PERSONAL INJURY SETTLEMENT AGREEMENT AND MUTUAL RELEASE
(State of Hawaiʻi)
[// GUIDANCE: This template is drafted to satisfy Hawaiʻi‐specific requirements for personal injury settlements, including release enforceability, structured settlement considerations, and minor‐approval protocols. Replace all bracketed placeholders before execution and obtain independent legal review.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
- Exhibits & Schedules
1. DOCUMENT HEADER
1.1 Title. Personal Injury Settlement Agreement and Mutual Release (this “Agreement”).
1.2 Date. Effective as of [EFFECTIVE DATE] (the “Effective Date”).
1.3 Parties.
(a) [CLAIMANT FULL LEGAL NAME], [status (individual, minor, etc.)], with an address at [ADDRESS] (“Releasor”).
(b) [DEFENDANT FULL LEGAL NAME], a [entity type/state], with an address at [ADDRESS] (“Releasee”).
[// GUIDANCE: If Releasor is a minor or incapacitated person, insert Guardian ad Litem or Conservator information and complete Section 3.8.]
1.4 Recitals.
A. A dispute has arisen out of an alleged personal injury incident that occurred on or about [DATE] in [LOCATION] (the “Incident”).
B. Releasor asserts that Releasee is legally responsible for damages arising from the Incident (the “Action”).
C. Releasee denies all liability but desires to resolve the Action without further litigation.
D. The Parties wish to compromise and settle all Claims (as defined below) upon the terms set forth herein, intending this Agreement to be fully enforceable under Hawaiʻi law.
NOW, THEREFORE, in consideration of the mutual covenants and the payment described herein, the Parties agree as follows:
2. DEFINITIONS
For purposes of this Agreement, the following capitalized terms shall have the meanings set forth below:
“Action” has the meaning stated in Recital B.
“Claims” means any and all past, present, or future claims, demands, actions, causes of action, suits, damages, losses, expenses, attorneys’ fees, costs, obligations, judgments, liabilities, and indemnities of any kind or nature whatsoever, whether known or unknown, foreseen or unforeseen, contingent or fixed, arising from or related to the Incident.
“Court Approval” means a final, non-appealable order issued by a court of competent jurisdiction in the State of Hawaiʻi approving this Agreement when required by law.
“Effective Date” has the meaning given in Section 1.2.
“Installment Payment Schedule” means the structured payment plan, if elected, as set forth on Exhibit B.
“Party” or “Parties” means individually or collectively Releasor and Releasee.
“Released Parties” means Releasee and each of its past, present, and future parents, subsidiaries, affiliates, insurers, reinsurers, shareholders, officers, directors, partners, members, employees, agents, attorneys, predecessors, successors, and assigns.
“Settlement Amount” means the consideration payable pursuant to Section 3.1.
“Structured Settlement” means the periodic payment arrangement, if any, described in Section 3.2 and Exhibit B.
3. OPERATIVE PROVISIONS
3.1 Settlement Payment.
(a) Releasee shall pay Releasor the total Settlement Amount of [US$__] (the “Settlement Amount”) as follows:
(i) Lump-Sum Option: [US$__] payable within [____] business days after the later of (1) execution of this Agreement by all Parties, and (2) receipt of any required Court Approval; or
(ii) Structured Settlement Option: pursuant to Section 3.2.
(b) All payments shall be made by [wire transfer/cashier’s check] to [PAYEE DETAILS].
[// GUIDANCE: Insert tax-reporting language if needed (e.g., IRC §§ 104 & 130 compliance).]
3.2 Structured Settlement (Optional).
(a) If the Parties elect a Structured Settlement, Releasee shall fund an annuity contract issued by a qualified insurer acceptable to Releasor (the “Annuity Issuer”) in the amount necessary to satisfy the Installment Payment Schedule.
(b) Title to and ownership of the annuity shall vest solely in Releasee or its designated assignee; Releasor shall have no rights beyond those of a general creditor to receive the periodic payments.
