Personal Injury Settlement Agreement - New Jersey

PERSONAL INJURY SETTLEMENT AND RELEASE AGREEMENT

(New Jersey – Court-Ready Template)

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

PERSONAL INJURY SETTLEMENT AND MUTUAL RELEASE AGREEMENT
This Personal Injury Settlement and Mutual Release Agreement (this “Agreement”) is made and entered into as of [EFFECTIVE DATE] (the “Effective Date”) by and between:

• [FULL LEGAL NAME OF INJURED PARTY], [individual | minor | incapacitated person], residing at [ADDRESS] (“Releasor”); and
• [FULL LEGAL NAME OF DEFENDANT(S)/INSURER(S)], a [state] [entity type], with principal offices at [ADDRESS] (“Releasee,” and together with its past, present, and future parents, subsidiaries, affiliates, officers, directors, shareholders, employees, agents, insurers, heirs, successors, and assigns, collectively, the “Released Parties”).

Recitals

A. On or about [INCIDENT DATE], Releasor allegedly sustained personal injuries and other damages arising out of [BRIEF DESCRIPTION OF ACCIDENT/INCIDENT] (the “Incident”).
B. Disputes have arisen between the Parties regarding liability for, and the nature and extent of, Releasor’s alleged injuries and damages (the “Claims”).
C. Without admitting liability, the Parties desire to fully, finally, and forever settle the Claims on the terms set forth herein for good and valuable consideration, the sufficiency of which is hereby acknowledged.

NOW, THEREFORE, in consideration of the mutual covenants, promises, and payments set forth herein, the Parties agree as follows:

2. DEFINITIONS

For purposes of this Agreement, the following terms shall have the meanings set forth below. Defined terms appear alphabetically and apply throughout the Agreement.

“Agreement” has the meaning set forth in the preamble.
“Claims” has the meaning set forth in Recital B.
“CMS” means the Centers for Medicare & Medicaid Services.
“Court Approval” means an order issued pursuant to N.J. Ct. R. 4:44 or 4:44A approving settlement of a claim by or on behalf of a minor or incapacitated person.
“Effective Date” has the meaning set forth in the Document Header.
“Incident” has the meaning set forth in Recital A.
“Medicare Program” means Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395–1395lll.
“Parties” means, collectively, Releasor and Releasee; “Party” refers to either of them.
“Released Parties” has the meaning set forth in the Document Header.
“Settlement Amount” means the total monetary consideration described in Section 3.1.

3. OPERATIVE PROVISIONS

3.1 Settlement Consideration

a. Lump-Sum Payment. Within [NUMBER] business days after the later of (i) the Effective Date and (ii) satisfaction of all Conditions Precedent in Section 3.4, Releasee shall pay to Releasor, or to [LAW FIRM TRUST/IOLTA ACCOUNT], the sum of [US$ ________] (the “Settlement Amount”) by [wire transfer | draft].

b. Structured Settlement (if applicable). In lieu of, or in addition to, the lump-sum payment, the Parties agree to the structured settlement annuity schedule set forth on Exhibit A (the “Structured Payments”). Releasee shall irrevocably fund the annuity through a qualified assignment compliant with the Internal Revenue Code § 130 and the New Jersey Structured Settlement Protection Act, N.J. Stat. Ann. §§ 2A:xx-xx to xx-xx (the “SSPA”).

3.2 Mutual Release of Claims

a. Releasor’s Release. Upon receipt of the Settlement Amount and any Structured Payments, Releasor 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 [________________________________] (“Released Claims”).

b. Releasee’s Release. Upon the Effective Date, Releasee, on behalf of itself and the other Released Parties, releases and forever discharges Releasor from any and all claims arising out of or relating to the Incident or the Claims, excluding enforcement of this Agreement.

c. Unknown Claims. No generic statutory or common-law 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 is a compromise of disputed claims and shall not be construed as an admission of liability, fault, or wrongdoing by any Party, which is expressly denied.

3.4 Conditions Precedent

The following are conditions precedent to Releasee’s payment obligations:

1. Receipt of a fully executed Agreement.
2. If Releasor is a minor or incapacitated person, entry of a Court Approval order.
3. Delivery to Releasee of a properly executed Stipulation of Dismissal with Prejudice for filing in [COURT NAME, DOCKET NO.].
4. Completion of Medicare/Medicaid lien resolution in accordance with Section 5.3.

3.5 Dismissal of Litigation

Within [NUMBER] business days after Releasee fulfills Section 3.1, the Parties shall file the Stipulation of Dismissal with Prejudice in the action identified above, each party to bear its own costs.

4. REPRESENTATIONS & WARRANTIES

Each Party represents and warrants, as applicable, that:

4.1 Authority. It has full power and authority to enter into and perform this Agreement and to grant the releases provided herein.

