PERSONAL INJURY SETTLEMENT AGREEMENT & MUTUAL RELEASE
(Iowa – Court-Approved Form)
[// GUIDANCE: All bracketed items must be completed or revised by counsel prior to execution. Cross-check defined terms for consistency.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
1. DOCUMENT HEADER
This Personal Injury Settlement Agreement & Mutual Release (the “Agreement”) is entered into as of [Effective Date] (the “Effective Date”) by and between:
• [Plaintiff/Claimant Full Legal Name], [individual | minor by and through [Guardian/Next Friend]], residing at [Address] (“Claimant”); and
• [Defendant/Respondent Full Legal Name], a [State] [Entity Type] with its principal place of business at [Address] (“Respondent”).
Collectively, Claimant and Respondent are the “Parties” and each a “Party.”
Recitals
A. An incident occurring on [Date of Loss] in [City, Iowa] allegedly caused bodily injuries and damages to Claimant (the “Incident”).
B. Claimant has asserted claims against Respondent (the “Claims”) in [Case Caption, Court, Docket No.] (the “Action”).
C. The Parties desire to fully and finally settle the Claims on the terms and conditions set forth herein, without admission of liability.
NOW, THEREFORE, in consideration of the mutual promises herein and other good and valuable consideration, the sufficiency of which is hereby acknowledged, the Parties agree as follows.
2. DEFINITIONS
For purposes of this Agreement:
“Affiliate” – any person or entity controlling, controlled by, or under common control with a Party.
“Applicable Law” – all federal, state, and local laws, regulations, and court rules governing the subject matter of this Agreement, including but not limited to Iowa Code ch. 682 (Structured Settlement Protection Act) and any court-approval requirements for settlements involving minors or incapacitated persons.
“Claims” – collectively, any and all past, present, or future claims, demands, causes of action, damages, costs, expenses, liens, and liabilities of every kind, arising from or related to the Incident.
“Confidential Information” – the existence, terms, and consideration of this Agreement, together with any non-public information exchanged in settlement negotiations.
“Court Approval” – a final, non-appealable order of an Iowa District Court approving this Agreement where required by Applicable Law (e.g., settlements involving minors).
“Settlement Amount” – the total consideration described in Section 3.1, representing the sole monetary obligation of Respondent and all Released Parties.
[// GUIDANCE: Insert additional defined terms as needed.]
3. OPERATIVE PROVISIONS
3.1 Settlement Payment.
(a) Lump-Sum Option: Respondent shall pay Claimant [US$ ___] in one lump-sum within [__] business days after (i) full execution of this Agreement and (ii) satisfaction of all Conditions Precedent in Section 3.3.
(b) Structured Settlement Option: In lieu of a lump-sum payment, the Parties agree to the structured payment schedule attached as Exhibit A (“Structured Payments”). The annuity issuer shall be [Qualified Assignment Company] and all Structured Payments shall be non-assignable except as permitted under Iowa Code ch. 682.
3.2 Payment Logistics.
(a) Payments shall be made by [wire transfer | cashier’s check] to [Payee] per written instructions delivered at least three (3) business days before the due date.
(b) Any payment received after its due date shall accrue simple interest at [__]% per annum until paid in full.
3.3 Conditions Precedent.
The following are express conditions precedent to Respondent’s payment obligation:
(i) Receipt of a fully executed original of this Agreement;
(ii) Receipt of Court Approval, if applicable;
(iii) Delivery of a duly executed Stipulation of Dismissal with prejudice in the Action; and
(iv) Receipt of satisfactory evidence of lien resolution under Section 5.2.
3.4 Dismissal of Action. Within three (3) business days after Respondent’s confirmation of the Settlement Amount being paid or funded, the Parties shall file with the court a stipulation to dismiss the Action with prejudice, each Party to bear its own costs and fees except as expressly provided herein.
3.5 No Admission of Liability. This Agreement is a compromise of disputed claims and shall not be construed as an admission of liability, negligence, or wrongdoing by any Party.
4. REPRESENTATIONS & WARRANTIES
Each Party represents and warrants to the other that:
4.1 Authority. It has full legal right, power, and authority to enter into and perform this Agreement; if acting on behalf of a minor, the signatory is duly appointed and authorized and will seek Court Approval.
4.2 No Assignment. No Claim or right released herein has been assigned, conveyed, or encumbered, except as disclosed in writing and resolved under Section 5.2.
4.3 Independent Counsel. It has had the opportunity to consult with legal counsel of its choice and enters this Agreement voluntarily, free from coercion or duress.
4.4 Accuracy. All factual statements made to induce settlement are complete and accurate to the best of the Party’s knowledge.
4.5 Survival. The representations and warranties in this Section survive the Effective Date and the consummation of the settlement.
5. COVENANTS & RESTRICTIONS
5.1 Mutual Release. Upon receipt and clearance of the Settlement Amount, Claimant irrevocably releases and forever discharges Respondent and Respondent’s insurers, successors, assigns, and Affiliates (collectively, the “Released Parties”), and Respondent releases Claimant and Claimant’s Affiliates, from any and all Claims.
5.2 Liens & Subrogation.
(a) Claimant shall identify, satisfy, and obtain written discharge of all medical, governmental, workers’ compensation, child-support, or third-party liens related to the Claims.
