PERSONAL INJURY SETTLEMENT AGREEMENT
(State of Oklahoma)
[// GUIDANCE: Delete all bracketed guidance comments and complete every placeholder prior to client signature.]
TABLE OF CONTENTS
- Definitions
- Settlement Consideration
2.1 Lump-Sum Payment
2.2 Structured Settlement (Optional)
2.3 Minor Settlement Approval (If Applicable) - Mutual Release and Covenant Not to Sue
- Dismissal of Action and Satisfaction of Judgment (If Any)
- Representations, Warranties, and Acknowledgements
- Liens, Subrogation, and Governmental Reimbursement Obligations
- Tax Treatment and IRS Code Compliance
- No Admission of Liability
- Confidentiality (Optional)
- Governing Law and Forum Selection
- Fees, Costs, and Enforcement
- Miscellaneous Provisions
- Execution; Notary and Court Approval
PERSONAL INJURY SETTLEMENT AGREEMENT
(“Agreement”)
This Agreement is entered into and made effective as of [EFFECTIVE DATE] (the “Effective Date”) by and between:
A. Claimant / Plaintiff: [FULL LEGAL NAME],
[check one] ☐ an individual of legal majority ☐ a minor acting through [PARENT/GUARDIAN AD LITEM NAME] (collectively, “Claimant”)
B. Defendant(s): [DEFENDANT LEGAL NAME], together with its past, present, and future parents, subsidiaries, affiliates, insurers, reinsurers, officers, directors, shareholders, agents, employees, predecessors, successors, and assigns (collectively, “Defendant”)
Each a “Party” and, collectively, the “Parties.”
RECITALS
A. An incident occurred on or about [DATE OF INCIDENT] in [CITY/COUNTY], Oklahoma (the “Incident”), allegedly causing Claimant personal injuries and damages (the “Action”).
B. The Parties desire to resolve fully and finally any and all claims arising out of or related to the Incident, without admission of liability, in accordance with Oklahoma law, including all rules governing releases, structured settlements, and (if applicable) judicial approval of minor settlements.
NOW, THEREFORE, for good and valuable consideration, the sufficiency and receipt of which are hereby acknowledged, the Parties agree as follows:
1. DEFINITIONS
For purposes of this Agreement, the following terms have the meanings set forth below:
“Action” means any past, present, or future suit, claim, demand, arbitration, or administrative proceeding arising out of or relating to the Incident.
“Claims” means all claims, causes of action, demands, debts, damages (including punitive), losses, liens, rights, and liabilities of every kind, whether known or unknown, suspected or unsuspected, accrued or unaccrued, contingent or absolute, in law, equity, or admiralty.
“Court” means the District Court of [COUNTY NAME] County, Oklahoma, unless otherwise ordered.
“Minor” means a natural person who has not yet reached the age of majority under Oklahoma law.
“Net Settlement Proceeds” means the Settlement Amount minus approved attorney fees, litigation expenses, medical liens, and other deductions authorized by the Court (if required).
“Released Parties” means Defendant and each of the affiliated persons and entities described in the Parties section above.
“Settlement Amount” means the total consideration described in Section 2 below.
2. SETTLEMENT CONSIDERATION
2.1 Lump-Sum Payment.
(a) Amount. Defendant shall pay Claimant the gross sum of $[AMOUNT.00] (the “Cash Payment”) within [__] calendar days after (i) execution of this Agreement by all Parties, (ii) receipt of a completed Form W-9 from Claimant’s counsel, and (iii) entry of any required court approval order.
(b) Delivery. Payment shall be made by certified check or wire transfer to the trust account of [LAW FIRM NAME, IOLTA INFORMATION] unless otherwise agreed in writing.
[// GUIDANCE: If the settlement is solely a lump-sum payment, delete Section 2.2.]
2.2 Structured Settlement (Optional).
(a) Election. If the Parties elect a structured settlement, Defendant (or its insurer) shall fund an annuity that provides periodic payments to Claimant in accordance with Exhibit A (the “Periodic Payments”).
