PERSONAL INJURY SETTLEMENT AGREEMENT

AND MUTUAL RELEASE OF ALL CLAIMS

(Louisiana – Compromise under La. Civ. Code art. 3071)

[// GUIDANCE: This template is drafted for use in Louisiana-based tort claims. It assumes no arbitration or jury-trial waiver, provides mutual releases, and caps liability at the Settlement Amount. Customize all bracketed items, delete any inapplicable optional provisions, and obtain court approval for minors or incompetents as required by La. Code Civ. Proc. art. 4265.]

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
   3.1 Settlement Consideration
   3.2 Dismissal of Litigation / Claims
   3.3 Court Approval for Minor or Incompetent Claimant
   3.4 Medicare/Medicaid and Other Liens
   3.5 Tax Treatment
4. Representations & Warranties
5. Covenants & Restrictions
6. Default & Remedies
7. Risk Allocation
   7.1 Mutual Release
   7.2 Indemnification re Liens
   7.3 Limitation of Liability
   7.4 Structured Settlement Compliance
8. Dispute Resolution
9. General Provisions
10. Execution Block

1. DOCUMENT HEADER

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

(a) [PLAINTIFF FULL LEGAL NAME], an individual with an address at [ADDRESS] (“Plaintiff”); and
(b) [DEFENDANT FULL LEGAL NAME], a [ENTITY TYPE] organized under the laws of [STATE], with its principal place of business at [ADDRESS] (“Defendant”).

Plaintiff and Defendant are sometimes referred to herein individually as a “Party” and collectively as the “Parties.”

Recitals

A. A dispute has arisen regarding alleged personal injuries sustained by Plaintiff on or about [DATE OF INCIDENT] in [PARISH, LOUISIANA] (the “Incident”).
B. The Parties desire to fully and finally settle any and all claims arising out of or related to the Incident, without admission of liability, pursuant to Louisiana law governing compromise (La. Civ. Code art. 3071 et seq.).
C. The Parties intend this Agreement to be a binding compromise and settlement enforceable in accordance with its terms.

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

2. DEFINITIONS

For purposes of this Agreement, the following capitalized terms shall have the meanings set forth below. All references to Sections are to Sections of this Agreement unless otherwise indicated.

“Agreement” means this Personal Injury Settlement Agreement and Mutual Release of All Claims.

“Claim(s)” means any and all past, present, or future claims, demands, causes of action, suits, rights, damages, costs, expenses, attorneys’ fees, and compensation of whatever nature, whether known or unknown, suspected or unsuspected, fixed or contingent, in law, equity, or otherwise, that arise out of or relate to the Incident.

“Court” means the [NAME OF LOUISIANA DISTRICT COURT] located in [PARISH], Louisiana, or such other court of competent jurisdiction as may approve this Agreement pursuant to Section 3.3.

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

“Gross Settlement Proceeds” means the total consideration described in Section 3.1, exclusive of any deductions, withholdings, or lien resolutions.

“Minor” means a person who has not attained the age of eighteen (18) years at the time of signing this Agreement.

“Net Settlement Proceeds” means the portion of the Settlement Amount remaining after payment of attorneys’ fees, lien holdbacks, costs, and expenses.

“Parties” and “Party(ies)” have the meanings set forth in the Document Header.

“Settlement Amount” has the meaning set forth in Section 3.1(a).

“Structured Settlement” means periodic payments of damages established under Section 3.1(b) and compliant with the Louisiana Structured Settlement Protection Act (“LSSPA”).

3. OPERATIVE PROVISIONS

3.1 Settlement Consideration

(a) Lump-Sum Payment. Defendant shall pay Plaintiff the total sum of [US $__] (the “Settlement Amount”) by wire transfer or settlement draft payable to [PAYEE NAME] within [__] business days after (i) execution of this Agreement by all Parties, (ii) receipt of any required Court approval under Section 3.3, and (iii) receipt of a completed Form W-9 from Plaintiff or Plaintiff’s counsel.

(b) Optional Structured Settlement. In lieu of or in addition to the lump-sum payment above, the Parties may agree to a Structured Settlement with the components set forth in Exhibit A (Structured Settlement Schedule), funded through a qualified assignment to [ANNUITY ISSUER]. All periodic payments shall be guaranteed, non-assignable, and non-accelerable except as permitted by the LSSPA.
[// GUIDANCE: Delete subsection (b) if no structured component is contemplated.]

(c) Sole Consideration. The Settlement Amount constitutes the sole and exclusive consideration for the releases granted herein. No additional sums shall be owed except as expressly provided in this Agreement.

