Personal Injury Settlement Agreement - Nevada

PERSONAL INJURY SETTLEMENT AGREEMENT

Nevada Scope, Approval, Funding, and Release Form

1. Settlement Classification

This form settles only the parties, claims, and interests expressly identified.
Do not use “all affiliates,” “all insurers,” “all providers,” “all lienholders,”
or similar categories unless each included person's release authority and
intended benefit are confirmed.

2. Approval and Capacity Gate

2.1 Adult claimant acting personally

☐ Identity and age confirmed

☐ Capacity concern: ☐ none identified ☐ separate legal review required

☐ Bankruptcy, guardianship, conservatorship, probate, public-benefit, or other
authority issue checked

2.2 Unemancipated minor

If the claimant is an unemancipated minor with a disputed claim for money
against a third person, NRS 41.200 controls the compromise route. The statute
identifies who may compromise, makes the compromise ineffective until district-
court approval, specifies venue and a verified written petition, requires the
listed facts and allocation information, and requires relevant medical and
health-care records for a personal-injury claim.

NRS 41.200 directs the court's proceeds route. After the specified deductions,
net proceeds over $2,500 ordinarily require the blocked financial investment
described in the statute, proof within 30 days, and the statute's reporting
rules; net proceeds of $2,500 or less follow subsection 5(b) and the court's
conditions. Insert the current court-approved terms rather than paraphrasing
them into a private payment direction.

2.3 Adult with a guardian or other representative

NRS 41.200 is not a generic approval statute for every incapacitated adult.
Identify the representative's actual appointment, powers, required notices,
court approval, bond, restricted account, and order under the governing law:

[REPRESENTATIVE / CASE / ORDER / AUTHORITY / REQUIRED APPROVAL]

No release becomes operative for that claimant until the separately identified
route is complete.

3. Parties, Claims, and Consideration

This Personal Injury Settlement Agreement (the “Agreement”) is entered into as
of [DATE] by:

• [CLAIMANT NAME AND CAPACITY] (“Claimant”); and
• [RESPONDING PARTY NAME AND CAPACITY] (“Responding Party”).

3.1 Dispute

The disputed claim concerns [DEFINED INCIDENT AND INJURIES]. Liability,
causation, damages, defenses, and the validity or amount of third-party
interests remain disputed except as expressly stated.

3.2 Settlement consideration

The total settlement consideration is $[AMOUNT], funded as follows:

The allocation schedule identifies fees, costs, lien or reimbursement
holdbacks, approved direct payments, claimant net proceeds, and any court-
controlled funds. A W-9, tax form, benefit-status information, or lien document
is a funding condition only if specifically listed with the responsible person
and deadline.

3.3 No admission

Payment resolves a disputed matter and is not an admission of liability,
wrongdoing, medical causation, damages, insurance coverage, lien validity, or
the truth of a pleading.

4. Release and Reservation Schedule

4.1 Released parties

The Claimant releases only the following persons and entities:

4.2 Released claims

Subject to payment and every approval condition, Claimant releases the
following claims arising from [DEFINED INCIDENT, DATE RANGE, AND SUBJECT]:

[PRECISELY DESCRIBE RELEASED CLAIMS]

☐ Known injuries only

☐ Known and unknown consequences of the defined incident, after counsel and
Claimant specifically reviewed the breadth

☐ Claims pleaded in the identified action

☐ Other: [________________________________]

Do not state that Nevada supplies a generic statutory waiver of unknown claims.
The intended breadth must appear in the agreement itself and must not silently
release a different incident, policy claim, bad-faith claim, property claim,
benefit claim, spouse or family claim, contribution claim, or nonparty right.

4.3 Reserved claims and rights

The following are not released:

• enforcement of this Agreement after a funding breach;
• claims against persons not listed as released parties;
• claims and interests listed here: [________________________________];
• rights that cannot lawfully be released; and
• obligations expressly continuing under the allocation, lien, court-order,
  or structured-payment schedules.

4.4 Other releasing persons

A spouse, parent, guardian, estate representative, bankruptcy trustee, insurer,
benefit plan, provider, governmental program, or attorney releases a claim only
through its own identified authority and signature or legally effective
resolution. Claimant does not warrant away another person's independent claim
merely by using a broad definition.

5. Hospital Liens and Other Recovery Interests

5.1 Nevada hospital-lien screen

NRS 108.590 can give a hospital a lien on a qualifying injury recovery for the
reasonable value of hospitalization before settlement. NRS 108.600 excludes
post-settlement hospitalization and necessary claimant attorney fees, costs,
and expenses from the statutory lien. NRS 108.605 and 108.610 contain fact-
specific notice, collection, recording, and service rules. After notice of a
perfected lien, NRS 108.650 can expose a person or insurer that pays without
the required hospital payment and directs separate payment in the circumstances
stated there.

Do not treat every medical bill as a perfected Nevada hospital lien, and do not
treat the absence of a recorded hospital lien as resolving federal, Medicaid,
benefit-plan, contractual, attorney, judgment, child-support, or other claims.

