PERSONAL INJURY SETTLEMENT AGREEMENT AND MUTUAL RELEASE
(District of Columbia)
[// GUIDANCE: Insert matter‐specific letterhead or caption here, if desired.]
TABLE OF CONTENTS
I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block
I. DOCUMENT HEADER
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Parties
1.1 Claimant: [CLAIMANT FULL LEGAL NAME], [individual/corporate form], residing/organized at [ADDRESS].
1.2 Respondent: [RESPONDENT FULL LEGAL NAME], [individual/corporate form], with principal place of business at [ADDRESS].
1.3 Released Parties: Respondent and each of its past, present, and future parents, subsidiaries, affiliates, officers, directors, employees, agents, insurers, reinsurers, successors, and assigns.
1.4 Releasing Parties: Claimant and each of his/her/their past, present, and future heirs, executors, administrators, agents, representatives, successors, and assigns. -
Effective Date
This Agreement is effective as of [EFFECTIVE DATE] (“Effective Date”). -
Recitals
WHEREAS, Claimant alleges that on or about [DATE OF INCIDENT] Claimant sustained personal injuries and other damages in [DESCRIPTION OF INCIDENT] (the “Incident”);
WHEREAS, Claimant has asserted or may assert claims, demands, causes of action, or suits (collectively, the “Claims”) against Respondent arising out of or relating to the Incident;
WHEREAS, Respondent denies all liability but desires to compromise and settle the Claims to avoid the burden, expense, and uncertainty of litigation; and
WHEREAS, the Parties desire to fully and finally settle any and all disputes between them upon the terms set forth herein, intending that this Agreement constitute a full, final, and complete mutual release.
NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the Parties agree as follows:
II. DEFINITIONS
For purposes of this Agreement, capitalized terms have the meanings set forth below:
“Action” means any pending or threatened legal, administrative, or arbitration proceeding relating to the Incident.
“Agreement” means this Personal Injury Settlement Agreement and Mutual Release, including all exhibits, schedules, and attachments.
“Business Day” means any day other than a Saturday, Sunday, or legal holiday in the District of Columbia.
“Court” means the Superior Court of the District of Columbia or any other court of competent jurisdiction located in the District of Columbia.
“Effective Date” has the meaning set forth in Section 2.
“Medicare” includes Medicare, Medicaid, SCHIP, and any other federal or state health-care reimbursement program.
“Minor” means an individual who has not yet attained eighteen (18) years of age under D.C. law.
“Parties” means, collectively, Claimant and Respondent; “Party” means any one of them.
“Released Claims” has the meaning set forth in Section 3.3.
“Settlement Amount” means the total consideration described in Section 3.1.
“Structured Settlement” means periodic payments funded through an annuity contract or other agreed mechanism pursuant to Section 3.2.
III. OPERATIVE PROVISIONS
3.1 Settlement Consideration
(a) Respondent shall pay Claimant the total sum of [US $__] (the “Settlement Amount”) as full and final consideration for the release and discharge of all Released Claims.
(b) Payment shall be made by [check/wire transfer] payable to “[LAW FIRM TRUST ACCOUNT]/[CLAIMANT NAME]” within [__] Business Days after (i) Respondent’s receipt of an executed original of this Agreement, (ii) delivery of a properly completed IRS Form W-9, and (iii) satisfaction of all conditions precedent in Section 3.4.
3.2 Structured Settlement (If Applicable)
(a) Part of the Settlement Amount shall be funded through periodic payments as set forth in Schedule A.
(b) The Structured Settlement shall comply with all applicable District of Columbia Structured Settlement Protection statutes and Internal Revenue Code § 104(a)(2).
(c) Claimant shall execute all documents reasonably required to establish the annuity or periodic-payment arrangement.
[// GUIDANCE: Delete Section 3.2 if the settlement is paid in a single lump sum.]
3.3 Mutual Release
(a) Released Claims. Upon Respondent’s tender of the Settlement Amount, Claimant irrevocably and unconditionally releases and forever discharges the Released Parties from any and all claims, demands, actions, causes of action, damages, costs, expenses, and liabilities of every kind, whether known or unknown, foreseen or unforeseen, that Claimant ever had or may have arising out of or in any way relating to the Incident.