(b) Qualified Assignment. The Parties intend any structured component to qualify under Internal Revenue Code §§ 104(a)(2) and 130. Defendant may assign its payment obligations to a qualified assignment company, and Claimant shall execute all documents reasonably requested to accomplish such assignment.
(c) Compliance with Oklahoma Structured Settlement Protection Act. No sale, assignment, or encumbrance of the Periodic Payments shall be valid unless approved by an Oklahoma court of competent jurisdiction in full compliance with the state’s Structured Settlement Protection Act.
2.3 Minor Settlement Approval (If Applicable).
(a) Court Petition. Because Claimant is a Minor, the Parties shall petition the Court for approval pursuant to Oklahoma law before disbursement of any Settlement Amount.
(b) Bond / Restricted Account. Net Settlement Proceeds shall be deposited into a federally insured, restricted bank account or U.S. Treasury obligations in the name of Claimant, to be withdrawn only upon Court order or upon Claimant reaching the age of majority, unless the Court orders another arrangement (e.g., structured settlement).
(c) Guardian ad Litem Fees. All guardian ad litem fees approved by the Court shall be paid from the Settlement Amount unless otherwise ordered.
3. MUTUAL RELEASE AND COVENANT NOT TO SUE
3.1 Release by Claimant. Upon payment of the Settlement Amount, Claimant irrevocably and unconditionally releases and forever discharges the Released Parties from any and all Claims arising out of or relating to the Incident.
3.2 Release by Defendant. Upon execution of this Agreement, Defendant releases Claimant from any and all Claims it now has or may have arising out of or relating to the Incident.
3.3 Covenant Not to Sue. Each Party covenants and agrees not to commence, prosecute, or maintain any action or proceeding based upon any Claim released herein.
3.4 Oklahoma Release Requirements. The Parties acknowledge that this mutual release is supported by adequate consideration, has been knowingly and voluntarily entered, and is intended to be valid, binding, and enforceable under Oklahoma law governing releases of tort claims.
4. DISMISSAL OF ACTION AND SATISFACTION OF JUDGMENT
Within five (5) business days after receipt of the Cash Payment (and Court approval, if required), Claimant shall file a dismissal with prejudice of the Action, or a satisfaction of judgment if applicable, in the Court. Each Party shall bear its own filing costs unless otherwise stated.
5. REPRESENTATIONS, WARRANTIES, AND ACKNOWLEDGEMENTS
5.1 Authority and Capacity. Each Party represents that it has full authority and legal capacity to enter into and perform this Agreement.
5.2 No Assignment of Claims. Each Party warrants that it has not assigned or transferred any Claim released herein.
5.3 Independent Counsel. Each Party represents that it has consulted, or had the opportunity to consult, independent legal counsel and enters this Agreement voluntarily.
5.4 Understanding of Terms. Each signatory acknowledges that he or she has read and understands all terms and that the Agreement is not subject to rescission except as expressly provided herein.
6. LIENS, SUBROGATION, AND GOVERNMENTAL REIMBURSEMENT OBLIGATIONS
6.1 Responsibility for Liens. Claimant is solely responsible for satisfaction of all medical, insurance, governmental, or other liens arising out of the Incident.
6.2 Indemnity for Unsatisfied Liens. Claimant shall indemnify and hold harmless the Released Parties against any lien or subrogation claim asserted after the Effective Date that arises from the Incident, except to the extent caused by Defendant’s failure to pay the Settlement Amount.
6.3 Medicare/Medicaid Compliance. Claimant affirms compliance with the Medicare Secondary Payer Act and any applicable Medicaid recovery statutes.
7. TAX TREATMENT AND IRS CODE COMPLIANCE
7.1 No Warranties. Defendant makes no representations regarding the taxability or non-taxability of the Settlement Amount. Claimant has relied solely on his or her own tax advisors.
7.2 Structured Settlement Qualification. To the extent Section 2.2 applies, the Parties intend that payments qualify for exclusion from gross income under IRC § 104(a)(2). The qualified assignment shall be treated in accordance with IRC § 130.