5.2 Other interests

5.3 Allocation of responsibility

Choose one counsel-approved approach for each identified interest:

☐ direct payment at closing

☐ escrow or trust holdback under written instructions

☐ final demand and negotiated satisfaction before claimant distribution

☐ claimant responsibility with a claim-specific representation and remedy

☐ disputed interest reserved for separate determination

No blanket claimant indemnity is included. Any indemnity must identify the
particular interest, notice, defense control, settlement authority, exclusions,
cap if lawful, duration, and interaction with escrow and actual payment.

6. Structured Payment Option

If periodic payments are selected, attach the complete payment schedule,
qualified-assignment documents if used, obligor, assignee, annuity issuer,
beneficiary terms, guaranteed and life-contingent portions, ownership, notices,
fees, tax review, and court approval.

NRS 42.275 defines a structured settlement as periodic payment of personal-
injury or sickness damages established by settlement or judgment. Nevada's
NRS 42.200-.400 transfer regime addresses a later sale, assignment, pledge, or
other transfer of structured-settlement payment rights. Under NRS 42.385, such
a transfer is ineffective without advance approval in a final court order and
the required findings. That later-transfer regime is not a substitute for
negotiating and documenting the initial periodic-payment settlement.

This Agreement does not pre-authorize a future transfer, promise that it will
be approved, or require the payee to sign future transfer papers.

7. Funding, Approval, and Dismissal Sequence

Select whether a signed dismissal is tendered into escrow before funding or
signed and filed after confirmed funding. Do not require dismissal first while
making payment depend on the dismissal unless the escrow instructions resolve
the circularity.

8. Confidentiality and Communications

☐ No confidentiality term

☐ Confidentiality limited to: [TERMS / AMOUNT / NONPUBLIC MATERIAL]

Permitted disclosures: [COURT / GOVERNMENT / TAX / LEGAL / FINANCIAL /
INSURER / BENEFIT / IMMEDIATE FAMILY / MEDICAL / ENFORCEMENT / OTHER]

No confidentiality term restricts truthful required disclosures, legal process,
regulatory or benefit reporting, insurer or tax administration, court approval,
enforcement, protected activity, or disclosures a court order makes public.

If the claim is brought under NRS 41.031 or against a present or former Nevada
state or political-subdivision officer or employee, immune contractor, or
State Legislator, apply NRS 41.0375. It bars confidentiality of settlement
terms, requires the agreement to include the attorney fees and costs paid, and
makes the agreement a public record; a conflicting provision is void.

No liquidated damages, forfeiture, clawback, injunction, or attorney-fee remedy
for a confidentiality breach is included unless separately drafted and
approved for the actual harm and governing law.

9. Breach and Enforcement

No party may “enter judgment,” obtain specific performance, recover statutory
interest, receive prevailing-party fees, or force dismissal merely because
generic text says so. Counsel must select the available procedural vehicle,
supporting authority, notice, evidence, and remedy for the actual case.

Payment duties are not excused by force majeure. This Agreement does not cap a
party's enforcement liability at the settlement amount or make the release an
exclusive remedy for a later breach.

10. General Terms

• Governing law: [NEVADA / OTHER AFTER CONFLICTS REVIEW]
• Entire agreement and incorporated documents: [LIST]
• Amendment and waiver: [TERMS]
• Assignment: [TERMS; COORDINATE WITH STRUCTURED PAYMENTS]
• Severability: [COUNSEL-APPROVED INSTRUCTION]
• Notices: [METHODS, ADDRESSES, AND WHEN EFFECTIVE]
• Counterparts and signature method: [AFFIRMATIVELY SELECT]
• Surviving terms: [LIST]

Delete any general term that conflicts with a court order, escrow instruction,
annuity or assignment document, insurer authority, lien resolution, or
incorporated schedule.

11. Signatures

Each signer represents only the authority specifically stated below.

Counsel acknowledgment, if selected

Counsel acknowledges [ONLY THE MATTERS EXPRESSLY STATED; DO NOT CREATE A
GUARANTY OR PERSONAL LIEN OBLIGATION].

No notary acknowledgment is included unless the court, a filing, a separate
instrument, or counsel requires it.

Required Attachments

1. Released-party and reserved-claim schedule
2. Settlement allocation and closing statement
3. Approval petition/order or representative-authority record, if applicable
4. Hospital-lien and other recovery-interest schedule
5. Escrow and dismissal instructions
6. Structured-payment documents, if applicable
7. Confidentiality terms, if affirmatively selected

Final Verification

☐ Every released party and claim is identifiable

☐ Independent claims and nonparty interests are not silently released

☐ Minor or representative approval route is correct and complete

☐ Hospital liens are screened under their actual notice and perfection facts

☐ Other reimbursement and recovery interests are separately resolved

☐ Initial periodic funding is distinguished from a later payment-right transfer

☐ Funding, escrow, distribution, and dismissal are sequenced without circularity

☐ Public-entity confidentiality limits were checked

☐ Enforcement remedies were selected rather than assumed

☐ All attached schedules and court orders are consistent

This form is complete only after Nevada counsel approves the final release,
closing conditions, signatures, and all incorporated attachments.