PERSONAL INJURY SETTLEMENT AGREEMENT AND MUTUAL RELEASE
(Mississippi)
[// GUIDANCE: Delete bracketed guidance comments before circulation to client or opposing counsel.]
TABLE OF CONTENTS
- Document Header ……………………………………………………………………………… 2
- Definitions ……………………………………………………………………………………… 3
- Operative Provisions ………………………………………………………………………… 5
- Representations & Warranties …………………………………………………………… 8
- Covenants & Restrictions ………………………………………………………………… 9
- Default & Remedies ………………………………………………………………………… 10
- Risk Allocation ………………………………………………………………………………… 11
- Dispute Resolution …………………………………………………………………………… 13
- General Provisions …………………………………………………………………………… 14
- Execution Block ……………………………………………………………………………… 16
1. DOCUMENT HEADER
1.1 Title. Personal Injury Settlement Agreement and Mutual Release (this “Agreement”).
1.2 Parties.
(a) “[Plaintiff Full Legal Name]” (the “Plaintiff”) [// GUIDANCE: If settlement involves a minor, insert “, by and through [Name], duly appointed [parent/natural guardian/next friend],”].
(b) “[Defendant Full Legal Name]” (the “Defendant”).
Each, a “Party,” and collectively, the “Parties.”
1.3 Recitals.
A. A controversy arose from an incident that occurred on [Date of Incident] in [City/County], Mississippi (the “Incident”), giving rise to certain personal-injury claims (the “Action”).
B. Plaintiff alleges that Defendant is legally responsible for damages arising from the Incident, which allegations Defendant expressly denies.
C. Without admission of liability, the Parties desire to fully and finally settle the Action on the terms set forth herein and to avoid the uncertainties, costs, and burdens of litigation.
D. The consideration for this Agreement is the mutual promises, releases, and payments described below, the sufficiency of which is hereby acknowledged.
1.4 Effective Date. This Agreement shall become effective on the date (the “Effective Date”) the last Party executes the Agreement and, if required under Mississippi law, the chancery court enters an order approving the settlement (“Court Approval”).
1.5 Governing Law & Jurisdiction. This Agreement shall be governed by and construed in accordance with the tort and contract laws of the State of Mississippi, without regard to its conflict-of-law principles.
2. DEFINITIONS
For purposes of this Agreement, capitalized terms shall have the meanings set forth below:
“Action” has the meaning set forth in Recital A.
“Affiliate” means, with respect to any entity, any parent, subsidiary, or other entity that, directly or indirectly, controls, is controlled by, or is under common control with such entity.
“Approved Payee” has the meaning set forth in Section 3.2(b).
“Claims” means any and all claims, demands, causes of action, liabilities, obligations, damages, costs, losses, and expenses of every kind, known or unknown, suspected or unsuspected, fixed or contingent, in law, equity, or otherwise, arising from or relating to the Incident or the Action.
“Court Approval” has the meaning set forth in Section 1.4.
“Defendant” has the meaning set forth in Section 1.2(b).
“Effective Date” has the meaning set forth in Section 1.4.
“Gross Settlement Amount” has the meaning set forth in Section 3.1.
“Lien” means any statutory, contractual, or equitable right of reimbursement, subrogation, or assignment held by a governmental agency, insurer, medical provider, or any other third party.
“Medicare Secondary Payer Laws” means the provisions codified at 42 U.S.C. § 1395y(b) and all related regulations and guidance.
“Minor” means a natural person under the age of eighteen (18) years under Mississippi law.
“Net Settlement Proceeds” has the meaning set forth in Section 3.4.
“Party” and “Parties” have the meanings set forth in Section 1.2.
“Plaintiff” has the meaning set forth in Section 1.2(a).
“Released Parties” has the meaning set forth in Section 7.2.
“Settlement Administrator” has the meaning set forth in Section 3.3.
“Structured Settlement” has the meaning set forth in Section 3.2.
3. OPERATIVE PROVISIONS
3.1 Gross Settlement Amount.
Defendant shall pay the total sum of [Settlement Amount in Words] Dollars (USD $[Numeric]) (the “Gross Settlement Amount”) in full satisfaction of all Claims, subject to Section 3.2 (Structured Settlement) and Section 3.4 (Deductions).
3.2 Structured Settlement (Optional).
(a) Election. If indicated below, the Parties agree that all or a portion of the Gross Settlement Amount shall be funded through a structured settlement annuity (the “Structured Settlement”) issued by a qualified assignment company in accordance with 26 U.S.C. § 130 and Mississippi Code Ann. § 11-7-159 et seq.
