Personal Injury Settlement Agreement - Minnesota

PERSONAL INJURY SETTLEMENT AGREEMENT AND CLAIMANT RELEASE

(Minnesota – Governed by State Tort Law)

TABLE OF CONTENTS

1. Document Header
2. Definitions

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

4. Representations & Warranties

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

1. DOCUMENT HEADER

This Personal Injury Settlement Agreement and Claimant Release (the “Agreement”) is made and entered into as of [Effective Date] (the “Effective Date”) by and between:

A. [Claimant Full Legal Name], [Claimant Address] (“Claimant”); and
B. [Defendant Full Legal Name], [Defendant Address] (“Defendant”).

Claimant and Defendant are referred to individually as a “Party” and collectively as the “Parties.”

Recitals
WHEREAS, Claimant alleges that on or about [Date of Incident] Claimant sustained personal injuries and damages arising out of [Brief Description of Incident] (the “Incident”);
WHEREAS, Defendant denies all liability with respect to the Incident;
WHEREAS, the Parties wish to settle the claims identified in Section 5.1 arising from the Incident upon the terms set forth herein;

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

2. DEFINITIONS

For purposes of this Agreement, the following terms have the meanings set forth below:

“Action” means any lawsuit, arbitration, administrative action, or other proceeding arising from or related to the Incident.

“Claims” means only the claims and damages identified in the completed release-scope selection in Section 5.1, subject to every stated reservation.

“Court” means a state court of competent jurisdiction located in the State of Minnesota.

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

“Incident” has the meaning set forth in the Recitals.

“Minor” means a claimant who has not reached the age of majority under governing law. An adult who lacks legal capacity is addressed separately where this Agreement refers to an incompetent claimant.

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

“Releasees” means Defendant, its past, present, and future parents, subsidiaries, affiliates, insurers, reinsurers, shareholders, officers, directors, employees, agents, representatives, successors, and assigns.

“Settlement Amount” means the total consideration payable under Section 3.1.

3. OPERATIVE PROVISIONS

3.1 Settlement Payment & Consideration

3.1.1 Settlement Amount. In full, final, and complete satisfaction of all Claims, Defendant shall pay or cause to be paid to Claimant the total sum of $[Settlement Amount Numeric] ([Settlement Amount Words] U.S. Dollars) (the “Settlement Amount”).

3.1.2 Form of Payment. Payment shall be made by [wire transfer / cashier’s check / settlement draft] payable to [Payee] within [___] days after execution by all Parties and entry of any required court approval and payment order. Claimant shall deliver any signed dismissal stipulation for holding pending cleared payment; Defendant may not file it before payment is received. For court-ordered deposits, payment shall follow the order's payee and delivery instructions.

3.1.3 Tax Allocation. The Parties shall record the agreed allocation, if any, among identified claims in [Tax Allocation Schedule / none]. This Agreement makes no representation about tax treatment; each Party remains responsible for its own required reporting and taxes.

3.1.4 No Admission of Liability. Payment of the Settlement Amount constitutes a compromise of disputed claims and shall not be construed as an admission of liability by Defendant or any Releasee.

3.2 Conditions Precedent

(a) Execution and delivery of this Agreement by all Parties;
(b) If Claimant is a minor or incompetent person, completion of the verified petition and entry of the written order required by Minn. Gen. R. Prac. 145 before proceeds are paid; if an action is pending, judicial approval of its compromise under Minn. Stat. § 540.08;
(c) If an Action is pending, delivery of a signed stipulation dismissing only the released Claims against the named Releasees after payment, suitable for filing with the Court.

3.3 Structured Settlement (Optional)

[Use this subsection only if the Parties complete Schedule A and any required court order approves it.]
3.3.1 Structure Terms. $[Structured Portion] of the Settlement Amount shall fund the periodic payments stated in Schedule A. The schedule must name the obligor, issuer, funding source, payment dates and amounts, beneficiary, security, and any guarantor.

3.3.2 Assignment. Any assignment of periodic-payment obligations requires a separately completed assignment agreement identifying the assignee and effective date. This Agreement does not guarantee tax qualification or authorize a later transfer of payment rights.

3.3.3 Security for Payments. The security and any continuing Defendant obligation are stated in Schedule A and any required court order. No recourse waiver is implied.

3.4 Minor Settlement Approval (If Applicable)

3.4.1 Court Approval. For a minor or incompetent claimant, no proceeds will be paid without a verified petition and written order under Minn. Gen. R. Prac. 145. If a lawsuit is pending, its compromise also requires judicial approval under Minn. Stat. § 540.08.

3.4.2 Disposition. The payor shall disburse the proceeds to the persons and depositories, and on the conditions, named in the order. Identify the order and account or structure in [COURT ORDER / SCHEDULE]. Funds deposited under Rule 145 require a later court order for release, including after majority.

3.4.3 Representative. [Representative name and capacity] signs for the claimant only to the extent authorized by [appointment / order / other authority], subject to the court's approval and payment order.

4. REPRESENTATIONS & WARRANTIES

4.1 Mutual Authority. Each Party represents and warrants that it has full capacity, power, and authority to enter into and perform this Agreement.

4.2 Claims Ownership. Claimant identifies any assignment, pledge, bankruptcy estate interest, or other person's claim affecting the listed Claims in [EXCEPTIONS / NONE]. Claimant releases only claims Claimant owns or is authorized to settle.

