Personal Injury Settlement Agreement - New Hampshire

PERSONAL INJURY SETTLEMENT AGREEMENT AND MUTUAL RELEASE

Before you use this: Identify every person who will sign or be released. If the injured claimant is a minor, complete Section 8 and obtain any required court approval before the release takes effect.

This Agreement is made on [DATE] between:

The incident occurred on [DATE] at [LOCATION] (the “Incident”). Claimant asserts that Defendant is responsible for [SHORT DESCRIPTION OF INJURY OR LOSS]. Defendant disputes liability. The parties agree to settle the claims described below without an admission of fault.

1. Payment and funding

1.1 Defendant, or the paying insurer identified above, will pay Claimant $[AMOUNT] in total settlement consideration, as follows:

1.2 If periodic payments are included, attach Exhibit A identifying each payment, obligor, funding instrument, payee, beneficiary, and any requested court approval. No annuity, tax, assignment, or transfer result is promised by this form.

1.3 The release in Section 3 becomes effective only when the parties have performed the funding steps stated above and any required order under Section 8 has been entered. For a structured obligation, the parties shall state what completed funding means: [DETAILS / “NOT APPLICABLE”]. If a payment is late, the unpaid obligation remains enforceable under this Agreement; the parties reserve all other relief available under applicable law.

2. Persons and claims covered

2.1 Released Persons. Defendant and only these additional persons or entities are released: [NAMES AND CAPACITIES / “NONE”]. A parent company, employee, agent, insurer, attorney, or successor is included only if identified here or if that person separately signs an express release. The paying insurer is included only if expressly listed.

2.2 Claimant's claims. Subject to Section 1.3, Claimant releases the Released Persons from Claimant's own claims for injuries and losses arising from the Incident, whether presently known or later discovered. The release includes the damages and expenses Claimant could seek for those injuries and losses. It does not release an independent claim owned by a person who has not signed this Agreement in that person's own capacity.

2.3 Defendant's claims. Subject to Section 1.3, Defendant releases Claimant from claims Defendant itself owns arising from the Incident. Defendant does not purport to release a claim owned by its insurer, affiliate, employee, or any other nonsignatory.

2.4 Reserved persons. Claims against persons other than the Released Persons remain reserved. Known potential defendants whose claims remain reserved: [NAMES / “NONE IDENTIFIED”]. Under N.H. Rev. Stat. Ann. § 507:7-h, a good-faith release of one of multiple persons liable in tort for the same injury does not discharge another unless the release expressly says so; the claim against another is reduced by the consideration paid for the release. This Agreement does not decide another person's fault or liability.

2.5 Independent claimant. A spouse or other person who owns a separate derivative claim releases that claim only if named here, states the consideration for that release, and signs below in that capacity: [NAME / “NONE”]; consideration: [AMOUNT OR OTHER TERMS / “NOT APPLICABLE”].

3. Pending action and documents

3.1 Pending court or insurance matter: [COURT, CASE NUMBER, OR CLAIM NUMBER / “NONE”]. Within [NUMBER] days after Section 1.3 is satisfied, the parties will sign and submit the agreed dismissal or closure document attached as Exhibit B, if needed. No party must dismiss a pending action before the settlement consideration is funded as agreed.

3.2 Each signer confirms that the signer has authority to settle the claims that signer owns and has disclosed any known assignment of those claims: [DETAILS / “NONE”]. No signer warrants another person's capacity or authority.

4. Asserted liens and recovery interests

4.1 The parties will list known or asserted medical-provider, health-plan, workers' compensation, Medicare, Medicaid, child-support, or other recovery interests in Exhibit C. For each, record the claimant, asserted amount, documents received, dispute status, responsible person, and payoff, direct payment, or holdback instruction.

4.2 A listed interest is not admitted to be valid merely because it is disclosed. The parties will follow the written allocation in Exhibit C and applicable law. This Agreement creates no blanket indemnity for unlisted interests and does not promise a particular tax or government-recovery result.

5. Optional confidentiality and other terms

5.1 ☐ Confidentiality elected. The signers will keep the settlement amount and terms confidential, except for disclosures to counsel, tax advisors, insurers, lien claimants, a court, government authority, or anyone else required by law or needed to perform this Agreement. If this box is unchecked, this paragraph does not apply.

5.2 Additional negotiated terms, if any: [DETAILS / “NONE”]. A term that changes the identified Released Persons, funding, or minor approval must be set out clearly in a signed amendment.

6. Disputes and general provisions

6.1 New Hampshire law governs this Agreement. A party may seek enforcement in a court with jurisdiction. This form creates no automatic attorney-fee award, interest rate, liability cap, jury waiver, or arbitration requirement.

6.2 This Agreement and its completed exhibits are the entire settlement between the signers concerning the Incident. A change must be written and signed by the affected parties. If a provision is unenforceable, a court may address the remaining provisions under applicable law; no signer agrees in advance to a particular remedy.

6.3 The signers have read the Agreement, had an opportunity to consult separate counsel, and sign voluntarily. Each signer receives a completed copy with all exhibits.

7. Signatures

8. Minor-claimant approval, if applicable

If Claimant is a minor, the signing parent or next friend shall identify the minor, net amount payable while still a minor, and any amount payable after majority: [DETAILS]. Under N.H. Rev. Stat. Ann. § 464-A:42, I, superior or district court approval and certified proof of an estate guardian appointment are required if more than $10,000 net will be paid to the minor while still a minor. Under paragraph II, a court may require approval for good cause for a net amount payable after majority. An estate guardianship necessitated by that section follows N.H. Circuit Court Probate Division Rule 111, including its petition and bond review. The parties will comply with any case-specific order before the release takes effect.

Exhibits

• Exhibit A — Payment schedule and funding documents, if periodic payments are used: [ATTACHED / NOT APPLICABLE]
• Exhibit B — Agreed dismissal or claim-closure document, if needed: [ATTACHED / NOT APPLICABLE]
• Exhibit C — Asserted interests and written resolution instructions: [ATTACHED / NONE IDENTIFIED]

Sources and References

• N.H. Rev. Stat. Ann. § 507:7-h: https://gc.nh.gov/rsa/html/LII/507/507-7-h.htm
• N.H. Rev. Stat. Ann. § 464-A:42: https://gc.nh.gov/rsa/html/XLIV/464-A/464-A-42.htm
• N.H. Circuit Court Probate Division Rule 111: https://www.courts.nh.gov/rules-circuit-court-state-new-hampshire-probate-division/rule-111-guardianship-minors-necessitated