PERSONAL INJURY SETTLEMENT AGREEMENT
(State of Oregon)
[// GUIDANCE: This template is drafted for use in settling tort claims governed by Oregon state law. It incorporates Oregon-specific requirements for release enforceability, structured settlements, and minor-claimant court approval. All bracketed terms must be completed or modified before execution.]
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
Personal Injury Settlement Agreement and Mutual Release
Effective Date: [EFFECTIVE DATE]
Parties
a. Claimant / Releasor: [CLAIMANT LEGAL NAME], an individual with principal residence at [ADDRESS] (“Claimant”).
b. Defendant / Releasee: [DEFENDANT LEGAL NAME], a [ENTITY TYPE & JURISDICTION] with principal place of business at [ADDRESS] (“Defendant”).
c. Insurer (if any): [INSURER LEGAL NAME], an insurer authorized to transact insurance in Oregon (“Insurer”).
Recitals
A. Claimant alleges personal injuries arising out of an incident that occurred on or about [DATE OF INCIDENT] (the “Incident”).
B. Claimant has asserted or contemplates asserting claims against Defendant for damages arising from the Incident (collectively, the “Claims”).
C. The Parties desire to fully and finally settle all Claims upon the terms and conditions set forth herein, to avoid the uncertainty and expense of litigation.
NOW, THEREFORE, in consideration of the mutual promises herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the Parties agree as follows:
2. DEFINITIONS
For purposes of this Agreement, the following capitalized terms shall have the meanings set forth below. Defined terms appear in alphabetical order and are cross-referenced throughout the document.
“Agreement” – This Personal Injury Settlement Agreement and Mutual Release, including all exhibits and schedules.
“Claims” – All past, present, and future claims, demands, causes of action, damages, costs, expenses, liens, and liabilities of every kind, whether known or unknown, arising out of or relating to the Incident.
“Court” – Any Oregon state court of competent jurisdiction.
“Effective Date” – The date first written above, or, if court approval of a minor’s settlement is required, the date on which the Court issues an order approving the settlement, whichever is later.
“Medicare Secondary Payer Laws” – 42 U.S.C. § 1395y(b) and related regulations.
“Minor” – A person under the age of eighteen (18) years.
“Parties” – Collectively, Claimant, Defendant, and Insurer, and “Party” means any one of them.
“Releasee(s)” – Defendant, Insurer, and each of their respective past, present, and future parents, subsidiaries, affiliates, officers, directors, employees, agents, attorneys, insurers, reinsurers, successors, and assigns.
“Releasor(s)” – Claimant and Claimant’s heirs, executors, administrators, personal representatives, successors, and assigns.
“Settlement Amount” – The total consideration to be paid by or on behalf of Defendant to Claimant pursuant to Section 3.
3. OPERATIVE PROVISIONS
3.1 Settlement Payment.
a. Gross Settlement Amount. Defendant (or Insurer) shall pay the total sum of [SETTLEMENT AMOUNT IN FIGURES] U.S. Dollars ([AMOUNT IN WORDS] USD) to Claimant as full and final consideration.
b. Form of Payment.
i. Lump-Sum Payment: [YES/NO].
ii. Structured Settlement: [YES/NO]. If “YES,” payments shall be made pursuant to the schedule in Exhibit A and shall comply with the Oregon Structured Settlement Protection Act, Or. Rev. Stat. §§ 33.850 – 33.875.
[// GUIDANCE: If any portion of the Settlement Amount will be paid through a structured annuity, confirm that an Oregon court order approving the transfer is obtained before any factoring transaction.]
3.2 Payee and Delivery. Unless otherwise agreed in writing, payment shall be made by cashier’s check or ACH to [TRUST ACCOUNT / CLAIMANT], delivered to Claimant’s counsel at [ADDRESS] no later than [NUMBER] days after (i) Defendant’s receipt of an executed original of this Agreement and (ii) satisfaction of all Conditions Precedent under Section 3.4.
3.3 Tax Treatment. No Party makes any representation as to the taxability of the Settlement Amount. Claimant shall be solely responsible for any taxes, interest, or penalties arising from receipt of the Settlement Amount, except as otherwise required by law.
3.4 Conditions Precedent. Defendant’s payment obligation is conditioned upon:
a. Claimant’s execution and delivery of this Agreement and any required IRS Forms W-9 or W-8;
b. Receipt of written confirmation that all known liens (including Medicare, Medicaid, ERISA, and workers’ compensation) have been satisfied, waived, or adequately protected; and
c. If Claimant is a Minor, entry of a final, non-appealable order by the Court approving the settlement pursuant to Or. Rev. Stat. § 126.725.
3.5 Satisfaction and Release. Upon Defendant’s timely payment of the Settlement Amount, the Claims shall be deemed satisfied in full, and Claimant shall execute any additional documents reasonably requested to evidence such satisfaction.
4. REPRESENTATIONS & WARRANTIES
4.1 Mutual Representations. Each Party represents and warrants that:
a. It has full power and authority to enter into and perform this Agreement;
b. The execution of this Agreement has been duly authorized;
c. It has not assigned or transferred any interest in the Claims (or defenses thereto) that would conflict with this Agreement; and
d. It has had the opportunity to consult with independent legal counsel of its choosing.