4.3 Recovery Interests. The Parties identify known Medicare conditional payments, Medicaid or other governmental recovery interests, and disputed or unknown amounts in the Section 7.1 schedule. If 42 U.S.C. § 1395y(b)(2)(B) applies, a responsible primary plan or recipient of its payment may owe reimbursement; the Parties shall follow the actual demand, resolution, and payment instructions applicable to that interest.

4.4 Survival. All representations and warranties set forth in this Agreement shall survive the Effective Date and the consummation of the settlement contemplated herein.

5. COVENANTS

5.1 Claimant Release. Effective only upon satisfaction of the Conditions Precedent and actual receipt of the Settlement Amount, Claimant releases only the Releasees and Claims completed here: Releasees by legal name [________________________________]; claim categories and date range [________________________________]; scope ☐ known claims only ☐ known and unknown Incident-related claims; reserved claims, persons, benefits, liens, and reimbursement rights [________________________________]. Claims owned by a nonsigner are not released.

5.2 Dismissal With Prejudice. If an Action is pending, Claimant shall file the agreed stipulation dismissing only the released Claims against the named Releasees within [___] business days after cleared payment, subject to any court order. Each Party bears its own litigation costs and fees unless a signed schedule states otherwise.

5.3 No Further Claims. Claimant covenants not to commence or prosecute any Action based on a Claim actually released by Section 5.1.

5.4 Confidentiality (Optional). [If applicable] The terms and existence of this Agreement are confidential and shall not be disclosed except as required by law or court order.

6. DEFAULT & REMEDIES

6.1 Events of Default. Any of the following constitute an “Event of Default”:
(a) Defendant fails to pay the Settlement Amount when due;
(b) Claimant fails to deliver dismissal documents or obtain required approvals;
(c) Breach of any representation, warranty, or covenant contained herein.

6.2 Notice & Cure. A Party alleging breach shall send written notice describing it to [notice address]. Any agreed cure period is [___] days after receipt; a payment deadline or court order controls if it requires earlier action.

6.3 Remedies. If a breach is not cured, an affected Party may seek relief available under governing law and the terms of any controlling court order. This Agreement does not create an automatic rescission, specific-performance, or attorney-fee award.

7. RISK ALLOCATION

7.1 Recovery-Interest Allocation. Before funding, the Parties shall complete a written schedule identifying every asserted Medicare, Medicaid, benefit-plan, medical-lien, insurer, attorney, governmental, or other third-party claim; its basis and status; any holdback or direct payment; the responsible person; and required proof of resolution. No blanket indemnity applies. Any claim-specific indemnity must identify the claim, indemnifying and protected persons, notice, defense control, settlement authority, exclusions, and liability measure. A private allocation does not alter an obligation imposed directly by governing law.

7.2 Defendant-Side Risk Allocation. Any defendant-side indemnity must identify the exact third-party claim, indemnifying and protected persons, notice, defense control, settlement authority, exclusions, and liability measure. No generic indemnity applies for settlement authority or insurance representations.

7.3 Payment Risk. Defendant's funding obligation and any separately identified guaranty remain as stated in Sections 3.1 and 3.3 and Schedule A. This Agreement does not cap an available remedy by reference to the Settlement Amount.

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 Minnesota, without giving effect to its conflict-of-laws principles.

8.2 Forum. An enforcement action may be brought in a court of competent jurisdiction, subject to any pending action, court order, and applicable venue law.

8.3 Waiver of Jury Trial. Intentionally Omitted.

8.4 Arbitration. Intentionally Omitted.

8.5 Attorneys’ Fees. Each Party bears its own enforcement fees and costs unless a signed schedule or applicable law provides otherwise.

9. GENERAL PROVISIONS

9.1 Entire Agreement. This Agreement constitutes the entire understanding between the Parties and supersedes all prior negotiations and agreements, whether oral or written, relating to the subject matter hereof.

9.2 Amendments & Waivers. No amendment or waiver of any provision shall be effective unless in writing and signed by all Parties. Waiver of any breach shall not constitute waiver of any subsequent breach.

9.3 Assignment. No Party may assign or delegate any rights or obligations under this Agreement without the prior written consent of the other Party, except that Defendant may assign its obligations to its insurer or a qualified assignment company in connection with a structured settlement.

9.4 Severability. If a provision is held unenforceable, the remaining provisions remain effective to the extent they can operate consistently with the Parties' settlement and any court order.

9.5 Counterparts. This Agreement may be executed in counterparts, which together form one agreement.

9.6 Successors & Assigns. This Agreement shall be binding upon and inure to the benefit of the Parties and their respective heirs, personal representatives, successors, and permitted assigns.

9.7 Headings. Section headings are for convenience only and shall not affect the interpretation of this Agreement.

9.8 Drafting. Each Party has had an opportunity to review this Agreement before signing.

10. EXECUTION BLOCK

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

CLAIMANT
________________________________________
Signature: ______________________________
Name: [Claimant Name]
Date: ___________________________________

DEFENDANT
________________________________________
Signature: ______________________________
Name: [Authorized Signatory]
Title: [Title]
Date: ___________________________________

NOTARY ACKNOWLEDGMENT (if the Parties elect to use one or an order requires it)

State of Minnesota, County of [________________]. On [__/__/____], [signer name] acknowledged signing this Agreement before me.

Notary: [signature / printed name / seal]

Sources and References

• Minn. Stat. § 540.08: https://www.revisor.mn.gov/statutes/cite/540.08
• Minn. Gen. R. Prac. 145: https://www.revisor.mn.gov/court_rules/gp/id/145/
• 42 U.S.C. § 1395y(b)(2)(B): https://www.govinfo.gov/link/uscode/42/1395y