Personal Injury Settlement Agreement - Kansas

PERSONAL INJURY SETTLEMENT AGREEMENT AND MUTUAL RELEASE

(Kansas)

TABLE OF CONTENTS

1. Document Header
2. Definitions

3. Operative Provisions
   3.1 Settlement Payment & Consideration
   3.2 Conditions Precedent
   3.3 Lien Resolution & Medicare Compliance
   3.4 Structured Settlement (Optional)
   3.5 Minor Settlement Approval (If Applicable)

4. Representations & Warranties

5. Covenants & Restrictions
6. Default & Remedies
7. Risk Allocation
8. Dispute Resolution
9. General Provisions
10. Execution Block

1. DOCUMENT HEADER

Personal Injury Settlement Agreement and Mutual Release (this “Agreement”) made and entered into as of [EFFECTIVE DATE] (the “Effective Date”) by and between:

a. [CLAIMANT FULL LEGAL NAME], [individual | natural guardian of minor | court-appointed conservator], having an address at [ADDRESS] (“Claimant”); and

b. [DEFENDANT/RELEASED PARTY FULL LEGAL NAME], a [corporation / LLC / individual] organized under the laws of [STATE OF ORGANIZATION] with its principal place of business at [ADDRESS] (“Released Party”).

Recitals
A. On [DATE OF INCIDENT], Claimant allegedly sustained personal injuries in [CITY, KANSAS] arising out of [BRIEF DESCRIPTION OF INCIDENT] (the “Incident”).
B. Claimant has asserted, or may assert, claims (the “Action”) against Released Party for damages arising from the Incident.
C. Released Party denies all liability but wishes to compromise and settle the Action.
D. The Parties desire to fully, finally, and irrevocably settle the Action upon the terms set forth herein.

NOW, THEREFORE, in consideration of the mutual promises, covenants, and releases set forth below, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties agree as follows:

2. DEFINITIONS

For ease of reference, the following terms shall have the meanings indicated below. Defined terms appear alphabetically and apply throughout this Agreement (including the Recitals).

“Action” means any and all past, present, or future civil, administrative, or other proceedings arising from the Incident.

“Agreement” has the meaning set forth in the opening paragraph.

“Applicable Law” means the law governing the Parties’ rights and obligations under this Agreement.

“Claimant” has the meaning set forth in the Document Header.

“Conditions Precedent” has the meaning set forth in Section 3.2.

“Court” means the District Court of [COUNTY], Kansas or any other court of competent jurisdiction approving this Agreement.

“Effective Date” has the meaning set forth in the Document Header.

“Incident” has the meaning set forth in Recital A.

“Minor” means a person who is a minor under applicable Kansas law.

“Parties” means Claimant and Released Party, collectively; “Party” means any one of them.

“Released Claims” has the meaning set forth in Section 7.1(a).

“Released Parties” has the meaning set forth in Section 7.1(b).

“Settlement Amount” means the total monetary consideration identified in Section 3.1(a).

“Structured Settlement” means the periodic payment arrangement, if any, described in Section 3.4.

3. OPERATIVE PROVISIONS

3.1 Settlement Payment & Consideration

a. Payment Obligation. Released Party shall pay $[SETTLEMENT AMOUNT] (the “Settlement Amount”) under the allocation completed below and any Schedule A. No deduction or withholding is authorized unless stated here: [ITEM, AMOUNT, PAYEE / NONE].
b. Payment Method. Unless Schedule A provides for periodic payments, the Settlement Amount shall be paid by [wire transfer / check] to [CLAIMANT / CLAIMANT AND COUNSEL / RESTRICTED ACCOUNT / OTHER PAYEE] at [PAYMENT INSTRUCTIONS] within [NUMBER] business days after satisfaction of the Conditions Precedent.
c. Consideration. The Settlement Amount and the mutual promises herein constitute adequate consideration for the releases and covenants contained in this Agreement.

3.2 Conditions Precedent

Payment of the Settlement Amount is expressly contingent upon satisfaction (or written waiver by Released Party) of all the following conditions (collectively, the “Conditions Precedent”):

1. Full execution and delivery of this Agreement by all Parties;

2. Delivery to Released Party of:
   i. a completed tax form if legally required for the agreed payment and requested in writing;
   ii. evidence of minor or protected-person authority and approval if required under Section 3.5; and
   iii. the payment instructions and lien-resolution schedule described in Section 3.3.

