PERSONAL INJURY SETTLEMENT AGREEMENT

(Florida – Comprehensive Form)

[// GUIDANCE: This template is designed for Florida-based personal injury claims. It includes optional language for (i) minors, and (ii) structured settlements. Delete all inapplicable bracketed provisions and verify factual details before execution.]

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
11. Exhibits & Schedules

1. DOCUMENT HEADER

PERSONAL INJURY SETTLEMENT AGREEMENT AND MUTUAL RELEASE
Effective Date: [●] 202__

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

1. [●], an individual [and natural parent/legal guardian of [Minor’s Name], a minor] (“Claimant”);
2. [●], an individual/entity (“Respondent”); and
3. [●], an insurance carrier authorized to transact insurance in Florida (“Insurer,” and together with Respondent, the “Released Parties”).

Claimant and the Released Parties are each a “Party” and collectively the “Parties.”

Recitals

A. An incident occurred on [Incident Date] at [Location] (“Incident”) allegedly causing Claimant to sustain personal injuries and damages (the “Claim”).
B. Claimant asserted, or intends to assert, claims sounding in negligence and related theories under Florida tort law against the Released Parties.
C. The Parties desire to resolve all disputes relating to the Incident without admission of liability upon the terms stated herein and for the consideration set forth below.

NOW, THEREFORE, in consideration of the mutual covenants and representations herein, and for other good and valuable consideration, the sufficiency of which is acknowledged, the Parties agree as follows:

2. DEFINITIONS

For purposes of this Agreement, capitalized terms have the meanings set forth below. Terms defined in the singular include the plural and vice-versa.

“Applicable Law” means all federal, state, or local statutes, regulations, and common-law principles governing the Claim or this Agreement, including but not limited to Chapter 744, Florida Statutes, for minor settlements and any applicable structured-settlement statutes.

“Closing Date” means the date on which Respondent/Insurer delivers the Settlement Payment in good funds pursuant to Section 3.2.

“Minor Court Approval” means entry of an order approving this Agreement by a Florida court of competent jurisdiction pursuant to Fla. Stat. § 744.3025, if Claimant is a minor.

“Release” has the meaning ascribed in Section 7.1.

“Settlement Amount” means the total consideration described in Section 3.1, inclusive of any attorney fees, costs, liens, and future medical expenses.

“Structured Settlement” means periodic payments funded through an annuity contract as described in Section 3.3, if elected.

3. OPERATIVE PROVISIONS

3.1 Settlement Consideration.
(a) Lump-Sum Option. Respondent/Insurer shall pay Claimant the gross amount of $[●] (“Settlement Amount”) within [●] business days after (i) execution of this Agreement by all Parties, (ii) receipt of a duly executed IRS Form W-9 from Claimant’s counsel, and (iii) satisfaction of all Conditions Precedent under Section 3.4.

(b) [Structured Settlement Option. In lieu of a lump sum, the Settlement Amount shall be funded through an annuity providing payments per Schedule 1. The annuity issuer shall be [Name], rated at least A- by A.M. Best on the date of purchase.]

3.2 Delivery of Funds. Payment shall be made by (check one): ☐ wire transfer ☐ cashier’s check, to the trust account of [Law Firm Name, IOLTA details] (“Trustee”). Trustee shall disburse funds in accordance with a closing statement signed by Claimant and Claimant’s counsel.

3.3 Liens & Medical Bills. Claimant is solely responsible for satisfaction of all known or unknown hospital, physician, Medicare, Medicaid, ERISA, workers’ compensation, and any other liens (collectively, “Liens”). [// GUIDANCE: Consider including hold-harmless language or escrow provisions if significant liens exist.]

3.4 Conditions Precedent. The obligations of the Released Parties are conditioned on:
(a) Receipt of a duly executed Release (Section 7.1);
(b) [Minor Court Approval]; and
(c) Return of all signed closing documents (including any required dismissal pleadings).

3.5 Dismissal of Actions. Within three (3) business days after Closing Date, Claimant shall file with the appropriate court a dismissal with prejudice of any pending action arising from the Incident, each Party to bear its own attorney fees and costs except as stated herein.

4. REPRESENTATIONS & WARRANTIES

4.1 Mutual Representations. Each Party represents and warrants that:
(a) Authority. It has full legal capacity, power, and authority to enter into and perform this Agreement, and entering into this Agreement does not violate any other agreement or court order.
(b) No Assignment. It has not assigned or transferred any interest in the Claim or any right that would be released under this Agreement.
(c) Voluntary Execution. It understands the legal effect of this Agreement, had the opportunity to consult independent counsel, and executes this Agreement voluntarily.

4.2 Claimant’s Additional Representations. Claimant further represents that:
(a) Accurate Information. All information provided in support of the Claim is true and complete to the best of Claimant’s knowledge;
(b) Liens. Claimant has disclosed all known Liens;
(c) Capacity. [If Claimant is a minor, Claimant’s natural guardian(s) execute this Agreement on the minor’s behalf and will seek Minor Court Approval].

5. COVENANTS & RESTRICTIONS

5.1 Confidentiality. To the fullest extent permitted by law, the Parties shall keep the terms, conditions, and existence of this Agreement confidential, except (i) as required by law or court order, (ii) for tax or financial planning, or (iii) to enforce this Agreement.

5.2 Non-Disparagement. Claimant shall not make any statement, public or private, intended to defame or disparage the Released Parties concerning the Incident after the Effective Date.