3.2 Dismissal of Litigation / Claims

(a) Within five (5) business days after receipt of the Settlement Amount (or commencement of structured payments), Plaintiff shall file a dismissal with prejudice of [CASE CAPTION / DOCKET NO.] and any other action arising from the Incident, each Party to bear its own costs and attorneys’ fees unless otherwise awarded in Section 6.3.

(b) If no lawsuit has been filed, Plaintiff shall execute a dismissal of any pending administrative or insurance claims and shall refrain from filing any future litigation concerning the Incident.

3.3 Court Approval for Minor or Incompetent Claimant

(a) If Plaintiff is a Minor or has been adjudicated incompetent, this Agreement is contingent upon approval by the Court pursuant to La. Code Civ. Proc. art. 4265 and any applicable tutorship or curatorship statutes.

(b) The Party seeking approval shall prepare and file all necessary pleadings, incur associated costs, and obtain a signed judgment approving the compromise (the “Approval Order”).

(c) Failure to obtain the Approval Order within [__] days of execution renders this Agreement null ab initio, unless the Parties mutually extend the deadline in writing.

3.4 Medicare/Medicaid and Other Liens

(a) Plaintiff represents that all known liens, subrogation claims, or reimbursement rights, including but not limited to those held by Medicare, Medicaid, TRICARE, VA, workers’ compensation carriers, hospitals, or private insurers, have been disclosed to Defendant in Schedule 1.

(b) Plaintiff shall be solely responsible for satisfying or otherwise resolving each lien listed in Schedule 1. Plaintiff agrees to indemnify, defend, and hold harmless the Released Parties (defined in Section 7.1) from any lienholder or governmental recovery action.

(c) Defendant may, in its sole discretion, withhold reasonable amounts from the Settlement Amount for conditional payment resolutions pursuant to 42 U.S.C. § 1395y(b) and applicable CMS guidance.

[// GUIDANCE: Modify subsection (c) if a Medicare Set-Aside (MSA) or professional administration is required.]

3.5 Tax Treatment

The Parties agree that no Party has made any representation regarding the tax consequences of this settlement. Plaintiff acknowledges that Plaintiff has been advised to seek independent tax counsel. No portion of the Settlement Amount shall be characterized as wages unless expressly stated in Exhibit B (Wage Allocation).

4. REPRESENTATIONS & WARRANTIES

Each Party represents and warrants, as of the Effective Date, that:

4.1 Authority. It has full right, power, and authority to enter into and perform this Agreement; all requisite corporate or personal actions have been taken.

4.2 No Assignment. It has not assigned, transferred, or otherwise conveyed any Claim released herein to any third party.

4.3 No Reliance. It enters into this Agreement relying solely on the terms set forth herein and on its own judgment and that of its counsel, not on any statement or representation by the opposing Party or its counsel.

4.4 No Pending Bankruptcy. It is not a debtor in any bankruptcy proceeding that would impair its ability to perform hereunder.

4.5 Material Breach Consequences. Any material inaccuracy in the foregoing representations shall constitute an Event of Default under Section 6.

All representations and warranties shall survive the Effective Date and the consummation of the transactions contemplated herein.

5. COVENANTS & RESTRICTIONS

5.1 Confidentiality (Optional). Except to the extent required by law, regulation, or Court order, the Parties and their counsel shall keep the terms and conditions of this Agreement confidential.
[// GUIDANCE: Delete or modify Section 5.1 if confidentiality is not desired or if there is a public-entity defendant.]

5.2 Non-Disparagement. The Parties agree not to make or cause to be made any statement that disparages or damages the reputation of the other Party regarding the Incident or this settlement.

5.3 Cooperation. Each Party shall execute all documents and take all further actions reasonably necessary to effectuate the intent of this Agreement, including delivery of dismissal pleadings and lien releases.

6. DEFAULT & REMEDIES

6.1 Events of Default. The following constitute an “Event of Default”:
(a) Failure of Defendant to timely tender the Settlement Amount or structured annuity funding;
(b) Failure of Plaintiff to file stipulated dismissals within the time set forth in Section 3.2;
(c) Material breach of any representation, warranty, or covenant contained herein.

6.2 Notice and Cure. The non-defaulting Party shall provide written notice specifying the alleged default. The defaulting Party shall have ten (10) business days to cure the default, except that payment defaults must be cured within five (5) business days.