3. The Parties complete any signed settlement allocation and lien-resolution instructions below. A Party may waive a condition benefiting that Party in writing, except a condition imposed by law.

3.3 Lien Resolution & Medicare Compliance

a. List each asserted medical, benefit, workers’ compensation, subrogation, or reimbursement interest tied to the Incident, its holder and amount, the Party responsible for resolving it, and the agreed direct payment, holdback, escrow, dispute, or waiver procedure. Write “None known” only after inquiry.

b. The Parties will identify whether Medicare made conditional payments for the same items or services and whether responsibility for those payments is demonstrated. Under 42 U.S.C. § 1395y(b)(2)(B)(ii), a responsible primary plan and an entity receiving its payment may owe reimbursement. This Agreement does not assume a universal Medicare set-aside requirement or shift another person’s statutory liability by silence. Any negotiated allocation or holdback is: [DETAILS / NONE].

3.4 Structured Settlement (Optional)

a. Election. ☐ No periodic payments. ☐ The Parties elect the periodic payments stated in completed Schedule A, which identifies the payor, any annuity issuer or assignment company, payment dates, and guaranteed amounts.
b. Tax and transfer review. The Parties will obtain tax advice on any periodic-payment arrangement before signing. Any later transfer of payment rights must satisfy the law applicable to that transfer; this Agreement does not itself grant a transfer or state that court approval is required for the initial arrangement.

3.5 Minor Settlement Approval (If Applicable)

If Claimant is a Minor, or if any portion of the Settlement Amount is payable to or for the benefit of a Minor:
a. K.S.A. § 38-152 permits a person with legal custody to settle for a Minor without court approval only if all subsection (a) requirements are met, including no appointed guardian or conservator, net proceeds to the Minor of $25,000 or less after specified deductions, the required affidavit or verified statement, and payment to a restricted account or qualifying annuity under subsections (c) and (d). The custodian's affidavit or verified statement must attest to a reasonable inquiry and, to the best of the custodian's knowledge, either full compensation for the Minor or no practical way to obtain more from the settling parties. It must also acknowledge the legal duty to place the proceeds in the restricted account or purchase the annuity. Identify the custodian, account or annuity, and payment route in the attachments. If represented, counsel must keep the statement in the file for five years. The Parties shall complete the statement and payment instructions before using this route.
b. If the statutory route is unavailable, or if a protected adult is the claimant, the Parties shall obtain the required representative authority and any required court order before the affected release or payment becomes effective. Approval order, representative authority, and restricted-payment instructions: [ATTACHMENTS / NONE].

4. REPRESENTATIONS & WARRANTIES

Each Party represents and warrants to the other that:
a. Authority. It has full authority and capacity to enter into and perform this Agreement, and, if an entity, that execution has been duly authorized.
b. No Assignment of Claims. It has not sold, assigned, pledged, or otherwise transferred any claim or right released herein.
c. Independent Counsel. It has had the opportunity to consult with independent legal counsel of its choice and enters into this Agreement voluntarily and with full understanding of its legal effect.
d. No Reliance. It is not relying on any statement or representation not expressly set forth in this Agreement.

All representations and warranties shall survive the Effective Date.

5. COVENANTS & RESTRICTIONS

5.1 Confidentiality. Except to the extent required by law or court order, necessary to enforce this Agreement or address tax, insurance, medical, or benefit matters, or needed for a truthful report to a government agency, the Parties shall keep the terms confidential. A Party may consult that Party’s attorney, tax advisor, and immediate family after informing them of this clause.

5.2 Non-Disparagement. Each Party agrees not to make knowingly false statements about the other concerning the Incident. This does not restrict truthful testimony, required disclosures, or reports to public agencies.

5.3 Further Assurances. Each Party shall execute and deliver such additional documents and take such further actions as may be reasonably necessary to effectuate the intent of this Agreement.

5.4 Tax Matters. Claimant acknowledges that neither Released Party nor its counsel has provided tax advice, and Claimant shall rely solely on his, her, or its own advisors.