☐ Structured Settlement elected. Amount to structure: USD $[Structured Amount].
☐ Lump-sum payment only.
(b) Funding & Payee. Defendant shall fund the Structured Settlement premium directly to a qualified assignment company, which shall cause an annuity contract to be issued naming [Plaintiff / Court-appointed fiduciary] as the payee (the “Approved Payee”).
(c) Non-Acceleration; Anti-Assignment. Payments under any Structured Settlement are not subject to acceleration, anticipation, or assignment except as permitted under applicable Mississippi structured-settlement-protection statutes.
3.3 Payment Mechanics.
(a) Time of Payment. Subject to Court Approval (if applicable) and receipt of executed release documents and W-9 forms, Defendant shall deliver the Gross Settlement Amount (or initial annuity premium) within [Number] business days after the Effective Date.
(b) Payment To. Payments shall be made payable to [Name of Settlement Administrator or Trust Account] (the “Settlement Administrator”) for the benefit of Plaintiff, unless otherwise ordered by the Court.
3.4 Deductions & Net Settlement Proceeds.
From the Gross Settlement Amount, the Settlement Administrator is authorized to deduct:
(i) Attorney’s fees of [Percentage]% pursuant to the fee contract between Plaintiff and counsel;
(ii) Litigation costs of USD $[Amount];
(iii) Verified Liens (Section 7.3); and
(iv) Court-approved guardian or conservator fees (if Plaintiff is a Minor).
The balance (the “Net Settlement Proceeds”) shall be disbursed in accordance with Section 3.5.
3.5 Disbursement of Net Settlement Proceeds.
(a) Adult Plaintiff. Net Settlement Proceeds shall be paid directly to Plaintiff.
(b) Minor Plaintiff. Net Settlement Proceeds shall be deposited into a court-supervised blocked account, trust, or guardianship estate as required by Miss. Code Ann. § 93-13-59 and relevant chancery-court rules.
[// GUIDANCE: Modify to track the approving chancellor’s specific order.]
3.6 Conditions Precedent.
The Parties’ obligations under this Agreement are conditioned upon:
(i) Execution of this Agreement by all Parties;
(ii) Receipt of all ancillary settlement documents, including Medicare affidavits; and
(iii) Court Approval if required pursuant to Section 4.3.
3.7 Dismissal of Action.
Within five (5) business days after confirmation of cleared settlement funds, Plaintiff shall file a stipulation of dismissal with prejudice in [Court and Cause No.]. Each Party shall bear its own costs unless otherwise specified herein.
4. REPRESENTATIONS & WARRANTIES
4.1 Mutual Authority. Each Party represents that it has full power and authority to enter into and perform this Agreement and has not sold, assigned, pledged, or otherwise transferred any Claim released herein.
4.2 No Reliance. Each Party acknowledges that it enters this Agreement based solely on the statements expressly contained herein and not in reliance on any statement or promise of the other Party or any other person not expressly set forth.
4.3 Minor Approval Representation. If Plaintiff is a Minor, the undersigned fiduciary represents that:
(a) A petition for Court Approval will be promptly filed; and
(b) All statutorily required notices and evidence will be submitted to the chancery court.
The representations in this Section 4.3 survive the Effective Date.
4.4 Tax Matters. Each Party has consulted or has had the opportunity to consult independent tax advisors regarding the tax consequences of this settlement.
5. COVENANTS & RESTRICTIONS
5.1 No Further Action. Plaintiff covenants not to commence, aid, or prosecute any Claim released in Section 7.2 against any Released Party.
5.2 Confidentiality (Optional).
☐ Confidentiality applies.
Plaintiff shall not disclose the terms or existence of this Agreement except to counsel, immediate family, tax or financial advisors, or as required by law or Court order.
☐ No confidentiality restriction.
5.3 Non-Disparagement. Each Party shall refrain from making any statement intended to malign or disparage the other Party concerning the Incident or this settlement.
5.4 Notice of Re-Opened Claims. If any third-party Claim relating to the Incident is asserted against Defendant after the Effective Date, Plaintiff shall provide prompt written notice and reasonably cooperate in the defense or resolution thereof.
6. DEFAULT & REMEDIES
6.1 Events of Default.
(a) Failure of Defendant to pay the Gross Settlement Amount or fund the Structured Settlement within the time specified; or
(b) Failure of Plaintiff to dismiss the Action pursuant to Section 3.7.
6.2 Cure Period. The non-breaching Party shall provide written notice specifying the default. The breaching Party shall have ten (10) business days to cure.