(c) The Installment Payment Schedule is attached as Exhibit B and incorporated herein.
(d) Any proposed sale, assignment, or encumbrance of structured payments is subject to applicable Hawaiʻi structured settlement protection statutes and must receive prior court authorization.
3.3 Delivery of Dismissal. Within [____] days after Releasor’s receipt of the full Settlement Amount (or confirmation that the annuity has been fully funded), Releasor shall execute and deliver to Releasee a stipulation dismissing the Action with prejudice, each Party to bear its own costs.
3.4 Consideration. The consideration set forth herein is in full and complete satisfaction of all Claims. Releasor acknowledges the adequacy and receipt of said consideration and warrants that no additional sums or relief are due.
3.5 Taxes. The Parties agree that no representations have been made regarding the tax treatment of the Settlement Amount. Releasor shall be solely responsible for any taxes, penalties, or interest assessed on the Settlement Amount.
3.6 No Admission of Liability. This Agreement constitutes a compromise of disputed claims and shall not be construed as an admission of liability by any Party.
3.7 Conditions Precedent. Releasee’s obligation to fund the Settlement Amount is subject to: (a) full execution of this Agreement by all Parties; (b) receipt of any required Court Approval; and (c) delivery of the dismissal pleadings described in Section 3.3.
3.8 Minor or Incompetent Releasor.
(a) If Releasor is a minor or incapacitated person, this Agreement is contingent upon approval by the [Hawaiʻi Family/Circuit/District] Court pursuant to applicable Hawaiʻi law.
(b) The guardian ad litem or conservator (“GAL”) shall file a petition for Court Approval within [____] days after execution of this Agreement.
(c) All proceeds shall be deposited, invested, or structured as directed in the court’s approval order.
(d) The GAL represents that he/she has independently evaluated the fairness of this settlement and believes it to be in the best interests of the minor or ward.
4. REPRESENTATIONS & WARRANTIES
4.1 By Releasor.
(a) Authority. Releasor has full legal right and authority to execute this Agreement, and, if applicable, the undersigned GAL is duly authorized by court order to act on Releasor’s behalf.
(b) No Assignment. Releasor has not sold, assigned, pledged, or otherwise transferred any Claim or interest therein.
(c) Review of Counsel. Releasor has had the opportunity to consult with independent counsel and enters into this Agreement freely and voluntarily.
4.2 By Releasee.
(a) Authority. Releasee’s signatory possesses full corporate or other authority to bind Releasee.
(b) No Conflicting Agreements. Execution of this Agreement does not violate any other agreement or legal obligation of Releasee.
4.3 Survival. The representations and warranties in this Section 4 shall survive execution and delivery of this Agreement.
5. COVENANTS & RESTRICTIONS
5.1 Non-Disparagement. Each Party agrees to refrain from any statement or publication that disparages the other Party concerning matters related to the Incident or this Agreement.
5.2 Confidentiality.
(a) Except as required by law or court order, the Parties shall keep the terms and amount of this settlement strictly confidential.
(b) Permitted Disclosures. Each Party may disclose the terms to (i) its attorneys, accountants, insurers, tax advisors, or as otherwise necessary to secure Court Approval; and (ii) governmental authorities as legally compelled.
(c) Liquidated Damages. Breach of this Section 5.2 shall entitle the non-breaching Party to liquidated damages of [US$__] per breach, not as a penalty but as a reasonable estimate of harm.
5.3 Cooperation. The Parties shall execute any further documents reasonably necessary to effectuate the purposes of this Agreement.
6. DEFAULT & REMEDIES
6.1 Events of Default. Any failure by Releasee to timely pay the Settlement Amount, or by Releasor to timely deliver the dismissal pleadings, constitutes a default (“Default”).