(b) Respondent’s Release. Upon Claimant’s execution of this Agreement, Respondent releases and discharges the Releasing Parties from any and all claims arising out of or relating to the Incident, including any right to recover costs or fees from Claimant.
(c) Scope. The releases in this Section 3.3 extend to claims for contribution, indemnity, subrogation, liens, and rights of reimbursement to the maximum extent permitted by law.
3.4 Conditions Precedent
(a) If Claimant is a Minor, this Agreement and any dismissal of the Action are subject to prior approval by the Court pursuant to District of Columbia law governing minor settlements.
(b) Claimant shall satisfy, resolve, or set aside from the Settlement Amount all known Medicare liens or other statutory liens as required by applicable law.
(c) Claimant’s counsel shall hold the Settlement Amount in trust until all conditions precedent are satisfied.
3.5 Dismissal of Action
Within five (5) Business Days after Respondent’s payment of the Settlement Amount and satisfaction of Section 3.4, Claimant shall file a stipulation of dismissal with prejudice of any Action pending in the Court, with each Party to bear its own costs and fees unless otherwise provided herein.
3.6 No Admission of Liability
This Agreement constitutes a compromise settlement of disputed claims and is not, and shall not be construed as, an admission of liability or wrongdoing by any Party.
3.7 Taxes
(a) The Parties intend that the Settlement Amount represent damages on account of personal physical injuries within the meaning of IRC § 104(a)(2); however, no Party makes any representation or warranty regarding tax treatment.
(b) Claimant shall be solely responsible for any federal, state, or local taxes arising from the Settlement Amount.
IV. REPRESENTATIONS & WARRANTIES
4.1 Mutual Representations
(a) Authority. Each Party has full right, power, and authority to enter into and perform this Agreement.
(b) Execution. This Agreement has been duly executed and delivered and constitutes legal, valid, and binding obligations enforceable in accordance with its terms.
4.2 Claimant’s Additional Representations
(a) No Assignment. Claimant has not assigned, conveyed, or transferred any interest in the Claims or any right to payment arising from the Incident.
(b) Independent Counsel. Claimant has been advised to seek, and has had the opportunity to obtain, independent legal and tax advice regarding this settlement.
(c) Capacity. If Claimant is signing on behalf of a Minor or incapacitated person, the undersigned has full legal authority to do so and will seek Court approval where required.
4.3 Survival
All representations and warranties shall survive the Effective Date and the payment of the Settlement Amount.
V. COVENANTS & RESTRICTIONS
5.1 Non-Disparagement
Neither Party shall make any statement intended to disparage the other Party or Released Parties in connection with the Incident, except as required by law or court order.
5.2 Confidentiality
(a) Except as otherwise provided herein, the Parties shall keep the terms of this Agreement confidential.
(b) Permitted Disclosures include communications to attorneys, tax advisors, insurers, auditors, and as otherwise required by law or Court order.
[// GUIDANCE: Confidentiality of personal injury settlements may be disfavored in certain jurisdictions. Evaluate strategic necessity.]
5.3 Medicare Reporting
The Parties shall cooperate to satisfy any reporting obligations under the Medicare, Medicaid, and SCHIP Extension Act and related regulations.
VI. DEFAULT & REMEDIES
6.1 Events of Default
(a) Failures by Respondent to timely tender the Settlement Amount.
(b) Failures by Claimant to obtain required Court approval for a Minor or incapacitated Claimant within [___] days.
6.2 Notice and Cure
The non-defaulting Party shall give written notice specifying the default. The defaulting Party shall have ten (10) Business Days to cure after receipt of notice.
6.3 Remedies
(a) Specific Performance. The non-defaulting Party may pursue specific performance to enforce payment or dismissal obligations.
(b) Attorney Fees. The prevailing Party in any action to enforce this Agreement shall be entitled to reasonable attorney fees and costs.
