PERSONAL INJURY SETTLEMENT AGREEMENT AND MUTUAL RELEASE
(New York Jurisdiction – Comprehensive Template)
[// GUIDANCE: Remove this cover note prior to execution. All bracketed, ALL-CAPS placeholders (e.g., [PARTY A NAME]) must be completed or deleted, and optional provisions either retained or removed based on deal specifics.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
1. DOCUMENT HEADER
1.1 Title
Personal Injury Settlement Agreement and Mutual Release (the “Agreement”).
1.2 Parties
This Agreement is entered into as of [EFFECTIVE DATE] (the “Effective Date”) by and between:
(a) [PARTY A NAME], [status, e.g., “an individual residing at” / “a New York corporation”], (“Claimant”); and
(b) [PARTY B NAME], [status, e.g., “an individual” / “ABC Insurance Company, a New York licensed insurer”], (“Released Party”).
Collectively, the Claimant and the Released Party are the “Parties” and each a “Party.”
1.3 Recitals
A. A [describe incident] occurred on or about [DATE] at/near [LOCATION] (the “Incident”).
B. Claimant alleges personal injuries and other damages arising from the Incident (the “Claims”).
C. Released Party denies liability but desires to compromise and settle all Claims.
D. The Parties enter into this Agreement for adequate and sufficient consideration, intending to be legally bound.
2. DEFINITIONS
Capitalized terms have the meanings assigned below and apply equally to singular and plural forms.
“Agreement” – this Personal Injury Settlement Agreement and Mutual Release, including all exhibits and schedules.
“Claims” – any and all past, present, or future claims, demands, causes of action, damages, costs, expenses, liens, and liabilities of any kind arising from or relating to the Incident.
“Confidential Information” – the terms of this Agreement and any non-public medical, financial, or personal data exchanged in connection herewith.
“Effective Date” – the date set forth in Section 1.2.
“Minor” – an individual who has not reached the age of majority under New York law.
“Parties / Party” – as defined in Section 1.2.
“Settlement Amount” – the consideration described in Section 3.1.
“Structured Settlement” – a series of future periodic payments described in Section 3.2, if elected.
3. OPERATIVE PROVISIONS
3.1 Settlement Payment
3.1.1 Payment Obligation. Released Party shall pay Claimant the total sum of [US $__] (the “Settlement Amount”) within [__] business days after (i) full execution of this Agreement and (ii) receipt of all closing documents set forth in Section 3.4.
3.1.2 Manner of Payment. Payment shall be made by [wire transfer/check] payable to [PAYEE] pursuant to the wire instructions attached hereto as Exhibit A.
3.2 Optional Structured Settlement
[OPTIONAL – Delete if lump-sum only]
3.2.1 Election. In lieu of, or in addition to, a lump-sum, Claimant may elect a structured settlement providing periodic payments that comply with New York’s structured settlement transfer laws.
3.2.2 Qualified Assignment & Annuity. If elected, Released Party shall purchase a qualified assignment and corresponding annuity contract from [ANNUITY PROVIDER] in strict compliance with applicable federal tax rules and New York General Obligations Law governing structured settlements.
[// GUIDANCE: Verify insurer’s solvency ratings; include schedule of payments as Exhibit B.]
3.3 Liens and Subrogation Interests
Claimant represents that all medical, workers’ compensation, Medicare/Medicaid, and other liens arising from the Incident have been or will be satisfied from the Settlement Amount, and Claimant agrees to defend, indemnify, and hold harmless Released Party from any unsatisfied lien claims.
3.4 Conditions Precedent
The following are conditions precedent to Released Party’s payment obligation:
(a) Return of fully executed originals of this Agreement;
(b) Execution of the Medicare affidavit attached as Exhibit C;
(c) Court approval of the settlement if required under Section 5.1 (Minor or Incompetent Claimant); and
(d) Such additional documentation reasonably requested by Released Party to effectuate the settlement.
3.5 Dismissal of Pending Action
Within three (3) business days following receipt of the Settlement Amount (or initial structured payment), Claimant shall file a stipulation of discontinuance with prejudice in [COURT & INDEX NO.] and provide proof thereof to Released Party.
4. REPRESENTATIONS & WARRANTIES
Each Party represents and warrants to the other that:
4.1 Authority. It has full power and authority to enter into and perform this Agreement;
4.2 No Assignment of Claims. It has not assigned or transferred, or purported to assign or transfer, to any third party any Claim or right released herein;
4.3 Independent Counsel. It has been advised and afforded the opportunity to seek independent legal counsel and has either done so or voluntarily chosen not to;
4.4 No Reliance. It is not relying on any statement or representation by the other Party or any other person regarding the merits or value of the Claims, except as expressly set forth herein.
All representations and warranties survive the Effective Date.
5. COVENANTS & RESTRICTIONS
5.1 Minor or Incompetent Claimant
[OPTIONAL – include if applicable]
If Claimant is a Minor or lacks legal capacity, this Agreement is conditioned upon, and shall not become effective until, approval by the Supreme Court of the State of New York or other court of competent jurisdiction pursuant to applicable rules governing compromises involving minors or incapacitated persons.
[// GUIDANCE: Counsel must prepare and file an infant compromise petition and obtain an order approving attorney fees, disbursements, and allocation of proceeds.]