4.2 No Assignment. No claims released herein have been sold, assigned, subrogated, or otherwise transferred to any third party.

4.3 Legal Counsel. It has had the opportunity to consult with independent legal counsel of its choice, and enters into this Agreement voluntarily, without coercion or duress.

4.4 Accuracy of Information. All information provided in connection with lien resolution, medical expenses, and damages is true, complete, and accurate to the best of its knowledge.

4.5 Survival. The representations and warranties in this Section 4 shall survive the Effective Date.

5. COVENANTS & RESTRICTIONS

5.1 Confidentiality. Except as required by law or court order, the Parties shall keep the terms of this Agreement and the amount of the Settlement Amount confidential.

5.2 Non-Disparagement. The Parties shall refrain from making any statement, written or oral, that could reasonably be construed to disparage the other Party concerning the Incident or this settlement.

5.3 Medicare/Medicaid and Other Recovery Interests. Before funding, the Parties shall complete a written schedule identifying every asserted Medicare, Medicaid, medical-provider, benefit-plan, insurer, attorney, governmental, or other claim; its basis and status; any reporting, holdback, or direct payment; the responsible person; and required proof of resolution. Do not use a generic hold-harmless clause as a substitute for that completed analysis.

5.4 SSPA Non-Transfer Covenant. Releasor shall not assign, accelerate, or encumber any Structured Payments without first obtaining court approval in compliance with the SSPA.

5.5 Further Assurances. Each Party shall execute and deliver any additional documents reasonably necessary to carry out the purposes of this Agreement.

6. DEFAULT & REMEDIES

6.1 Event of Default. Failure by either Party to perform any material obligation under this Agreement within [10] business days after written notice shall constitute an “Event of Default.”

6.2 Remedies.
a. Monetary Default by Releasee. Releasor may enforce payment, plus interest at the New Jersey post-judgment rate from the due date until paid.
b. Breach of Confidentiality or Non-Disparagement. The non-breaching Party may seek damages and injunctive relief in the Superior Court of New Jersey, without the necessity of posting bond.
c. Attorney’s Fees. The prevailing Party in any action to enforce this Agreement shall be entitled to reasonable attorney’s fees and costs.

6.3 Cumulative Remedies. All rights and remedies are cumulative and non-exclusive.

7. RISK ALLOCATION

7.1 Indemnification.
a. No blanket third-party-claim or lien indemnity applies.
b. Any claim-specific indemnity must identify the exact third-party 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 Limitation of Liability. The Released Parties’ aggregate liability under this Agreement shall not exceed the Settlement Amount and any Structured Payments expressly set forth herein.

7.3 Insurance. Releasee represents that liabilities released herein are covered by policy no. [POLICY NUMBER] issued by [INSURER] and that such insurer consents to this settlement.

7.4 Force Majeure. No Party shall be liable for delay or failure in performance due to acts of God, war, terrorism, or other causes beyond its reasonable control; provided, however, that payment obligations shall not be excused.

8. DISPUTE RESOLUTION

8.1 Governing Law. This Agreement shall be governed by and construed in accordance with the internal laws of the State of New Jersey without regard to conflict-of-law principles.

8.2 Forum Selection. The Parties submit to the exclusive jurisdiction of the Superior Court of New Jersey, [COUNTY] Vicinage, and waive any objection to venue or forum non conveniens.

8.3 Arbitration. The Parties expressly agree that no arbitration provisions apply.

8.4 Jury Trial. Nothing herein constitutes a waiver of any constitutional right to trial by jury.

9. GENERAL PROVISIONS

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

9.2 Amendments and Waivers. No amendment or waiver of any provision shall be effective unless in writing and signed by all Parties.

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 to successors by merger or operation of law.

9.4 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 render it valid.

9.5 Successors and Assigns. This Agreement binds and benefits 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 constitute one instrument. Signatures transmitted by facsimile or electronic means (e.g., PDF, DocuSign) shall be deemed originals.

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

10. EXECUTION BLOCK

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

RELEASOR

_________________________________________
[NAME]
Date: ____________________

RELEASEE

_________________________________________
[AUTHORIZED SIGNATORY NAME]
[Title], [Entity Name]
Date: ____________________

NOTARIZATION (if required)

State of New Jersey
County of [___]

On this ____ day of __________, 20__, before me, the undersigned Notary Public, personally appeared [NAME], satisfactorily proven to be the person whose name is subscribed to this instrument, and acknowledged that he/she executed the same for the purposes therein contained.

__________________________________
Notary Public
My Commission Expires: ____________

EXHIBIT A – STRUCTURED PAYMENT SCHEDULE