6.3 Remedies. If an Event of Default is not timely cured, the non-defaulting Party may:
(a) Seek specific performance or entry of judgment for the unpaid Settlement Amount plus statutory interest;
(b) Recover reasonable attorneys’ fees, court costs, and expenses incurred in enforcing this Agreement;
(c) Pursue any other remedy available at law or in equity consistent with Louisiana public policy.

7. RISK ALLOCATION

7.1 Mutual Release

(a) Released Parties. “Released Parties” means, collectively, each Party and its past, present, and future parents, subsidiaries, affiliates, insurers, reinsurers, successors, assigns, officers, directors, shareholders, partners, members, employees, agents, heirs, and personal representatives.

(b) Scope of Release. Effective upon (i) payment of the Settlement Amount and (ii) execution hereof, each Party, on behalf of itself and its Released Parties, irrevocably and unconditionally releases and forever discharges the other Party and its respective Released Parties from any and all Claims.

(c) Louisiana Waiver of Unknown Claims. Each Party acknowledges familiarity with Louisiana Civil Code art. 3078 and expressly waives the benefits thereof, understanding that this release extends to all Claims, whether known or unknown, foreseen or unforeseen.

(d) No Admission. This Agreement and any consideration exchanged constitute a compromise of disputed claims and shall not be construed as an admission of liability or fault.

7.2 Indemnification re Liens

Each Party (“Indemnifying Party”) shall indemnify, hold harmless, and defend the other Party and its Released Parties from any losses, liabilities, costs, expenses, or attorneys’ fees arising from the Indemnifying Party’s breach of Section 4.2 (No Assignment) or Section 3.4 (Liens).

7.3 Limitation of Liability

The total liability of Defendant to Plaintiff—and of Plaintiff to Defendant—arising out of or related to the Incident shall not exceed the Settlement Amount, except in the event of (i) non-payment of the Settlement Amount, (ii) fraud, or (iii) willful concealment of liens.

7.4 Structured Settlement Compliance

Any Structured Settlement shall be established in full compliance with the LSSPA and applicable Internal Revenue Code §§ 104 and 130. Plaintiff agrees not to transfer, sell, or assign any periodic payments except pursuant to a Court order issued under the LSSPA.

8. DISPUTE RESOLUTION

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

8.2 Forum Selection. The Parties irrevocably submit to the exclusive jurisdiction of the state courts of [PARISH], Louisiana, for any action arising out of or relating to this Agreement or the Incident.

8.3 Waiver of Jury Trial. INTENTIONALLY OMITTED.
[// GUIDANCE: Jury waiver is “not_applicable” per user’s metadata.]

8.4 Arbitration. INTENTIONALLY OMITTED.

8.5 Equitable Relief. Nothing herein restricts a Party from seeking temporary restraining orders, preliminary injunctions, or other equitable relief to enforce this Agreement.

9. GENERAL PROVISIONS

9.1 Entire Agreement. This Agreement, together with all Exhibits and Schedules, constitutes the entire understanding between the Parties and supersedes all prior negotiations and agreements regarding the subject matter hereof.

9.2 Amendments; Waivers. No amendment or waiver of any provision shall be effective unless in a written instrument signed by all Parties. Any waiver shall be limited to its express terms.

9.3 Assignment. No Party may assign or delegate its rights or obligations under this Agreement without the prior written consent of the other Party, except that Defendant may assign its payment obligations to an annuity issuer under Section 3.1(b).

9.4 Successors & Assigns. This Agreement shall be binding upon and inure to the benefit of the Parties and their respective successors and permitted assigns.

9.5 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 achieve its original intent.

9.6 Counterparts; Electronic Signatures. This Agreement may be executed in counterparts, each of which shall be deemed an original but all of which together constitute one instrument. Signatures transmitted via electronic means (e.g., PDF, DocuSign) shall be deemed originals for all purposes.

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.

PLAINTIFF

[PLAINTIFF NAME]

Date: ______

DEFENDANT

[AUTHORIZED SIGNATORY NAME]
[Title], [DEFENDANT NAME]

Date: ______

[// GUIDANCE: Consider adding notarization or witness lines if required by insurer, structured settlement company, or local court rules.]

EXHIBIT A

STRUCTURED SETTLEMENT SCHEDULE
[Insert annuity payment dates, amounts, payee, and guaranteed period.]

EXHIBIT B

WAGE ALLOCATION (IF APPLICABLE)
[Specify any portion of Settlement Amount treated as wages for IRS Form W-2 reporting.]

SCHEDULE 1

LIEN DISCLOSURE
[List Medicare conditional payments, Medicaid liens, ERISA liens, workers’ compensation liens, hospital or provider liens, child support liens, etc.]

End of Template