PERSONAL INJURY SETTLEMENT AGREEMENT

AND MUTUAL RELEASE

(Montana)

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
4. Representations & Warranties
5. Covenants & Restrictions
6. Default & Remedies
7. Risk Allocation
8. Dispute Resolution
9. General Provisions
10. Execution Block

1. DOCUMENT HEADER

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

1. [CLAIMANT NAME], an individual [residing at] / [a minor, by and through his/her legal guardian [GUARDIAN NAME]] (“Claimant”); and
2. [RESPONDENT NAME], a [ENTITY TYPE] organized under the laws of [STATE] with its principal place of business at [ADDRESS] (“Respondent”).

Claimant and Respondent may be referred to herein individually as a “Party” and collectively as the “Parties.”

1.1 Recitals

A. Claimant alleges injuries and damages arising out of an incident that occurred on [DATE OF INCIDENT] in [LOCATION] (the “Incident”).
B. Respondent denies liability but desires to resolve all claims arising from or related to the Incident.
C. The Parties wish to fully, finally, and forever compromise, settle, and release all claims on the terms set forth herein, to avoid the expense and uncertainty of litigation.

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

[// GUIDANCE: Keep Recitals succinct; do not include admissions of liability unless strategically required.]

2. DEFINITIONS

For purposes of this Agreement, the following capitalized terms shall have the meanings ascribed to them below. Undefined capitalized terms have the meanings given elsewhere in this Agreement.

“Action” means any past, present, or future civil action, arbitration, administrative proceeding, or claim arising out of or related to the Incident.

“Confidential Information” has the meaning given in Section 5.2.

“Court Approval” means any approval, order, or authorization from a court of competent jurisdiction required under applicable Montana law for settlements involving minors or incapacitated persons.

“Released Claims” has the meaning given in Section 3.2.

“Released Parties” means Respondent and its past and present parents, subsidiaries, affiliates, insurers, reinsurers, officers, directors, employees, agents, attorneys, predecessors, successors, and assigns.

“Settlement Amount” means the total consideration described in Section 3.1, including any Periodic Payments.

“Structured Settlement” or “Periodic Payments” means a schedule of future payments funded through an assignment and/or annuity contract as detailed in Exhibit A (if elected).

[// GUIDANCE: Add or delete defined terms as needed for deal specifics.]

3. OPERATIVE PROVISIONS

3.1 Consideration

3.1.1 Lump-Sum Payment. Respondent shall pay Claimant [US $__] (“Lump-Sum Payment”) within [__] days after (i) execution of this Agreement by all Parties, (ii) delivery to Respondent of a duly executed IRS Form W-9 (if applicable), and (iii) receipt of any required Court Approval.

3.1.2 Structured Settlement (Optional). In lieu of or in addition to the Lump-Sum Payment, the Parties may agree to Periodic Payments as set forth in Exhibit A. Respondent’s obligation to make Periodic Payments shall be satisfied and extinguished upon (a) payment of the premium to the qualified assignment company/annuity issuer, and (b) confirmation of the annuity contract in favor of Claimant.

3.1.3 No Admission. Payment of the Settlement Amount is a compromise of disputed claims and shall not be construed as an admission of liability by any Party.

3.2 Mutual Release

3.2.1 Claimant’s Release. Upon receipt of the Settlement Amount, Claimant, on behalf of himself/herself and his/her heirs, assigns, and representatives, irrevocably and unconditionally releases and forever discharges the Released Parties from any and all actions, causes of action, claims, liens, demands, damages, costs, losses, expenses, and liabilities of every kind and nature, known or unknown, anticipated or unanticipated, in law or equity, arising out of or related to the Incident (“Released Claims”).

3.2.2 Respondent’s Release. Respondent hereby releases Claimant and his/her heirs, assigns, and representatives from any and all claims arising out of or related to the Incident.

3.2.3 Scope and Waiver of § 1542-Type Rights. Claimant expressly waives any statute or doctrine that might otherwise limit the scope of this release to known or suspected claims.