6. DEFAULT & REMEDIES

6.1 Default by Released Party. Failure to pay as required by Section 3.1 is a default. After written notice and [10] days to cure, Claimant may seek the unpaid amount, any interest at the agreed lawful rate of [____]% per year from [DATE / EVENT], and reasonable enforcement fees and costs if awarded under this Agreement and applicable law. For an adult claimant, Section 7.1 makes the release effective only upon payment; a signed minor settlement under K.S.A. § 38-152(e) has the statutory effect described there. Any pending court dismissal or reinstatement remains subject to court procedure and orders.

6.2 Default by Claimant. For a proved breach of an enforceable covenant, Released Party may seek relief available under this Agreement and applicable law. This Agreement sets no automatic penalty or liquidated damages.

7. RISK ALLOCATION

7.1 Mutual Release

a. Released Claims. Except for the statutory effect of a signed minor settlement under K.S.A. § 38-152(e), effective only when the agreed Settlement Amount is paid as required, Claimant releases the persons identified in subsection (b) from claims Claimant owns arising from the Incident in these selected categories: ☐ bodily injury; ☐ property damage; ☐ medical expense; ☐ lost income; ☐ these specified later developments of the identified injuries [DETAILS]; ☐ other [DETAILS]. The release excludes non-signers’ claims, enforcement of this Agreement, later independent conduct, and [OTHER EXCLUSIONS / NONE]. Released Party releases Claimant only from claims Released Party owns arising from the Incident, excluding enforcement of this Agreement.
b. Released Parties. “Released Parties” means the Released Party named in the opening paragraph and only these additional persons or entities specifically identified here: [NAMES / NONE]. No unnamed potentially liable person is discharged by this Agreement. The Parties do not determine any nonparty’s liability or proportion of fault; any allocation in a later negligence action remains subject to K.S.A. § 60-258a.

7.2 Limitation of Liability

The Settlement Amount is the consideration for this compromise. This clause does not cap liability for breach of this Agreement or determine the rights of nonsigners or public agencies.

7.3 No Admission of Liability

This Agreement is a compromise of disputed claims and shall not be construed as an admission of liability or wrongdoing by either Party.

7.4 Delayed Performance

If a transfer method becomes unavailable, the paying Party shall promptly notify the other Party and arrange an agreed lawful replacement method. The payment obligation remains due unless the Parties agree in writing to a new date.

8. DISPUTE RESOLUTION

8.1 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Kansas, without regard to its conflicts-of-law rules.

8.2 Forum Selection. Any action arising out of or relating to this Agreement shall be brought exclusively in the District Court of [COUNTY], Kansas, and each Party irrevocably submits to the personal jurisdiction of such court.

8.3 Trial Rights. This Agreement does not require arbitration or waive a jury trial.

9. GENERAL PROVISIONS

9.1 Amendment & Waiver. No amendment or waiver of any provision shall be effective unless in writing and signed by all Parties.

9.2 Assignment. No Party may assign, delegate, or otherwise transfer its rights or obligations under this Agreement without the prior written consent of the other Party, except that Released Party may assign its payment obligations to a qualified assignment company under Section 3.4.

9.3 Severability. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force and effect, and the invalid provision shall be reformed to the minimum extent necessary to make it valid.

9.4 Integration. This Agreement constitutes the entire agreement of the Parties with respect to its subject matter and supersedes all prior oral or written agreements.

9.5 Counterparts; Electronic Signatures. This Agreement may be executed in one or more counterparts (including by facsimile or electronic PDF), each of which shall be deemed an original but all of which together shall constitute one instrument.

10. EXECUTION BLOCK

IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.

ATTORNEY ACKNOWLEDGMENT

The undersigned, counsel for Claimant, hereby certifies that he/she has explained the terms and legal effect of this Agreement to Claimant (and to Claimant’s parent/guardian/conservator, if applicable) and believes that Claimant understands and voluntarily accepts the same.

Signature: __________________________
Name: [ATTORNEY NAME]
Kansas Bar Number: [NUMBER]
Date: ________________________________

SCHEDULE A — PERIODIC PAYMENTS (COMPLETE ONLY IF ELECTED)

Total portion of Settlement Amount funded through periodic payments: $[____________]

Obligated payor: [________________________________]

Annuity issuer, if any: [________________________________]

Assignment company, if any: [________________________________]

Other funding, security, and payment instructions agreed by the Parties: [________________________________]

Claimant initials: [____] Released Party initials: [____]

End of Document