8. NO ADMISSION OF LIABILITY
This Agreement is a compromise of disputed claims. Neither execution of this Agreement nor performance of any obligation hereunder shall be construed as an admission of liability or wrongdoing by any Party.
9. CONFIDENTIALITY (Optional)
9.1 Scope. Except as required by law or court order, the Parties shall keep the terms of this Agreement confidential.
9.2 Permitted Disclosures. Disclosure is permitted to (i) tax, legal, or financial advisors; (ii) governmental authorities; and (iii) immediate family members, provided each recipient agrees to be bound by this confidentiality provision.
[// GUIDANCE: Delete Section 9 entirely if confidentiality is not a negotiated term.]
10. GOVERNING LAW AND FORUM SELECTION
10.1 Governing Law. This Agreement shall be governed by and construed in accordance with the substantive tort and contract laws of the State of Oklahoma, without regard to its conflict-of-laws rules.
10.2 Exclusive Venue. Any claim or proceeding arising out of or relating to this Agreement shall be filed exclusively in the state courts of [COUNTY NAME] County, Oklahoma, and the Parties irrevocably submit to that jurisdiction.
[// GUIDANCE: Arbitration and jury waiver are intentionally omitted per user instructions.]
11. FEES, COSTS, AND ENFORCEMENT
11.1 Attorney Fees. In any action to enforce this Agreement, the prevailing Party shall be entitled to recover reasonable attorney fees and costs.
11.2 Specific Performance. Each Party acknowledges that monetary damages may be inadequate to remedy a breach and agrees that the other Party may seek specific performance or injunctive relief, in addition to any other remedy.
12. MISCELLANEOUS PROVISIONS
12.1 Amendments and Waivers. No amendment or waiver of any provision shall be effective unless in writing and signed by all Parties.
12.2 Severability. If any provision is held invalid, the remaining provisions shall remain in full force and effect and shall be construed to fulfill the original intent.
12.3 Assignment. No Party may assign its rights or obligations without prior written consent of the other Parties, except that Defendant may assign obligations under Section 2.2 to a qualified assignment company.
12.4 Successors and Assigns. This Agreement shall bind and benefit the Parties and their respective successors and permitted assigns.
12.5 Entire Agreement. This Agreement constitutes the entire agreement among the Parties regarding its subject matter and supersedes all prior negotiations and writings.
12.6 Counterparts; Electronic Signatures. This Agreement may be executed in counterparts (including PDF or electronically signed counterparts), each of which shall be deemed an original, and all of which together constitute one instrument.
13. EXECUTION; NOTARY AND COURT APPROVAL
13.1 Signatures. The Parties have executed this Agreement as of the Effective Date.
13.2 Notarization. [Check one] ☐ Required ☐ Waived by mutual agreement.
13.3 Court Approval for Minor or Structured Settlement. If Section 2.2 or 2.3 applies, this Agreement shall become effective only upon entry of a final, non-appealable order approving the settlement.
SIGNATURES
CLAIMANT / PLAINTIFF
[PRINT NAME]
Date: ______
[If Minor]
PARENT / GUARDIAN AD LITEM
[PRINT NAME & CAPACITY]
Date: ______
ATTORNEY FOR CLAIMANT
[ATTORNEY NAME], OBA # __
Date: ____
DEFENDANT
Authorized Signatory
Title: ____
Date: ______
ATTORNEY FOR DEFENDANT
[ATTORNEY NAME], OBA # __
Date: ____
[// GUIDANCE: Attach notary acknowledgements and any required exhibits (e.g., Exhibit A – Periodic Payment Schedule) immediately following this page.]
[// GUIDANCE:
1. Review Oklahoma Title 12 procedural requirements for minor settlements and structured settlements; attach any mandated petitions or proposed orders.
2. Confirm Medicare compliance and lien resolution before disbursement.
3. Retain executed originals in accordance with Oklahoma Rules of Professional Conduct and court record-keeping requirements.]