[// GUIDANCE: Montana requires release language to be clear and conspicuous. Consider using bold, caps, or separate paragraph headings to enhance enforceability.]

3.3 Conditions Precedent

a. Execution and delivery of this Agreement by all Parties;
b. Court Approval where required (see Section 4.5);
c. Receipt by Respondent of any lien resolutions or subrogation notices reasonably requested.

3.4 Taxes & Medicare Compliance

a. Each Party shall be responsible for its own tax obligations arising from the Settlement Amount.
b. The Parties intend to comply with the Medicare Secondary Payer Act. Claimant represents that (i) he/she is not a Medicare beneficiary OR (ii) any conditional payments have been satisfied and a final demand letter will be provided.

3.5 Liens

Claimant warrants that all hospital, medical, attorney, or other liens shall be satisfied or compromised from the Settlement Amount, and Respondent shall have no responsibility therefor.

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 that no further consent is necessary.

4.2 Voluntary Agreement. Each Party represents that it (i) has read and understands this Agreement, (ii) has been advised to seek, and has had an opportunity to obtain, independent legal counsel, and (iii) enters into this Agreement voluntarily and without duress.

4.3 No Prior Assignment. Each Party represents that it has not assigned or transferred any Released Claim or right to any third party.

4.4 Accuracy of Information. Claimant represents that all information provided to Respondent concerning the Incident and damages is true, complete, and accurate to the best of Claimant’s knowledge.

4.5 Minor or Incapacitated Claimant.
a. If Claimant is a minor or otherwise lacks legal capacity, the guardian executing this Agreement represents that he/she is duly appointed and authorized to act on Claimant’s behalf.
b. The Parties acknowledge that finality of this Agreement is contingent upon Court Approval as required under applicable Montana law for settlements involving minors or incapacitated persons.

4.6 Survival. The representations and warranties in this Section 4 shall survive the execution and delivery of this Agreement.

5. COVENANTS & RESTRICTIONS

5.1 No Further Litigation. Claimant covenants not to commence, prosecute, or maintain any Action against the Released Parties concerning any Released Claim.

5.2 Confidentiality. Except as required by law or court order, the Parties shall keep the terms and amount of this settlement confidential. Disclosure to tax advisors, insurers, or as necessary to secure Court Approval is permitted, provided the recipient agrees to similar confidentiality.

5.3 Non-Disparagement. The Parties agree not to make any statement intended to defame or disparage the other Party in connection with the Incident or this settlement.

5.4 Medicare/Medicaid Reporting. Claimant shall cooperate with Respondent to provide any information reasonably necessary for mandatory insurer reporting.

5.5 Further Assurances. The Parties shall execute such further documents and take such actions as may be reasonably necessary to carry out the intent of this Agreement.

6. DEFAULT & REMEDIES

6.1 Events of Default. The following constitute defaults:
a. Respondent’s failure to pay the Lump-Sum Payment or Periodic Payments when due;
b. Claimant’s breach of the covenants in Section 5.

6.2 Notice & Cure. The non-breaching Party shall provide written notice of default. The breaching Party shall have [__] days to cure monetary defaults and [__] days to cure non-monetary defaults.

6.3 Remedies.
a. Monetary Default by Respondent: Claimant may enter judgment for the unpaid portion of the Settlement Amount plus interest at [__]% per annum, attorneys’ fees, and costs.
b. Breach by Claimant: Respondent may seek injunctive relief, damages, and costs, including repayment of any Settlement Amount already paid, to the extent permitted by law.

6.4 Attorneys’ Fees. The prevailing Party in any action to enforce this Agreement shall be entitled to reasonable attorneys’ fees, costs, and expenses.

7. RISK ALLOCATION

7.1 Mutual Release. See Section 3.2.

7.2 Limitation of Liability. Except for obligations expressly provided herein, neither Party shall be liable to the other for any special, consequential, or punitive damages arising out of this Agreement.

