Personal Injury Settlement Agreement - Hawaii

PERSONAL INJURY SETTLEMENT AGREEMENT AND MUTUAL RELEASE

(State of Hawaiʻi)

1. DOCUMENT HEADER

1.1 Title. Personal Injury Settlement Agreement and Mutual Release (this “Agreement”).

1.2 Date. Effective only upon the last event selected in Section 3.7 (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”).

1.4 Recitals.
A. A dispute has arisen out of an alleged personal injury incident that occurred on or about [__/__/____] 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 only the claims and parties expressly identified in this Agreement, subject to all selected approval, lien-resolution, funding, and dismissal conditions.

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.

“Released Claims” means only the claims described in Exhibit A, including the expressly selected known or unknown claims, through the Release Date. It excludes every claim or right listed as reserved in Exhibit A.

“Approval Order” means any court or administrative order that counsel determines is required for this settlement, in the form identified in Exhibit D.

“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.

“Release Date” means the date or event stated in Exhibit A, which may be the Effective Date but must not be left blank.

“Released Parties” means only the persons and entities individually named in Exhibit A. A category label does not release an unnamed person or entity unless Hawaii counsel deliberately includes that result in Exhibit A.

“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 the total Settlement Amount of $[________] as follows:

☐ Lump sum of $[________] due within [____] calendar days after the Funding Conditions in Section 3.7 are satisfied.

☐ Structured payments stated in Exhibit B.

(b) All payments shall be made by [wire transfer/cashier’s check] to [PAYEE DETAILS].

(c) Allocation among claimant, counsel trust account, lien or reimbursement payees, structured-settlement assignee, and any court-restricted account is stated in Exhibit C. No payee may rely on this Agreement to determine tax, public-benefit, trust, lien, or professional-responsibility treatment.

3.2 Structured Settlement (Optional).
(a) If selected, Exhibit B must identify each payment, payee, date, funding asset, obligor, assignee, annuity issuer, beneficiary, commutation or death-payment term, cost disclosure, and qualified-assignment or tax assumption supplied by the Parties' advisors.

(b) The Parties make no representation in this form about ownership, creditor status, tax qualification, public-benefit treatment, or issuer security. Those terms must appear in the final structured-settlement documents.

(c) Haw. Rev. Stat. § 676-3 requires advance approval in a final court order or order of a responsible administrative authority before a transfer of structured-settlement payment rights can be effective, with the findings stated in that section. No future transfer is authorized by this Agreement.

3.3 Dismissal and Release Sequence.

☐ No action is pending; no dismissal is required.

☐ A claimant-signed stipulation for dismissal is delivered to [ESCROW / COUNSEL] with this Agreement and may be filed only after written confirmation that all funding conditions are satisfied.

☐ Other sequence approved by counsel and any Approval Order: [________________________________]

Unless Exhibit A states otherwise, dismissal is with prejudice only as to the Released Claims against the Released Parties. Costs and fees in the dismissed action are allocated as follows: [________________________________].

3.4 Consideration. The Settlement Amount and promises in this Agreement resolve the Released Claims. Receipt is acknowledged only when funds or required funding instruments have actually been delivered.

3.5 Taxes and Benefits. No Party relies on this form for tax characterization, reporting, public-benefit eligibility, special-needs planning, or allocation of penalties and interest. Any negotiated allocation or reporting position appears in Exhibit C and remains subject to governing law.

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 Effectiveness and Funding Conditions. Select every applicable condition and identify which event creates the Effective Date:

☐ Signature by all Parties and required representatives

☐ Entry of the Approval Order described in Exhibit D

☐ Final determination of good faith under Haw. Rev. Stat. § 663-15.5

☐ Delivery of the dismissal document to escrow under Section 3.3

☐ Final lien/reimbursement amounts or agreed holdback under Exhibit C

☐ Other: [________________________________]

Effective Date event: [________________________________]

3.8 Capacity or Approval Gate. If the claimant is a minor, lacks capacity, acts through a fiduciary, has a pending estate matter, or otherwise requires approval, Hawaii counsel must complete Exhibit D with the correct court, proceeding, fiduciary authority, petition, notice, hearing, findings, restricted-account or distribution terms, and effective-date language. No representative makes a warranty beyond the authority shown in the attached order or instrument.