(c) Reinstatement of Claims. If Respondent is in uncured default, Claimant may declare this Agreement null and void and reinstate any Released Claims, less any payments already received.
VII. RISK ALLOCATION
7.1 Indemnification for Liens
(a) Claimant shall indemnify and hold harmless the Released Parties from all Medicare, Medicaid, ERISA, TRICARE, workers’ compensation, or other statutory or contractual lien claims arising out of the Incident.
(b) Respondent shall indemnify and hold harmless Claimant from any claims by Respondent’s insurers or reinsurers arising solely from Respondent’s failure to pay premiums or secure coverage.
7.2 Limitation of Liability
The Parties’ aggregate liability to one another under this Agreement shall not exceed the Settlement Amount, except for liabilities arising from a Party’s breach of its indemnification obligations or intentional misconduct.
7.3 Force Majeure
No Party shall be liable for delay in performing obligations under this Agreement arising from events beyond its reasonable control, including natural disasters, acts of God, terrorism, war, or governmental action, provided that such Party gives prompt notice and uses reasonable efforts to mitigate delay.
VIII. DISPUTE RESOLUTION
8.1 Governing Law
This Agreement, and any dispute hereunder, shall be governed by and construed in accordance with the laws of the District of Columbia without regard to its conflicts-of-law principles.
8.2 Forum Selection
The Parties consent to the exclusive jurisdiction of the Superior Court of the District of Columbia (or, if federal jurisdiction is mandatory, the United States District Court for the District of Columbia) for any dispute arising out of or relating to this Agreement or its enforcement.
8.3 Arbitration; Jury Waiver
The Parties expressly waive arbitration and acknowledge that no jury trial has been demanded. Any fact-finder shall be the Court sitting without a jury.
8.4 Equitable Relief
Nothing in this Agreement limits a Party’s right to seek injunctive or other equitable relief to enforce confidentiality, non-disparagement, or other continuing obligations.
IX. GENERAL PROVISIONS
9.1 Entire Agreement; Integration
This Agreement constitutes the entire understanding among the Parties and supersedes all prior negotiations or agreements, written or oral, concerning its subject matter.
9.2 Amendments and Waivers
No amendment or waiver of any provision of this Agreement is effective unless set forth in writing signed by all Parties. A waiver on one occasion is not a waiver on subsequent occasions.
9.3 Assignment
Neither Party may assign or delegate any right or obligation under this Agreement without the prior written consent of the other Party, except that Respondent may assign its payment obligations to a qualified assignment company for purposes of a Structured Settlement.
9.4 Severability
If any provision of this Agreement 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 make it enforceable.
9.5 Successors and 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 but all of which together constitute one instrument. Signatures exchanged electronically (e.g., via PDF or e-signature platform) are deemed originals.
9.7 Headings
Headings are for convenience only and do not affect interpretation.
9.8 Construction
The Parties acknowledge that they have jointly participated in drafting this Agreement; therefore, no presumption shall arise against any Party by virtue of authorship.
X. EXECUTION BLOCK
IN WITNESS WHEREOF, the Parties have executed this Personal Injury Settlement Agreement and Mutual Release as of the Effective Date.
CLAIMANT
[NAME]
Date: _______
If Claimant is a Minor or Incapacitated Person:
[NAME], as [Parent/Guardian/Conservator] of [MINOR/INCAPACITATED PERSON NAME]
Date: _______
RESPONDENT
[AUTHORIZED SIGNATORY NAME]
[Title]
[COMPANY NAME]
Date: _______
[// GUIDANCE: Add notary acknowledgment blocks if desired or if required for Minor settlements or structured settlements.]
Schedule A – Structured Settlement Payment Terms
[If applicable, insert detailed periodic payment schedule, annuity issuer, payment start date, payment frequency, guaranteed period, payment recipient, and “lifetime only” or “period certain” descriptors.]
[// GUIDANCE: Obtain insurer’s life-contingent annuity quotes and verify compliance with the D.C. Structured Settlement Protection Act before finalizing.]
END OF AGREEMENT