PERSONAL INJURY SETTLEMENT AGREEMENT
AND MUTUAL RELEASE
(Delaware – Court-Ready Template)
[// GUIDANCE: Bracketed text such as [PARTY NAME] is for user customization. Delete all guidance notes prior to execution.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
3.1 Settlement Payment
3.2 Conditions Precedent and Subsequent
3.3 Tax Treatment
3.4 Confidentiality (Optional) - Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
7.1 Mutual Release
7.2 Indemnification
7.3 Limitation of Liability
7.4 Insurance (If Applicable) - Dispute Resolution
- General Provisions
- Execution Block
- Court Approval Annex (Minor or Structured Settlement Only)
1. DOCUMENT HEADER
This Personal Injury Settlement Agreement and Mutual Release (this “Agreement”) is made and entered into as of [EFFECTIVE DATE] (the “Effective Date”) by and between:
• [CLAIMANT FULL LEGAL NAME], [an individual / a minor, by and through his/her legal guardian, [GUARDIAN NAME]/] (“Claimant”); and
• [DEFENDANT FULL LEGAL NAME], [a Delaware corporation / limited liability company / individual] (“Defendant”).
Claimant and Defendant are each a “Party” and collectively the “Parties.”
Recitals
A. On or about [DATE OF INCIDENT], Claimant allegedly sustained personal injuries and damages arising out of [BRIEF DESCRIPTION OF ACCIDENT / INCIDENT] (the “Incident”).
B. Claimant has asserted, or may assert, claims against Defendant in connection with the Incident, including any action filed as [CASE CAPTION AND COURT, IF APPLICABLE] (the “Action”).
C. Without admission of liability, and to avoid the costs and uncertainty of litigation, the Parties wish to fully and finally resolve all matters between them on the terms set forth herein.
NOW, THEREFORE, in consideration of the mutual promises and covenants herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the Parties agree as follows:
2. DEFINITIONS
The following terms, when capitalized, have the meanings set forth below. Terms defined elsewhere have the same meaning throughout this Agreement.
“Action” – see Recital B.
“Agreement” – this Personal Injury Settlement Agreement and Mutual Release, including all Exhibits and the Court Approval Annex (if applicable).
“Claim(s)” – any and all past, present, or future claims, demands, causes of action, obligations, damages, costs, expenses, and liabilities of every kind or nature, whether known or unknown, direct or indirect, suspected or unsuspected, contingent or non-contingent, arising from or related to the Incident.
“Court Approval” – written approval of this Agreement by a Delaware state court of competent jurisdiction as required for (i) settlements involving minors or incapacitated persons, or (ii) structured settlements, in accordance with applicable Delaware law.
“Effective Date” – see Document Header.
“Minor” – an individual who has not reached eighteen (18) years of age under Delaware law.
“Parties / Party” – see Document Header.
“Released Claims” – all Claims released pursuant to Section 7.1.
“Released Parties” – Defendant, its past and present affiliates, officers, directors, employees, insurers, attorneys, agents, successors, and assigns; and Claimant, his/her heirs, representatives, insurers, attorneys, agents, successors, and assigns.
“Settlement Amount” – the total consideration payable by or on behalf of Defendant to Claimant pursuant to Section 3.1.
“Structured Settlement” – periodic payments funded through an annuity or qualified assignment in compliance with applicable state and federal structured-settlement regulations.
3. OPERATIVE PROVISIONS
3.1 Settlement Payment
3.1.1 Form of Payment. The Settlement Amount shall be [USD $___], paid as follows (select one):
(a) Lump-Sum Payment. [USD $___] within [___] days after all Conditions Precedent in Section 3.2 are satisfied, by [check / wire transfer] to the trust account of [CLAIMANT’S COUNSEL].
(b) Structured Settlement. A Structured Settlement with a present value of [USD $___], funded by an annuity issued by [ANNUITY ISSUER] providing periodic payments as detailed in Exhibit A.
[// GUIDANCE: If (b) is elected, ensure compliance with Delaware’s Structured Settlement Protection Act and obtain Court Approval. Attach annuity schedule as Exhibit A.]
3.1.2 Liens & Offsets. Claimant shall be solely responsible for satisfaction of all medical, governmental, or other liens relating to the Incident. Defendant may issue joint checks or make direct payments to lienholders only as required by law or written lien confirmation.
3.2 Conditions Precedent and Subsequent
(a) Execution of this Agreement by all Parties;
(b) Delivery of any required Court Approval;
(c) Receipt of valid [Form W-9] and payment instructions from Claimant’s counsel; and
(d) For Structured Settlements, delivery of a qualified assignment and annuity contract acceptable to Defendant.
Failure of any Party to fulfill a Condition Precedent within [30] days of the Effective Date permits the non-defaulting Party to terminate this Agreement by written notice.
3.3 Tax Treatment
Each Party acknowledges and agrees that (i) no representation has been made regarding the tax treatment of the Settlement Amount; (ii) each Party has consulted, or had the opportunity to consult, independent tax advisors; and (iii) consistent with I.R.C. § 104(a)(2), amounts received on account of personal physical injuries are intended to be excluded from gross income to the extent permitted by law.
3.4 Confidentiality (Optional)
Except as required by law or Court Approval, the Parties shall keep the terms of this Agreement confidential.
[// GUIDANCE: If confidentiality is required, consider including liquidated damages and carve-outs for tax, legal, and regulatory disclosures.]
4. REPRESENTATIONS & WARRANTIES
4.1 Authority. Each Party represents that it has full authority and capacity to enter into and perform this Agreement. If Claimant is a Minor, the undersigned legal guardian represents that Court Approval will be sought promptly and that he/she has full authority to bind the Minor subject to such approval.