4. REPRESENTATIONS & WARRANTIES

4.1 By Releasor.
(a) Authority. Releasor identifies every person signing personally or in a representative capacity and attaches the authority document, if any, in Exhibit D.

(b) Assignment and Subrogation. Except as disclosed in Exhibit C, Releasor has not assigned, pledged, sold, or transferred a Released Claim. This statement does not deny a disclosed statutory, contractual, subrogation, reimbursement, or lien interest.

(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 identifies the capacity of its signatory and any insurer, assignee, or other funding person whose consent is required.
(b) No Conflicting Agreements. Execution of this Agreement does not violate any other agreement or legal obligation of Releasee.

4.3 Reliance and Survival. The Parties identify any representation that survives funding and the survival period: [________________________________]. No unstated representation survives merely because it appears in a recital.

5. COVENANTS & RESTRICTIONS

5.1 Non-Disparagement (Optional).

☐ No non-disparagement covenant.

☐ The following persons agree to the narrowly defined restriction below: [________________________________]

The restriction does not prohibit truthful testimony, legal process, reports to or communications with government or regulatory authorities, communications protected by governing law, medical care, insurance or benefit administration, tax reporting, or confidential advice from counsel and professional advisors.

5.2 Confidentiality (Optional).

☐ No confidentiality covenant.

☐ The following settlement information is confidential: [________________________________]

Permitted disclosures include those required for an Approval Order or a Haw. Rev. Stat. § 663-15.5 good-faith determination, legal process, tax or benefit reporting, lien/reimbursement resolution, insurance administration, professional advice, and any other disclosure protected or required by governing law. The court procedure in § 663-15.5 addresses confidentiality when a good-faith petition is used; counsel must coordinate this clause with that procedure.

☐ No preset damages for breach.

☐ Counsel-approved remedy or damages provision: [________________________________]

5.3 Cooperation. The Parties shall execute further documents reasonably necessary to carry out the completed exhibits, but no later document expands the Released Claims, Released Parties, payment duties, or reserved rights unless it satisfies Section 9.2.

6. DEFAULT & REMEDIES

6.1 Events of Default. A material failure to perform an express obligation after its conditions have occurred is a default. A dispute over a lien, approval, funding condition, or escrow instruction is not automatically a default unless this Agreement expressly allocates that risk.

6.2 Notice and Cure.

☐ No contractual cure period.

☐ Written notice and [____] calendar days to cure at the addresses in Section 9.9, except for: [________________________________]

6.3 Remedies.
(a) Select negotiated remedies; availability remains subject to governing law and any Approval Order:

☐ Action to enforce the Agreement

☐ Judgment for an unpaid liquidated amount

☐ Contract interest at [____]% per year beginning [__/__/____]. Haw. Rev. Stat. § 478-2 supplies a ten-percent rate when no express written contract fixes a different rate for covered obligations; counsel must separately review any agreed rate, State obligation, judgment, and commencement date.

☐ Motion or stipulation concerning the pending Action: [________________________________]

☐ Other: [________________________________]

6.4 Fees and Costs.

☐ Each Party bears its own enforcement fees and costs except as a court otherwise awards under governing law.

☐ Counsel-approved fee provision: [________________________________]

7. RELEASE, RESERVED CLAIMS, AND THIRD-PARTY INTERESTS

7.1 Claimant Release. On the Effective Date and subject to actual funding, Releasor releases the Released Parties from the Released Claims identified in Exhibit A. The release does not extend to a person, entity, claim, time period, benefit, enforcement right, or obligation listed as reserved.

7.2 Release by Releasee (Optional).

☐ No reciprocal release.

☐ Releasee releases Releasor from the following claims: [________________________________]

7.3 Other Alleged Tortfeasors and Good Faith. Exhibit A must state whether claims against any nonsettling person are reserved. Haw. Rev. Stat. § 663-15.5(a) addresses the effect of a good-faith release on nonreleased joint tortfeasors or co-obligors, claim reduction, and contribution. If a Party seeks the statute's protection, counsel must complete Exhibit D with the petition, service, objection, confidentiality, order, cross-claim, and appeal steps required by § 663-15.5(b)-(g).

7.4 Liens, Reimbursement, and Holdback. Exhibit C must identify every known or potential insurer, government program, medical provider, attorney, funding company, benefit plan, child-support agency, or other person asserting a lien, reimbursement, subrogation, assignment, or payment interest. It must allocate investigation, notice, negotiation, payment, escrow, holdback, indemnity, and cooperation duties. No blanket indemnity applies unless written in Exhibit C after claim-specific review.