7.3 Insurance. Respondent represents that it maintains liability insurance applicable to the Incident. No third-party beneficiary rights are created herein.

7.4 Force Majeure. No Party shall be liable for failure to perform due to events beyond its reasonable control; provided, however, that payment obligations are not excused.

8. DISPUTE RESOLUTION

8.1 Governing Law. This Agreement and any dispute arising hereunder shall be governed by, and construed in accordance with, the laws of the State of Montana, without regard to conflict-of-laws principles.

8.2 Forum Selection. The Parties consent to exclusive jurisdiction and venue in the state courts located in [COUNTY], Montana for any action arising out of or relating to this Agreement.

8.3 Arbitration. Not applicable.

8.4 Jury Waiver. Not applicable.

8.5 Temporary or Equitable Relief. Nothing herein limits either Party’s right to seek temporary, preliminary, or permanent injunctive relief to enforce Sections 5 or 6.

9. GENERAL PROVISIONS

9.1 Entire Agreement. This Agreement constitutes the entire agreement of the Parties with respect to the subject matter and supersedes all prior negotiations, understandings, or agreements.

9.2 Amendment; Waiver. No amendment or waiver is effective unless in writing and signed by all Parties. A waiver on one occasion is not a waiver on subsequent occasions.

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 Respondent may assign its obligation to make Periodic Payments to a qualified assignment company or annuity issuer.

9.4 Severability. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force, and the court shall reform the affected provision to the minimum extent necessary to achieve the Parties’ intent.

9.5 Successors & Assigns. This Agreement binds and benefits the Parties and their respective heirs, personal representatives, successors, and permitted assigns.

9.6 Counterparts; Electronic Signatures. This Agreement may be executed in counterparts, each of which is deemed an original, and all of which together constitute one instrument. Signatures delivered by facsimile, PDF, or secure electronic signature service shall be deemed originals.

9.7 Headings. Headings are for convenience only and shall not affect interpretation.

9.8 Time of the Essence. Time is of the essence for all obligations herein.

9.9 Construction. The Parties acknowledge that each has participated in the drafting of this Agreement and that no presumption shall arise favoring one Party over the other.

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 NAME], as legal guardian of [MINOR NAME]
Date: ________

RESPONDENT

By: _____
Name: ____
Title: ____
Date: _____

NOTARY ACKNOWLEDGMENT (if required)

State of ____
County of __

On this _ day of __, 20, before me, the undersigned, a Notary Public in and for said state, personally appeared _____, known to me (or satisfactorily proven) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged that he/she/they executed the same for the purposes therein contained.

IN WITNESS WHEREOF, I hereunto set my hand and official seal.

Notary Public
My Commission Expires: __

EXHIBIT A

(Structured Settlement / Periodic Payments)

1. Payee: [CLAIMANT NAME or Annuity Trust]
2. Qualified Assignment Company: ________
3. Annuity Issuer: _________
4. Guarantee Period: ______
5. Payment Schedule:
   • $_ on ___ (Date)
   • $_ on _ (Date)
   • $_ per ______ commencing _ and continuing for _ years.

[// GUIDANCE: Attach the annuity illustration and assignment documents as part of Exhibit A.]

[// GUIDANCE TO PRACTITIONER:
1. Confirm Montana statutory requirements for minor settlements (court approval threshold, bond requirements, etc.) and insert any mandatory language or citations.
2. Tailor confidentiality language to comport with ethical rules and any statutory disclosure mandates (e.g., Montana Code Annotated § 28-2-702 regarding confidentiality in settlement agreements, if applicable).
3. Verify Medicare, Medicaid, ERISA, or workers’ compensation liens and adjust Section 3.4 and 3.5 accordingly.
4. Review insurance policy restrictions before including non-disparagement or indemnity provisions.
5. For “high-risk” releases (e.g., wrongful death), consider separate releases for statutory beneficiaries.
6. Obtain judicial approval of structured settlements under Montana structured settlement protection statutes (if assignment/annuity transfer contemplated).]