4.2 Claimant’s Representations. Claimant further represents and warrants that:
a. Claimant is the sole owner of the Claims and has the exclusive right to settle them;
b. Claimant has not filed for bankruptcy and is not subject to any pending bankruptcy proceeding; and
c. Claimant understands that this Agreement extends to all injuries and damages, whether known or unknown, foreseen or unforeseen, that may have resulted or may in the future result from the Incident.
4.3 Survival. The representations and warranties in this Section 4 shall survive the Effective Date and remain enforceable.
5. COVENANTS & RESTRICTIONS
5.1 No Further Claims. Releasor(s) covenant not to sue Releasee(s) on any Claims.
5.2 Confidentiality. Unless disclosure is required by law or court order, the Parties shall keep the terms of this Agreement confidential. [OPTIONAL – carve-outs for tax advisors, insurers, etc.]
5.3 Non-Disparagement. Each Party agrees to refrain from making any statement reasonably expected to defame or disparage the other Party in connection with the Incident.
5.4 Medicare/Medicaid Compliance. The Parties shall cooperate to comply with all applicable Medicare Secondary Payer Laws, including any mandatory insurer reporting obligations.
6. DEFAULT & REMEDIES
6.1 Event of Default. Failure by Defendant to pay the Settlement Amount in full within the time period specified constitutes a material default.
6.2 Cure Period. Defendant shall have five (5) business days after receipt of written notice of default to cure.
6.3 Remedies. If Defendant fails to cure within the cure period:
a. Claimant may file an action in the Court to enforce this Agreement and recover the unpaid balance, plus prejudgment interest at the statutory rate, and
b. Defendant shall be liable for Claimant’s reasonable attorney fees and costs incurred in enforcing this Agreement.
7. RISK ALLOCATION
7.1 Mutual Release and Indemnification.
a. Release by Claimant. For valuable consideration, Claimant hereby releases and forever discharges Releasee(s) from the Claims.
b. Release by Defendant. In consideration of the foregoing release, Defendant releases Claimant from any claims arising out of the filing or prosecution of the Claims.
c. Scope. The releases in this Section 7.1 are intended to be broad and shall be interpreted to the fullest extent permissible under Oregon law.
[// GUIDANCE: Oregon requires clear, conspicuous language for waivers of unknown future injuries. Select boldface, uppercase, or separate paragraph with initials if desired.]
7.2 Limitation of Liability. The Settlement Amount represents the Parties’ full settlement of the Claims; Releasee(s) shall have no further liability beyond the Settlement Amount.
7.3 Insurance. If a structured annuity is used, Defendant shall procure an annuity contract issued by a life insurer rated at least A- (A.M. Best) and shall name Claimant as payee and owner (or as otherwise permitted under Or. Rev. Stat. §§ 33.850 – 33.875).
7.4 Force Majeure. No Party shall be liable for failure to perform its obligations (other than payment of money) where such failure is caused by events beyond its reasonable control, provided that the affected Party gives prompt notice and uses diligent efforts to resume performance.
8. DISPUTE RESOLUTION
8.1 Governing Law. This Agreement shall be governed by and construed in accordance with the substantive laws of the State of Oregon without regard to its conflict-of-laws principles.
8.2 Forum Selection. The Parties consent to exclusive jurisdiction and venue in the state courts sitting in [COUNTY], Oregon.
8.3 Arbitration and Jury Trial. No provision of this Agreement shall be construed to require arbitration or to waive the right to trial by jury.
9. GENERAL PROVISIONS
9.1 Entire Agreement. This Agreement constitutes the entire agreement among the Parties with respect to the subject matter hereof and supersedes all prior negotiations and understandings.
9.2 Amendments; Waiver. Any amendment or waiver must be in writing and signed by all Parties. No waiver shall be deemed a waiver of any subsequent breach.
9.3 Assignment. No Party may assign its rights or delegate its obligations under this Agreement without the prior written consent of the other Parties, except that Defendant may assign payment obligations to Insurer or annuity provider.
9.4 Severability. If any provision is held invalid or unenforceable, the remainder shall be enforced to the fullest extent permitted by law, and the invalid provision shall be reformed to reflect the Parties’ intent as closely as possible.
9.5 Successors and Assigns. This Agreement binds and benefits the Parties and their respective successors and permitted assigns.
9.6 Counterparts; Electronic Signatures. This Agreement may be executed in counterparts, each of which is deemed an original, and all of which together constitute the same instrument. Signatures delivered via facsimile or secure electronic signature service shall be deemed originals.
9.7 Headings. Section headings are for convenience only and do not affect interpretation.
10. EXECUTION BLOCK
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.
CLAIMANT / RELEASOR
[CLAIMANT LEGAL NAME]
Date: ________
DEFENDANT / RELEASEE
By: _____
Name: ____
Title: _____
Date: ____
INSURER (IF APPLICABLE)
By: _____
Name: ____
Title: _____
Date: ____
[// GUIDANCE: Oregon does not generally require notarization for releases, but counsel may elect to include acknowledgment for evidentiary purposes. Attach a notary block if desired.]
EXHIBIT A – STRUCTURED PAYMENT SCHEDULE
[Detail annuity issuer, payment dates, amounts, beneficiaries, commutation provisions, and assignment language consistent with Or. Rev. Stat. §§ 33.850 – 33.875.]
[// GUIDANCE: If Claimant is a Minor, counsel must file a petition for approval of the settlement under Or. Rev. Stat. § 126.725 and secure a court order before disbursing any funds. Consider establishing a conservatorship or blocked account per court instructions.]