(b) Claimant shall indemnify and hold the Released Parties harmless from any lienholder assertions arising from the Claims.
5.3 Confidentiality. Except as required by law or court order, neither Party shall disclose Confidential Information to any third party other than attorneys, insurers, tax advisers, or as necessary to obtain Court Approval.
5.4 Non-Disparagement. The Parties agree not to make statements reasonably expected to harm the reputation of the other Party regarding the Incident or this settlement.
5.5 Tax Matters. Each Party shall be solely responsible for its own tax obligations. No Party provides tax advice; each is advised to consult its own tax professional.
6. DEFAULT & REMEDIES
6.1 Events of Default.
(a) Failure of Respondent to timely pay the Settlement Amount in accordance with Section 3 constitutes a “Payment Default.”
(b) Breach of Section 5.2 (Liens), 5.3 (Confidentiality), or 5.4 (Non-Disparagement) constitutes a “Covenant Default.”
6.2 Notice & Cure.
(a) The non-breaching Party shall give written notice specifying the default.
(b) Respondent shall have five (5) business days to cure a Payment Default; ten (10) business days to cure any other default.
6.3 Remedies.
(a) If Respondent fails to cure a Payment Default, Claimant may file the Agreement with the Iowa District Court and obtain judgment for the unpaid Settlement Amount, accrued interest, and reasonable attorney fees.
(b) For a Covenant Default, the non-breaching Party may seek specific performance and/or monetary damages, including attorney fees.
7. RISK ALLOCATION
7.1 Mutual Indemnification. Each Party (the “Indemnifying Party”) shall indemnify, defend, and hold harmless the other Party and its Released Parties from any Losses arising out of a breach of this Agreement or any representation herein.
7.2 Limitation of Liability. Except for obligations under Section 7.1, the total aggregate liability of Respondent and the Released Parties is strictly capped at the Settlement Amount.
7.3 Force Majeure. Neither Party shall be liable for delay or non-performance caused by events beyond its reasonable control (excluding financial incapacity). The affected Party shall notify the other promptly and use commercially reasonable efforts to mitigate.
7.4 Structured Settlement Protections. Claimant acknowledges that any Structured Payments are subject to the anti-assignment and court-approval provisions of Iowa Code ch. 682 and the Internal Revenue Code § 104(a)(2).
8. DISPUTE RESOLUTION
8.1 Governing Law. This Agreement and any dispute arising hereunder shall be governed by the laws of the State of Iowa, without regard to its conflict-of-laws principles.
8.2 Forum Selection. The Parties irrevocably submit to the exclusive jurisdiction of the Iowa District Court in [County] County, Iowa (state court), for any action arising out of or relating to this Agreement or its enforcement.
8.3 Arbitration. The Parties expressly agree that arbitration shall not apply unless a separate written agreement is executed after the Effective Date.
8.4 Jury Trial. Nothing herein constitutes a waiver of the right to a jury trial.
8.5 Injunctive Relief. Either Party may seek injunctive or equitable relief to enforce Sections 5.2–5.4 without prejudice to any other remedies.
9. GENERAL PROVISIONS
9.1 Entire Agreement. This Agreement constitutes the entire understanding of the Parties with respect to the subject matter and supersedes all prior negotiations or agreements.
9.2 Amendment & Waiver. No modification or waiver is effective unless in a written instrument signed by both Parties. A waiver on one occasion is not a waiver on any subsequent occasion.
9.3 Assignment. Neither Party may assign this Agreement without the prior written consent of the other, except that Respondent may assign payment obligations to a qualified assignment company in connection with a structured settlement.
9.4 Successors & Assigns. This Agreement binds and inures to the benefit of the Parties and their permitted successors and assigns.
9.5 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 required to reflect the Parties’ intent.
9.6 Headings. Section headings are for convenience only and shall not affect interpretation.
9.7 Counterparts; Electronic Signatures. This Agreement may be executed in counterparts, each of which is deemed an original. Signatures transmitted electronically (e.g., PDF, DocuSign) are binding and enforceable.
9.8 Further Assurances. Each Party shall execute and deliver further documents and take additional actions reasonably necessary to effectuate this Agreement.
10. EXECUTION BLOCK
IN WITNESS WHEREOF, the Parties hereto have executed this Agreement as of the Effective Date.
CLAIMANT
[Claimant Name]
Date: _____
[If Minor]:
[Guardian/Next Friend Name],
as Legal Representative of [Minor Name]
Date: _____
RESPONDENT
[Authorized Signatory Name]
Title: ____
for and on behalf of [Respondent Legal Name]
Date: _____
NOTARY ACKNOWLEDGMENT (if required)
State of Iowa )
County of __ ) ss.
On this _ day of _, 20__, before me, a Notary Public in and for said State, personally appeared ____, to me known to be the person(s) named in and who executed the foregoing instrument, and acknowledged that he/she/they executed the same as his/her/their voluntary act and deed.
Notary Public in and for the State of Iowa
My commission expires: __
[// GUIDANCE: Attach the following, if applicable:
• Exhibit A – Structured Payment Schedule
• Exhibit B – Lien Resolution Statement
• Court Approval Order (once obtained)]