Personal Injury Settlement Agreement - North Dakota
PERSONAL INJURY SETTLEMENT AND RELEASE AGREEMENT
(North Dakota – Template)
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
- Schedule 1 – Payment Terms (Lump-Sum / Structured)
- Schedule 2 – Liens & Subrogation Interests
1. DOCUMENT HEADER
1.1 Title
Personal Injury Settlement and Mutual Release Agreement (the “Agreement”)
1.2 Parties
This Agreement is entered into by and between:
(a) [CLAIMANT NAME], an individual [and natural parent/guardian of [MINOR NAME]] with a principal residence at [ADDRESS] (“Claimant”); and
(b) [DEFENDANT NAME], a [corporation/individual] with a principal address at [ADDRESS] (“Released Party”).
Claimant and Released Party are each a “Party” and, collectively, the “Parties.”
1.3 Recitals
A. On or about [DATE OF INCIDENT], Claimant allegedly sustained personal injuries and other damages arising out of an incident located at [LOCATION] (the “Incident”).
B. Claimant has asserted, or may assert, personal-injury claims against Released Party (the “Action”).
C. Without admission of liability, the Parties desire to fully and finally settle all disputes arising from the Incident on the terms set forth herein.
1.4 Effective Date & Governing Jurisdiction
This Agreement becomes effective on the date last signed by the Parties (the “Effective Date”) and shall be governed by the substantive tort law of the State of North Dakota.
2. DEFINITIONS
“Action” – the actual or potential civil proceeding(s) relating to the Incident.
“Claim(s)” – any past, present, or future cause of action, demand, or damage of whatever nature arising out of or related to the Incident.
“Court” – the District Court of the State of North Dakota having subject-matter jurisdiction over the Action.
“Effective Date” – as defined in Section 1.4.
“Liens” – any statutory, contractual, or equitable right of reimbursement, including but not limited to Medicare, Medicaid, ERISA, workers’ compensation, and medical-provider liens.
“Minor” – any settling individual under eighteen (18) years of age.
“Released Claims” – as defined in Section 3.2.
“Released Parties” – Released Party and its past, present, and future parents, subsidiaries, affiliates, officers, directors, employees, agents, insurers, reinsurers, and assigns.
“Settlement Amount” – the total consideration described in Section 3.1 and Schedule 1.
“Structured Settlement” – periodic payment arrangement established under Schedule 1, if elected.
3. OPERATIVE PROVISIONS
3.1 Consideration; Payment Mechanics
(a) Settlement Amount. Released Party shall pay Claimant the total sum of [US$ AMOUNT] (inclusive of attorneys’ fees and costs) in accordance with Schedule 1.
(b) Funding Deadline. Payment shall be funded no later than [NUMBER] calendar days following (i) execution of this Agreement by all Parties, and (ii) receipt by Released Party of any Court approval required under Section 3.4.
(c) Conditions Precedent. Payment is conditioned on Claimant’s delivery of:
(i) an executed original of this Agreement;
(ii) duly executed dismissal with prejudice of the Action; and
(iii) Court-approved guardianship or compromise order, if applicable.
3.2 Mutual Release of Claims
(a) Release by Claimant. Upon receipt of the Settlement Amount, Claimant releases only the Released Parties and claims completed here: Released Parties by legal name [________________________________]; claim categories and date range [________________________________]; scope ☐ known claims only ☐ known and unknown Incident-related claims after counsel review; reserved claims, persons, benefits, liens, and reimbursement rights [________________________________].
(b) Release by Released Party. Upon payment of the Settlement Amount, Released Party releases Claimant from all counterclaims, contribution actions, or indemnity claims related to the Incident.
(c) Scope. The Released Claims include, without limitation, all claims for bodily injury, pain and suffering, medical expenses, lost wages, loss of consortium, property damage, punitive or exemplary damages, and any derivative claims.
(d) Unknown Claims. No generic waiver is presumed. Unknown claims are included only if the applicable scope box in subsection (a) is selected after counsel review and the intended consequences are stated in the completed release description.
