DEFENDANT ADDRESS] (“Released Party”).

Claimant and Released Party are sometimes referred to individually as a “Party” and collectively as the “Parties.”

Recitals

A. Claimant alleges injuries arising out of an incident occurring on or about [DATE OF INCIDENT] at or near [LOCATION] (the “Incident”).
B. Released Party denies liability but desires to resolve all claims relating to the Incident.
C. The Parties wish to settle all claims fully and finally, without admission of liability, upon the terms set forth below.

NOW, THEREFORE, in consideration of the mutual promises and the payment described herein, the sufficiency of which is acknowledged, the Parties agree as follows:

2. DEFINITIONS

For ease of reference, the following terms shall have the meanings set forth below:

“Agreement” means this Personal Injury Settlement and Release Agreement, together with all exhibits, schedules, and addenda hereto.

“Claim(s)” means only the claims and damages identified in the completed release-scope selection in Section 5.1, subject to every stated reservation.

“Court Approval” means approval of this Agreement by a court of competent jurisdiction when required under applicable Colorado law, including settlements involving minors or incapacitated persons.

“Gross Settlement Amount” means the total amount to be paid to Claimant pursuant to Section 3.1.

“Settlement Proceeds” means the net amount payable to Claimant (or Claimant’s representatives) after deduction of attorney’s fees, costs, and any lien resolution payments.

“Structured Settlement” means the portion, if any, of the Gross Settlement Amount that will be funded through the purchase of an annuity contract or other periodic payment arrangement compliant with applicable state and federal structured settlement laws.

3. OPERATIVE PROVISIONS

3.1 Settlement Payment

a. Lump-Sum Option. Released Party shall pay Claimant the Gross Settlement Amount of $[AMOUNT] in a single, lump-sum payment within ☐ business days after (i) execution of this Agreement by all Parties, (ii) receipt of all required Court Approval, and (iii) delivery of a completed Form W-9 by Claimant.

b. Structured Settlement Option. In lieu of (or in addition to) a lump-sum payment, the Parties agree to fund a Structured Settlement as set forth in Exhibit A (Structured Settlement Terms). The annuity issuer shall be [ANNUITY COMPANY], rated not less than A- by A.M. Best as of the Effective Date.

3.2 Delivery of Funds

All lump-sum payments shall be made by wire transfer or certified funds to the trust account of Claimant’s counsel, [LAW FIRM NAME], IOLTA Account No. [___], ABA Routing No. [___], Account No. [___].

3.3 Conditions Precedent

Payment obligations are conditioned upon:

1. Execution of this Agreement by all Parties;
2. Receipt of any required Court Approval (see Section 3.4);
3. Resolution or waiver of all known medical, governmental, and subrogation liens (see Section 5.3); and
4. Delivery of any other documentation reasonably requested by Released Party to effectuate the settlement (e.g., Medicare reporting forms).

3.4 Minor or Incapacitated Claimant

If Claimant is a minor or otherwise lacks legal capacity:
a. This Agreement shall be submitted for Court Approval as required under applicable Colorado law.
b. No settlement funds shall be disbursed until an order approving the settlement is entered and all statutory protections (including placement of proceeds in a restricted account or court-approved trust) are satisfied.
c. Guardian ad litem fees, if any, shall be paid from [insert party responsible].

3.5 Tax Treatment

The Parties intend that the Settlement Proceeds for physical personal injuries or sickness shall be excludable from Claimant’s gross income under 26 U.S.C. § 104(a)(2). Claimant acknowledges and agrees that Released Party makes no representation concerning tax consequences and that Claimant has relied solely on Claimant’s tax advisers.

3.6 No Admission of Liability

This Agreement is a compromise of disputed claims and shall not be construed as an admission of liability, negligence, or wrongdoing by any Party.

4. REPRESENTATIONS & WARRANTIES

4.1 Mutual Representations. Each Party represents and warrants that:
a. It has full power and authority to enter into and perform this Agreement;
b. The execution and performance of this Agreement do not violate any other agreement or legal obligation;
c. It has not assigned or transferred any Claim released herein; and
d. It enters into this Agreement voluntarily, without duress, and after consultation with legal counsel.

4.2 Claimant-Specific Representations. Claimant further represents and warrants that:
a. Claimant is the sole person/entity entitled to assert the Claims;
b. No bankruptcy proceeding has been filed by or against Claimant that would affect this Agreement; and
c. Claimant has disclosed to Released Party all known medical, governmental, and other liens relating to the Claims.

5. COVENANTS & RESTRICTIONS

5.1 Mutual Release

a. Upon receipt of the Gross Settlement Amount, Claimant releases only the Released Persons and Claims identified below:

• Released Persons by legal name: [________________________________]
• Claim categories and date range: [________________________________]
• Scope: ☐ known claims only ☐ known and unknown Incident-related claims, selected after counsel review of the consequences
• Reserved claims, persons, benefits, liens, and reimbursement rights: [________________________________]

b. In consideration of the foregoing release, Released Party releases Claimant from any and all claims arising out of or relating to the Incident.