4.2 No Assignment. Each Party represents that it has not assigned or transferred any Claim or right released herein.
4.3 Independent Counsel. Each Party acknowledges that it (i) has been represented by independent legal counsel or had the opportunity to do so, (ii) has read and fully understands this Agreement, and (iii) enters into this Agreement voluntarily and without reliance on any representation not set forth herein.
4.4 No Admission of Liability. The Parties acknowledge that Defendant denies all liability and that this Agreement is a compromise settlement of disputed Claims.
All representations and warranties survive the Effective Date and the delivery of consideration.
5. COVENANTS & RESTRICTIONS
5.1 No Further Claims. Claimant covenants not to assert any Released Claim against any Released Party.
5.2 Cooperation. The Parties shall execute such additional instruments and take such further actions as may be reasonably necessary to effectuate the purposes of this Agreement.
5.3 Lien Resolution. Claimant shall (i) identify all known liens, (ii) timely satisfy or resolve such liens, and (iii) indemnify Defendant against any liability for unsatisfied liens pursuant to Section 7.2.
6. DEFAULT & REMEDIES
6.1 Monetary Default. If Defendant fails to pay the Settlement Amount when due, Claimant may provide written notice and a [10-day] cure period. Absent cure, Claimant may (i) enforce this Agreement as a judgment for the unpaid amount plus interest at the legal rate, or (ii) reinstate the Action solely for purposes of entering judgment on this Agreement.
6.2 Non-Monetary Default. For any other breach, the non-defaulting Party shall provide written notice and a [30-day] cure period before pursuing available equitable or legal remedies.
6.3 Attorneys’ Fees. The prevailing Party in any action to enforce this Agreement is entitled to reasonable attorneys’ fees and costs.
7. RISK ALLOCATION
7.1 Mutual Release
(a) Upon receipt of the Settlement Amount, Claimant irrevocably and unconditionally releases and forever discharges Defendant and all other Released Parties from any and all Released Claims.
(b) Defendant, upon payment of the Settlement Amount, releases Claimant and all other Released Parties from any claims arising out of the Incident.
(c) The Parties expressly waive any rights under laws that would otherwise limit the scope of unknown or unsuspected claims, intending that the releases herein be construed as broadly as permitted by Delaware law.
7.2 Indemnification
Each Party (“Indemnifying Party”) shall indemnify, defend, and hold harmless the other Party (“Indemnified Party”) from and against any third-party claims arising from (i) breach of this Agreement, or (ii) any lien, subrogation, or reimbursement claim asserted contrary to Section 5.3.
7.3 Limitation of Liability
The total liability of Defendant under this Agreement shall not exceed the Settlement Amount, except for willful failure to pay such amount.
7.4 Insurance (If Applicable)
[INSURER NAME] shall fund the Settlement Amount pursuant to policy number [POLICY #]. Nothing herein modifies coverage defenses as between Defendant and its insurer.
8. DISPUTE RESOLUTION
8.1 Governing Law. This Agreement shall be governed by and construed in accordance with the substantive laws of the State of Delaware, without regard to conflicts-of-law principles.
8.2 Forum Selection. Any action arising out of or relating to this Agreement shall be filed exclusively in the state courts located in [NEW CASTLE / KENT / SUSSEX] County, Delaware, and each Party irrevocably submits to the personal jurisdiction of such courts.
[// GUIDANCE: Arbitration and jury waiver are intentionally omitted per user metadata.]
9. GENERAL PROVISIONS
9.1 Amendment & Waiver. No amendment or waiver is effective unless in a writing signed by all Parties. Failure to enforce any provision is not a waiver of future enforcement.
9.2 Assignment. No Party may assign this Agreement without prior written consent of the other, except Defendant may assign its payment obligation to an annuity issuer in a Structured Settlement.
9.3 Successors & Assigns. This Agreement binds and benefits the Parties and their respective successors and permitted assigns.
9.4 Severability. If any provision is held invalid, the remaining provisions remain enforceable, and the invalid provision shall be reformed to the minimal extent necessary to achieve its purpose.
9.5 Integration. This Agreement constitutes the entire agreement between the Parties concerning the subject matter and supersedes all prior negotiations and understandings.
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 by facsimile, PDF, or compliant e-signature platform constitute original signatures.
10. EXECUTION BLOCK
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.
| Claimant | Defendant |
|---|---|
| [CLAIMANT NAME] | [DEFENDANT NAME] |
| Signature: ________ | Signature: ________ |
| Date: _______ | Date: _______ |
| Address: ____ | Title (if entity): _______ |
[// GUIDANCE: Add notary blocks if desired under Delaware Uniform Law on Notarial Acts.]
11. COURT APPROVAL ANNEX
(Complete ONLY if Claimant is a Minor or the Settlement includes a Structured Settlement)
The undersigned petition the [Court of Chancery / Superior Court] of the State of Delaware for approval of the foregoing settlement and represent that the settlement is fair, reasonable, and in the best interests of the Minor and/or consistent with Delaware Structured Settlement requirements.
| Guardian ad Litem / Petitioner | Attorney for Claimant |
|---|---|
| _______ | ___ |
| Signature & Date | Signature & Date |
[COURT ORDER OF APPROVAL ATTACHED HERETO AS EXHIBIT B]
[// GUIDANCE: After customization, review for consistency, delete guidance notes, and ensure all defined terms are used correctly. Obtain necessary Court Approval before disbursing funds under Sections 3.1 and 3.2.]