3.3 No Admission of Liability
This Agreement constitutes a compromise settlement. Neither execution nor performance shall be construed as an admission of liability, fault, or wrongdoing by any Party.
3.4 Minor Settlement Procedure (If Applicable)
(a) Representation and Separate Approval Inquiry. N.D. R. Civ. P. 17(b) governs who may sue or defend for a Minor and when the court must or may appoint a guardian ad litem; it does not itself create a minor-settlement approval procedure. Before execution or funding, the Parties shall identify and satisfy any separate approval, conservatorship, protective-order, or court-order requirement applicable to the Minor and the settlement proceeds.
(b) Guardian ad Litem. The Parties shall cooperate in obtaining a guardian ad litem or other protective order if required or directed by the court under N.D. R. Civ. P. 17(b) or other applicable law.
(c) Protection of Proceeds. Any lump-sum or structured payment for a Minor shall use the payee, account, annuity, transfer, and withdrawal restrictions required by the approving court or other applicable authority. Do not assume that anti-assignment or non-commutation language is mandated merely because payments are structured.
(d) Early-Settlement Warning. N.D.C.C. § 9-08-08 makes a personal-injury settlement voidable if made within thirty days after the injury, or while the injured person remains under disability from the injury and within six months after the injury. North Dakota counsel should confirm enforceability before execution or funding.
3.5 Structured Settlement (If Elected)
(a) Assignment and Annuity. Released Party may satisfy all or part of the Settlement Amount by purchasing an annuity contract from a qualified assignment company, with payments to Claimant as set forth in Schedule 1.
(b) Qualified Funding. The Structure shall be intended to qualify for income-tax exclusion under Internal Revenue Code § 104(a)(2).
(c) Non-Commutation. Claimant shall have no right to accelerate, assign, pledge, or otherwise encumber Structure payments, except as permitted by North Dakota law.
4. REPRESENTATIONS & WARRANTIES
4.1 Claimant
(a) Capacity and Authority to Contract;
(b) Sole Ownership of Claims; no prior assignment;
(c) No bankruptcy pending or contemplated;
(d) Advice of Counsel: Claimant has consulted with independent counsel and understands the legal effect of this Agreement.
4.2 Released Party
(a) Corporate authority (if entity);
(b) Execution constitutes valid and binding obligation;
(c) No conflicting agreements prohibit settlement.
4.3 Survival. All representations and warranties survive execution and delivery of this Agreement.
5. COVENANTS & RESTRICTIONS
5.1 Dismissal of Action. Within three (3) business days after receipt of the Settlement Amount (or Court approval, if later), Claimant shall file a stipulation for dismissal with prejudice, each party to bear its own costs.
5.2 Confidentiality [OPTIONAL]. Except as required by law, Claimant shall keep the terms of this Agreement confidential.
5.3 Liens & Subrogation.
(a) Schedule 2 must identify each asserted recovery interest, its basis and status, any holdback or direct payment, the responsible person, and required proof of resolution.
(b) No blanket indemnity applies to disclosed or undisclosed interests. Any claim-specific indemnity must identify the exact third-party claim and negotiated procedure.
5.4 Cooperation in Approvals. The Parties shall cooperate in obtaining any court or governmental approval required for this settlement, including Medicare/Medicaid compliance documentation, if applicable.
6. DEFAULT & REMEDIES
6.1 Failure to Pay. If Released Party fails to fund the Settlement Amount within the deadline in Section 3.1(b), Claimant may:
(a) enforce specific performance of this Agreement, plus interest at [RATE]% per annum, or
(b) declare the Agreement null and void and reinstate the Action.
6.2 Breach of Confidentiality. In the event of an uncured breach of Section 5.2, the non-breaching Party may seek monetary damages or injunctive relief.
6.3 Attorney Fees & Costs. The prevailing Party in any action to enforce this Agreement shall recover reasonable attorney fees and costs.
7. RISK ALLOCATION
7.1 Claim-Specific Indemnity Only. Any indemnity must identify the exact third-party claim, indemnifying and protected persons, notice procedure, defense control, settlement authority, exclusions, and liability measure in Schedule 2. A private allocation does not alter an obligation imposed directly by governing law.