5.2 Non-Disparagement
Each Party agrees not to make any public statement reasonably expected to disparage or harm the reputation of the other regarding the Incident or this settlement.
5.3 Confidentiality
Except as may be required by law or court order, the Parties shall keep Confidential Information strictly confidential.
5.4 Cooperation
The Parties shall execute such further instruments and take such further actions as may be reasonably necessary to effectuate the purposes of this Agreement.
6. DEFAULT & REMEDIES
6.1 Event of Default. Failure by a Party to perform any material obligation under this Agreement within five (5) business days after written notice and opportunity to cure constitutes an Event of Default.
6.2 Remedies. Upon an Event of Default, the non-defaulting Party may (a) seek specific performance; (b) rescind the Agreement; and/or (c) pursue any other remedy available at law or in equity, including reasonable attorneys’ fees and costs.
6.3 Limitation. Notwithstanding the foregoing, Claimant’s exclusive monetary remedy for any breach by Released Party shall not exceed the unpaid portion of the Settlement Amount.
7. RISK ALLOCATION
7.1 Mutual Release
7.1.1 Scope. Effective upon satisfaction of Section 3.4, Claimant, on behalf of himself/herself and all Releasing Parties (defined below), fully and forever releases and discharges Released Party and its insurers, reinsurers, affiliates, officers, directors, employees, agents, successors, and assigns (collectively, the “Released Parties”), from the Claims.
7.1.2 Releasing Parties. “Releasing Parties” means Claimant, Claimant’s heirs, executors, administrators, personal representatives, agents, successors, and assigns.
7.1.3 Unknown Claims. Claimant expressly waives any and all rights under any statute or common-law principle that might otherwise limit the scope of this Release to known or suspected Claims.
7.1.4 Reciprocal Release. Released Party releases Claimant and Releasing Parties from any claims arising out of the Incident, excluding obligations under this Agreement.
[// GUIDANCE: The breadth of release must comply with New York public policy; overly broad releases of future negligence are unenforceable.]
7.2 No Admission of Liability
This Agreement is a compromise of disputed claims and does not constitute an admission of liability by any Party.
7.3 Taxes
Claimant is solely responsible for any federal, state, or local taxes, penalties, or interest associated with the Settlement Amount, other than amounts allocable to Released Party’s own income.
7.4 Force Majeure
Neither Party shall be liable for delays or failure in performance resulting from acts beyond its reasonable control, including natural disasters, war, or governmental action, provided that the affected Party provides prompt notice and resumes performance when the impediment is removed.
8. DISPUTE RESOLUTION
8.1 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of New York, including its substantive tort law, without regard to its conflict-of-laws principles.
8.2 Forum Selection. Any action arising out of or relating to this Agreement shall be brought exclusively in the Supreme Court of the State of New York, [COUNTY] County, or, if jurisdictionally available, the Civil Court of the City of New York, [COUNTY] County.
8.3 No Arbitration. The Parties expressly agree that binding arbitration shall not apply.
8.4 Jury Trial. Each Party acknowledges that New York law preserves the constitutional right to a jury trial; no jury waiver is included or intended.
9. GENERAL PROVISIONS
9.1 Amendment and Waiver. This Agreement may be amended only by a writing signed by all Parties. No waiver of any provision shall be effective unless in writing and signed by the waiving Party.
9.2 Assignment. No Party may assign its rights or delegate its duties hereunder without the prior written consent of the other Party, except that Released Party may assign its obligation to a structured-settlement assignment company in accordance with Section 3.2.
9.3 Successors and Assigns. This Agreement is binding upon and inures to the benefit of the Parties and their respective successors and permitted assigns.
9.4 Severability. If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect, and the invalid provision shall be reformed to the minimum extent necessary to render it enforceable.
9.5 Integration. This Agreement contains the entire understanding of the Parties regarding its subject matter, superseding all prior negotiations or agreements, whether oral or written.
9.6 Counterparts; Electronic Signatures. This Agreement may be executed in one or more counterparts, each of which is deemed an original, but all of which together constitute one instrument. Signatures transmitted electronically (e.g., via PDF or verified e-signature platform) shall be deemed original.
9.7 Headings. Section headings are for convenience only and do not affect interpretation.
9.8 Costs and Fees. Except as otherwise provided herein, each Party shall bear its own attorneys’ fees and costs.
10. EXECUTION BLOCK
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.
CLAIMANT
[PARTY A NAME]
Signature: _____
Name: _____
Date: _______
[OPTIONAL – Notary Block, if required for minor or structured settlements]
State of New York )
County of ___ ) ss.:
On the _ day of _, 20__, before me, the undersigned, personally appeared ______, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same.
Notary Public
RELEASED PARTY
[PARTY B NAME]
By: _____
Name: _____
Title: _____
Date: _______
[CORPORATE ACKNOWLEDGMENT, if applicable]
Exhibits (List)
Exhibit A – Wire Instructions
Exhibit B – Structured Settlement Payment Schedule [if elected]
Exhibit C – Medicare/Medicaid Affidavit
[// GUIDANCE: For minor settlements, attach proposed Infant Compromise Order and allocate fees/expenses per court rules. For structured settlements, annex insurance carrier disclosures required under NY Insurance Law.]