5.3 Cooperation. The Parties shall execute and deliver such further instruments and take such further actions as may reasonably be required to carry out the intent of this Agreement.

6. DEFAULT & REMEDIES

6.1 Events of Default.
(a) Payment Default: Failure of Respondent/Insurer to deliver the Settlement Amount in full by the Closing Date.
(b) Breach Default: Material breach of any covenant, representation, or warranty herein.

6.2 Notice & Cure. A non-defaulting Party shall provide written notice specifying the nature of the default. The defaulting Party has ten (10) business days to cure a Payment Default and fifteen (15) business days to cure any other default, unless such default is incapable of cure.

6.3 Remedies. If a default is not timely cured, the non-defaulting Party may:
(a) Seek specific performance;
(b) Obtain judgment for the unpaid Settlement Amount with interest at the statutory rate; and/or
(c) Recover attorney fees and costs incurred in enforcing this Agreement.

7. RISK ALLOCATION

7.1 Mutual Release. Upon Closing Date, Claimant, on behalf of himself/herself, [the minor Claimant], heirs, executors, administrators, and assigns, 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, that arise out of or relate to the Incident (“Release”). The Released Parties, in turn, release Claimant from any claims arising out of the Incident.

[// GUIDANCE: Florida law requires releases to be clear and unequivocal. Broad language such as “all claims, whether known or unknown” has been enforced by Florida courts.]

7.2 No Admission. This Agreement is a compromise of disputed claims. Nothing herein shall be construed as an admission of liability, which the Released Parties expressly deny.

7.3 Limitation of Liability. The Settlement Amount constitutes the sole monetary obligation of the Released Parties for the Claim. In no event shall the Released Parties be liable for any additional damages, punitive damages, or expenses beyond the Settlement Amount and any obligations expressly assumed herein.

7.4 Indemnification for Liens. Claimant shall indemnify, defend, and hold harmless the Released Parties from any loss, liability, or expense (including reasonable attorney fees) arising from any Claim-related Lien asserted after the Effective Date.

7.5 Force Majeure. No Party shall be liable for failure to perform caused by acts of God, war, terrorism, or other events beyond its reasonable control, provided that such Party gives notice and resumes performance as soon as practicable.

8. DISPUTE RESOLUTION

8.1 Governing Law. This Agreement and all disputes hereunder are governed by the substantive laws of the State of Florida without regard to conflict-of-law principles.

8.2 Forum Selection. The state courts located in [County Name], Florida shall have exclusive jurisdiction over any action to enforce or interpret this Agreement. Each Party irrevocably submits to such jurisdiction and waives any objection based on venue or forum non conveniens.

8.3 Arbitration / Jury Waiver. [Intentionally omitted pursuant to Parties’ agreement—see Metadata.]

9. GENERAL PROVISIONS

9.1 Entire Agreement. This Agreement constitutes the entire understanding between the Parties with respect to the subject matter and supersedes all prior or contemporaneous communications.

9.2 Amendment; Waiver. No amendment or waiver is effective unless in writing and signed by all Parties. Waiver of any breach shall not constitute waiver of any other or subsequent breach.

9.3 Assignment. No Party may assign its rights or delegate its duties without the prior written consent of the other Parties, except that Insurer may assign obligations to a successor in interest by operation of law.

9.4 Severability. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force, and the invalid portion shall be reformed to the minimum extent necessary to reflect the Parties’ intent.

9.5 Successors & Assigns. This Agreement binds and benefits the Parties and their respective heirs, executors, administrators, legal representatives, successors, and permitted assigns.

9.6 Counterparts; Electronic Signatures. This Agreement may be executed in multiple counterparts, each of which is deemed an original. Signatures transmitted electronically or by facsimile are deemed original signatures and fully enforceable.

9.7 Headings. Section 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: [●]
Address: [●]
Date: _________

[If Minor]
NATURAL GUARDIAN:

Signature: _____
Name: [●], as parent/legal guardian of [Minor]
Date: _________

RESPONDENT:

Signature: _____
Name: [●]
Title: [●]
Date: _________

INSURER:

Signature: _____
Name: [●]
Title: [Claims Representative]
Date: _________

[Notary Acknowledgment Block – include if required by Fla. Stat. § 695.03 for recordable documents or if otherwise desired.]

11. EXHIBITS & SCHEDULES

• Schedule 1 – Structured Settlement Payment Schedule (if elected)
• Exhibit A – Dismissal With Prejudice (form)
• Exhibit B – Closing Statement & Lien Resolution Affidavit

[// GUIDANCE:
1. Minor Settlement Approval – If the net settlement to a minor exceeds $15,000, Florida law generally requires court approval (see Fla. Stat. § 744.3025). Customize Section 3 to condition effectiveness on such approval and consider appointing a guardian ad litem where necessary.
2. Medicare/Medicaid Compliance – Evaluate Medicare Secondary Payer obligations and include set-aside arrangement language if applicable.
3. Structured Settlements – Confirm compliance with structured settlement protection statutes and secure court approval for transfers.
4. Tax Treatment – Personal injury proceeds are generally excludable from gross income under I.R.C. § 104(a)(2). Structured settlements preserve this exclusion; lump-sum settlements do not yield investment-income tax benefits. Insert client-specific tax disclaimers as needed.
5. Record Retention – Retain executed agreements for the longer of six (6) years or applicable statute of limitations for malpractice claims.]