Personal Injury Settlement Agreement - Ohio

PERSONAL INJURY SETTLEMENT AGREEMENT AND NEGOTIATED RELEASE

1. Parties and Matter

This Agreement is made on [__/__/____] between:

Claimant: [________________________________]

Paying party: [________________________________]

Additional released party, if any: [________________________________]

The dispute arises from the incident described below. Liability is disputed unless expressly stated otherwise.

2. Scope Gate

Stop and use a counsel-approved addendum or different form if the matter involves:

☐ a minor or incapacitated person;

☐ an estate, survival, or wrongful-death claim;

☐ a class, aggregate, or multiple-claimant settlement;

☐ workers' compensation or an employment benefit;

☐ bankruptcy;

☐ Medicare, Medicaid, public benefits, or another reimbursement interest;

☐ a governmental claimant or defendant;

☐ structured or periodic payments;

☐ an assignment or transfer of payment rights; or

☐ required court, agency, fiduciary, or insurer approval.

Counsel conclusion: [________________________________]

3. Settlement Consideration

The paying party will pay $[____________] according to the completed funding schedule.

No deadline, interest, fee, penalty, or remedy applies unless it is written below and approved by counsel.

Negotiated late-funding term, if any: [________________________________]

4. Released Parties and Claims

Only the persons and entities listed below are released.

Upon confirmed receipt of the agreed consideration and satisfaction of any completed approval condition, Claimant releases the listed released parties from the claims identified below arising from the incident.

Claims released: [________________________________]

Claims, parties, property, benefits, or rights expressly reserved: [________________________________]

This Agreement does not release a person or claim that is not identified with sufficient specificity in the completed schedules.

5. Approval, Funding, and Dismissal Sequence

☐ No special approval has been identified after counsel review.

☐ Approval is required. Complete below.

If a lawsuit is pending, the dismissal document will be delivered or filed only after: [confirmed funding / escrow confirmation / other trigger: ________________________________].

6. Liens, Reimbursement, Fees, and Holdbacks

Person responsible for resolution: [________________________________]

Holdback and disbursement instructions: [________________________________]

No party assumes another party's lien, reimbursement, tax, or fee obligation except as expressly written and approved here: [________________________________].

7. Factual Representations

Each signing party represents only that:

• the signer has read the completed Agreement and schedules;
• the signer has authority to sign for the named party;
• the signer has had the opportunity to obtain legal and tax advice;
• no promise outside the completed written Agreement induced the signature; and
• the signer understands the identified released and reserved claims.

Additional negotiated representation: [________________________________]

8. Confidentiality and Communications

☐ No confidentiality term.

☐ Confidentiality term attached as Schedule [____] after counsel review.

Permitted disclosures and required exceptions: [________________________________]

Agreed public statement, if any: [________________________________]

No nondisparagement, secrecy, liquidated-damages, injunction, or fee term applies unless separately written and approved.

9. Enforcement and General Terms

10. Signatures

Counsel Approval

Claimant's counsel: [________________________________] · Date: [__/__/____]

Paying party's counsel: [________________________________] · Date: [__/__/____]

Schedule A — Released Parties and Claims

[________________________________]

Schedule B — Funding, Liens, Holdbacks, and Disbursement

[________________________________]

Schedule C — Approval or Special Process

[________________________________]