6.2 Notice & Cure. The non-defaulting Party shall provide written notice of Default and a [10]-day cure period.
6.3 Remedies.
(a) If Releasee is in Default, Releasor may (i) enforce specific performance, plus interest at [___]% per annum; (ii) obtain judgment for the unpaid balance; and/or (iii) reinstate the Action.
(b) If Releasor is in Default, Releasee may seek specific performance or vacate this Agreement and defend the Action.
6.4 Attorneys’ Fees. The prevailing Party in any dispute to enforce this Agreement shall recover reasonable attorneys’ fees, costs, and expenses.
7. RISK ALLOCATION
7.1 Mutual Release & Indemnification.
(a) Releasor, for himself/herself and for all Released Parties, irrevocably releases and forever discharges Releasee and the Released Parties from all Claims.
(b) Releasee, for itself and its successors, releases Releasor from any and all claims arising out of or related to the Incident.
(c) Each Party shall indemnify, defend, and hold harmless the other Party from any third-party claims arising from a breach of this Agreement.
7.2 Limitation of Liability. Except for obligations expressly stated herein, the Parties’ aggregate liability is limited to the Settlement Amount.
7.3 Force Majeure. No Party shall be liable for delay or failure in performance caused by events beyond its reasonable control, including acts of God, natural disasters, war, or governmental action.
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 Hawaiʻi, without regard to conflict-of-laws principles.
8.2 Forum Selection. Any suit, action, or proceeding arising out of or relating to this Agreement shall be brought exclusively in the [state court of competent jurisdiction in ______ County, Hawaiʻi]. Each Party irrevocably submits to such jurisdiction and waives any objection to venue.
8.3 Arbitration. The Parties expressly agree that arbitration is not required.
8.4 Jury Trial Waiver. Each Party knowingly waives the right to trial by jury to the extent permitted by Hawaiʻi law.
[// GUIDANCE: Omit Section 8.4 entirely if jury waiver is deemed impermissible or undesirable.]
9. GENERAL PROVISIONS
9.1 Entire Agreement. This Agreement constitutes the entire understanding between the Parties and supersedes all prior negotiations and agreements relating to its subject matter.
9.2 Amendments. No amendment or waiver shall be effective unless in writing and signed by all Parties.
9.3 Assignment. No Party may assign its rights or delegate its duties without prior written consent of the other Party, except to permitted successors 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 provision shall be reformed to the minimum extent necessary.
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 counterparts, each of which is deemed an original. Signatures transmitted electronically (e.g., via PDF or electronic signature platform) are effective as originals.
9.7 Headings. Section headings are for convenience only and shall not affect interpretation.
9.8 Interpretation. The Parties have jointly participated in drafting; thus, no presumption or rule of construction shall apply against any Party.
10. EXECUTION BLOCK
IN WITNESS WHEREOF, the Parties have executed this Personal Injury Settlement Agreement and Mutual Release as of the Effective Date.
RELEASOR
Signature: _____
Name: [CLAIMANT NAME]
Date: _________
[// GUIDANCE: If minor/incapacitated, add GAL line:]
Guardian ad Litem / Conservator: ________
RELEASEE
Signature: _____
Name: [AUTHORIZED SIGNATORY]
Title: [TITLE]
Date: _________
[Optional Notarization Block – Hawaiʻi]
State of Hawaiʻi
County of __
On this _ day of _, 20__, before me personally appeared ________, to me known to be the person(s) described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed.
Notary Public, State of Hawaiʻi
My Commission Expires: _______
11. EXHIBITS & SCHEDULES
• Exhibit A – Stipulation for Dismissal with Prejudice
• Exhibit B – Installment Payment Schedule (Structured Settlement)
• Schedule 1 – Court Approval Order (if applicable)
[// GUIDANCE: Attorneys should verify compliance with Hawaiʻi Revised Statutes, Hawaiʻi Rules of Civil Procedure (including Rule 17(c) regarding minors), and any local court rules. Tailor the confidentiality, tax, and structured settlement provisions as necessary for the specific facts and regulatory landscape.]