7.5 No Liability Cap or Force-Majeure Override. The Settlement Amount is consideration for the Released Claims, not a universal cap on liability for breach of this Agreement. No force-majeure clause excuses payment, approval, escrow, lien, dismissal, confidentiality, or other duties unless the Parties add a specific counsel-reviewed term here: [________________________________].

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 and Venue. Any court filing must be made in a court with subject-matter jurisdiction and proper venue. The Parties' proposed forum, subject to those requirements and any Approval Order, is: [________________________________].

8.3 Dispute Process. Select one after counsel reviews scope, cost allocation, emergency relief, appeal, confidentiality, and claimant-capacity issues:

☐ Court proceedings; no contractual arbitration requirement

☐ Mediation before a non-emergency enforcement filing

☐ Arbitration under the attached counsel-completed rider

No jury waiver is included in this form. Any proposed waiver requires a separate, conspicuous, claim-specific provision reviewed under current Hawaii law.

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 is effective unless stated in a record signed by all affected Parties and approved through any process required by an Approval Order or governing law.

9.3 Assignment. No Party may assign its rights or delegate its duties without prior written consent of the other Party, except as expressly stated in Exhibit B or permitted by an Approval Order or governing law.

9.4 Severability. To the extent permitted by governing law and any Approval Order, an unenforceable provision may be severed only if doing so does not materially change the settlement exchange or release scope.

9.5 Persons Bound. This Agreement binds only each signatory and the persons or entities that signatory has authority to bind. Exhibit A must identify any estate, heir, representative, successor, insurer, or assignee intended to be bound or benefited.

9.6 Counterparts and Electronic Signatures. This Agreement may be signed in counterparts. Under Haw. Rev. Stat. § 489E-5, electronic-transaction treatment depends on each Party's agreement to transact electronically; § 489E-7 prevents denial of effect solely because a record or signature is electronic. Select one:

☐ The Parties agree to conduct this settlement transaction electronically.

☐ Wet-ink originals are required for: [________________________________]

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

9.8 Interpretation. Drafting history and interpretive presumptions are governed by applicable law; no heading expands the Released Claims or Released Parties.

9.9 Notices. Required notices must be sent by [METHOD] to the addresses below, with effectiveness determined by [DELIVERY EVENT]:

Releasor / Counsel: [________________________________]

Releasee / Counsel: [________________________________]

10. EXECUTION BLOCK

The Parties sign on the dates below. The Effective Date is determined only under Section 3.7.

RELEASOR

Signature: __________________________________
Name: [CLAIMANT NAME]
Date: [__/__/____]

Representative capacity, if any: [________________________________]

Authority document / order: [________________________________]

RELEASEE

Signature: __________________________________
Name: [AUTHORIZED SIGNATORY]
Title: [TITLE]
Date: [__/__/____]

ADDITIONAL REQUIRED SIGNATORY

Signature: __________________________________

Name and capacity: [________________________________]

Date: [__/__/____]

OPTIONAL ACKNOWLEDGMENT

Use only if counsel, an Approval Order, escrow, or recording requirement calls for acknowledgment. Insert the current notarial certificate appropriate to the signer and act; do not use a generic prefilled certificate.

11. EXHIBITS & SCHEDULES

• Exhibit A — Released Parties, Released Claims, Reserved Claims, and Other Alleged Tortfeasors
• Exhibit B — Structured Payment and Funding Terms (if selected)
• Exhibit C — Payment Allocation, Fees, Costs, Liens, Reimbursement, Holdbacks, and Tax/Benefit Review
• Exhibit D — Capacity, Fiduciary Authority, Court/Administrative Approval, and HRS § 663-15.5 Procedure
• Exhibit E — Dismissal or Escrow Documents

SOURCES AND CURRENT-LAW NOTES

• Haw. Rev. Stat. § 663-15.5 — release effect and optional good-faith settlement procedure for joint tortfeasors and co-obligors.
• Haw. Rev. Stat. § 676-3 — advance approval and findings for a transfer of structured-settlement payment rights.
• Haw. Rev. Stat. § 478-2 and § 478-3 — written-contract/legal interest and judgment interest.
• Haw. Rev. Stat. § 489E-5 and § 489E-7 — agreement to use electronic means and legal recognition of electronic records and signatures.