5.2 Covenant Not to Sue

Claimant covenants that neither Claimant nor anyone acting on Claimant’s behalf will institute any action against any Released Person based on any Claim released herein.

5.3 Lien Resolution

Before funding, the Parties shall complete a written recovery-interest schedule identifying every asserted medical, workers’ compensation, Medicare, Medicaid, benefit-plan, insurer, attorney, governmental, or other claim; its basis and status; any holdback or direct payment; the responsible person; and required proof of resolution.

5.4 Confidentiality

Unless disclosure is required by law or court order, the Parties shall keep the terms of this Agreement confidential. Permitted disclosures include immediate family, attorneys, tax advisers, and insurers.

6. DEFAULT & REMEDIES

6.1 Events of Default
a. Failure of Released Party to deliver the Gross Settlement Amount when due;
b. Failure of Claimant to obtain required Court Approval within [___] days after filing the approval motion; or
c. Material breach of Sections 5.1-5.4.

6.2 Notice & Cure
The non-breaching Party shall give written notice specifying the alleged default. The breaching Party shall have [10] business days from receipt to cure.

6.3 Remedies
If the default is not cured within the cure period:
a. The non-breaching Party may seek specific performance, damages, or rescission;
b. The prevailing Party shall be entitled to reasonable attorneys’ fees and costs; and
c. Interest on unpaid amounts shall accrue at the statutory rate set by Colo. Rev. Stat. § 5-12-102(1) (simple interest) from the cure period’s expiration until paid.

7. RISK ALLOCATION

7.1 Limitation of Liability

Released Party’s aggregate liability under this Agreement shall not exceed the Gross Settlement Amount.

7.2 Indemnification

No blanket lien, reimbursement, or representation indemnity applies. Any claim-specific indemnity must identify the exact third-party claim, indemnifying and protected persons, notice procedure, defense control, settlement authority, exclusions, and liability measure. A private allocation does not alter an obligation imposed directly by governing law.

7.3 Force Majeure

No Party shall be liable for delayed performance caused by events beyond its reasonable control (e.g., natural disasters, governmental orders). Payment obligations already matured are not excused.

8. DISPUTE RESOLUTION

8.1 Governing Law
This Agreement shall be governed by and construed in accordance with the laws of the State of Colorado, without regard to conflict-of-laws principles.

8.2 Forum Selection
Any action or proceeding arising out of this Agreement shall be filed exclusively in the District Court for [COUNTY] County, Colorado, and each Party irrevocably submits to such court’s jurisdiction.

8.3 Arbitration & Jury Trial Waiver
[INTENTIONALLY OMITTED – not applicable per metadata.]

9. GENERAL PROVISIONS

9.1 Entire Agreement
This Agreement constitutes the entire agreement among the Parties with respect to its subject matter and supersedes all prior understandings.

9.2 Amendments & Waivers
No amendment or waiver is effective unless in a writing signed by all Parties. A waiver is effective only for the specific circumstance given.

9.3 Assignment
No Party may assign its rights or delegate its duties without the prior written consent of the other Party, except that Released Party may assign to its insurers.

9.4 Successors & Assigns
This Agreement is binding upon and inures to the benefit of the Parties and their respective successors and permitted assigns.

9.5 Severability
If any provision is held unenforceable, the remaining provisions shall remain in full force, and the invalid provision shall be reformed to the maximum extent permitted by law.

9.6 Counterparts; Electronic Signatures
This Agreement may be executed in counterparts, each of which is deemed an original, and all of which together constitute one instrument. Signatures delivered via electronic means (e.g., PDF, DocuSign) are effective.

9.7 Headings
Headings are for convenience only and shall not affect interpretation.

10. EXECUTION BLOCK

IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.

CLAIMANT

Signature: _______________________________
Name: [CLAIMANT NAME]
Date: ___________________________________

[If minor/incapacitated:]
Signature: _______________________________
Name: [GUARDIAN NAME], as legal guardian of [MINOR NAME]
Date: ___________________________________

RELEASED PARTY

Signature: _______________________________
Name: [AUTHORIZED SIGNATORY]
Title: [TITLE]
Entity: [DEFENDANT NAME]
Date: ___________________________________

[OPTIONAL NOTARY BLOCK – Colorado]
State of Colorado )
County of __________ ) ss.

Subscribed and sworn before me this ____ day of __________, 20__, by _____________________________.

Notary Public: __________________________
My Commission Expires: ________________

EXHIBIT A

STRUCTURED SETTLEMENT TERMS