7.2 Limitation of Liability. The total liability of Released Parties in connection with the Incident shall not exceed the Settlement Amount.
7.3 Force Majeure. No Party shall be liable for delay in performance caused by events beyond its reasonable control, provided such Party gives prompt notice and resumes performance as soon as practicable.
8. DISPUTE RESOLUTION
8.1 Governing Law. This Agreement is governed by the substantive laws of the State of North Dakota, without regard to conflict-of-laws principles.
8.2 Forum Selection. Any dispute arising under this Agreement shall be resolved exclusively in the District Court of [COUNTY], State of North Dakota.
8.3 Arbitration & Jury Trial. The Parties hereby acknowledge that arbitration and jury-trial waiver provisions are not applicable under the metadata instructions.
9. GENERAL PROVISIONS
9.1 Entire Agreement. This Agreement constitutes the entire agreement between the Parties and supersedes all prior negotiations and agreements concerning the subject matter hereof.
9.2 Amendment; Waiver. No amendment or waiver is effective unless in writing and signed by all Parties. Waiver of any breach does not constitute waiver of any other or subsequent breach.
9.3 Assignment. No Party may assign its rights or delegate its duties without the prior written consent of all other Parties, except that Released Party may assign obligations to a qualified assignment company for purposes of a Structured Settlement.
9.4 Severability. If any provision is held invalid or unenforceable, the remaining provisions remain in full force, and the invalid provision shall be reformed to the minimum extent necessary to render it valid.
9.5 Successors & Assigns. This Agreement binds and inures to the benefit of the Parties and their respective heirs, executors, administrators, successors, and permitted assigns.
9.6 Counterparts; Electronic Signatures. This Agreement may be executed in any number of counterparts, each of which is deemed an original, and all of which together constitute one instrument. Signatures delivered by electronic means shall be deemed original and binding.
10. EXECUTION BLOCK
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.
| CLAIMANT | RELEASED PARTY |
|---|---|
| Signature: _____________________ | Signature: _____________________ |
| Name: [CLAIMANT NAME] | Name: [AUTHORIZED SIGNATORY] |
| Date: ________________________ | Title: _________________________ |
| Date: ______________________ |
[If Minor:]
Signature of Parent/Guardian: ________________________
Name: ___________________________
Date: ___________________________
11. SCHEDULE 1 – PAYMENT TERMS
Choose one of the following options (delete non-applicable):
-
Lump-Sum Payment:
Amount: US$ ☐
Payment Method: [Wire transfer / Certified check] to [Trust Account Name].
Funding Date: ☐. -
Structured Settlement:
Total Present Value: US$ ☐
Payee: [CLAIMANT / MINOR NAME]
Periodic Payments:
• $[___] on [DATE] and annually thereafter for [___] years.
• $[___] lump-sum on [DATE].
Annuity Issuer: [COMPANY NAME], rated not less than A- by A.M. Best.
Qualified Assignment Company: [NAME], assuming Released Party’s payment obligation.
12. SCHEDULE 2 – LIENS & SUBROGATION INTERESTS
- Medicare Conditional Payment Amount: $[___]
- Medicaid: $[___]
- Private Health Insurance: $[___]
- Hospital/Provider Liens: $[___]
- Workers’ Compensation Carrier: $[___]
- Other: $[___]
About this template
- Last updated
- August 29, 2026
- Jurisdiction
- North Dakota
- Category
- Personal Injury
Legal authority
- N.D.C.C. § 9-08-08 (early personal-injury settlements are voidable in specified circumstances)
- N.D. R. Civ. P. 17(b) (representation of a minor or incompetent person)
Personal injury cases are brought by people who were hurt because of someone else's carelessness: car crashes, slip and falls, defective products, and more. Demand letters, settlement agreements, and court filings in these cases have to document the injuries, the medical treatment, the lost income, and the exact legal basis for holding the other side responsible. Well-prepared paperwork is what drives higher settlements and forces insurers to take the claim seriously.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
The statutes this template relies on are listed under Legal authority.
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