6.3 Remedies.
(a) If Defendant defaults and fails to cure, Plaintiff may reinstate the Action or enter judgment for the unpaid portion of the Gross Settlement Amount plus interest at the Mississippi statutory rate.
(b) If Plaintiff defaults and fails to cure, Defendant may seek specific performance, dismissal with prejudice, and recovery of reasonable attorney’s fees incurred enforcing this Agreement.
6.4 Attorneys’ Fees. The prevailing Party in any action to enforce this Agreement shall be entitled to recover reasonable attorneys’ fees, costs, and expenses.
7. RISK ALLOCATION
7.1 Limitation of Liability. Defendant’s aggregate liability for the Claims shall not exceed the Gross Settlement Amount.
7.2 Mutual Release.
(a) Plaintiff, on behalf of himself/herself, heirs, beneficiaries, successors, and assigns, irrevocably and unconditionally releases and forever discharges Defendant and its Affiliates, insurers, employees, officers, directors, agents, and attorneys (collectively, the “Released Parties”) from any and all Claims.
(b) Defendant, on behalf of itself and its insurers, releases Plaintiff from any claims for costs, sanctions, or malicious prosecution arising from the Action.
7.3 Indemnification for Liens.
Plaintiff shall indemnify, defend, and hold harmless the Released Parties from any Liens asserted against the Gross Settlement Amount, except for Liens expressly deducted under Section 3.4.
[// GUIDANCE: Consider Medicare Set-Aside obligations if lifetime medicals are implicated.]
7.4 Medicare Compliance. The Parties intend this settlement to satisfy all reporting and reimbursement obligations under Medicare Secondary Payer Laws. Plaintiff affirms that, as of the Effective Date, he/she is ☐ / is not ☐ a Medicare beneficiary.
7.5 Force Majeure. No Party shall be liable for delay or failure of performance caused by events beyond its reasonable control, including acts of God, war, or governmental action, provided that such Party gives prompt notice and resumes performance as soon as practicable.
8. DISPUTE RESOLUTION
8.1 Governing Law. Mississippi law governs all matters arising out of or relating to this Agreement.
8.2 Forum Selection. Any action arising from this Agreement shall be brought exclusively in the [Circuit / Chancery] Court of [County], Mississippi, and the Parties consent to personal jurisdiction therein.
8.3 Waiver of Jury Trial. Intentionally Omitted.
[// GUIDANCE: The metadata specifies “jury waiver: not applicable.”]
8.4 Arbitration. Intentionally Omitted.
[// GUIDANCE: The metadata specifies “arbitration: not applicable.”]
8.5 Equitable Relief. Nothing herein precludes a Party from seeking temporary or preliminary equitable relief in aid of the exclusive jurisdiction designated above.
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 and agreements.
9.2 Amendments. No amendment or waiver shall be effective unless in writing and signed by all Parties.
9.3 Assignment. No Party may assign its rights or delegate its duties without prior written consent of the other Party, except that Defendant may assign payment obligations to a qualified assignment company for Structured Settlement funding.
9.4 Successors & Assigns. This Agreement binds and benefits the Parties and their respective heirs, executors, administrators, legal representatives, successors, and permitted 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 necessary to comply with applicable law.
9.6 Counterparts; Electronic Signatures. This Agreement may be executed in multiple counterparts, each of which is deemed an original. Signatures delivered via facsimile, PDF, or industry-standard electronic signature platform shall be deemed original.
9.7 Headings. Section headings are for convenience only and do not affect interpretation.
9.8 Interpretation. The Parties acknowledge that this Agreement was negotiated by sophisticated counsel and shall not be construed against either Party as drafter.
10. EXECUTION BLOCK
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.
PLAINTIFF
[Plaintiff Full Legal Name]
Signature: _____
Name: ______
Title (if any): ____
Date: _______
[// GUIDANCE: If minor:]
By: _____
Name: [Guardian/Fiduciary]
Capacity: ☐ Parent ☐ Guardian ad litem ☐ Conservator
Date: _____
DEFENDANT
[Defendant Full Legal Name]
Signature: _____
Name: ______
Title / Corporate Capacity: ___
Date: ________
[OPTIONAL NOTARY BLOCK]
State of Mississippi )
County of ____ )
On this ___ day of _, 20_, before me, the undersigned Notary Public, personally appeared _______, known to me or satisfactorily proven to be the person(s) whose name(s) are subscribed to the foregoing instrument, and acknowledged that he/she executed the same for the purposes therein contained.
Witness my hand and official seal.
Notary Public
My Commission Expires: _______