Personal Injury Settlement Agreement - Oregon

PERSONAL INJURY SETTLEMENT AGREEMENT AND RELEASE

(Oregon)

1. Parties, Incident, and Purpose

This Personal Injury Settlement Agreement and Release (the “Agreement”) is entered into by:

• Claimant / Releasor: [FULL LEGAL NAME AND ADDRESS]
• Defendant / Releasee: [FULL LEGAL NAME, ENTITY TYPE, AND ADDRESS]
• Insurer or funding person, if a party: [NAME, CAPACITY, AND ADDRESS]

The disputed claim arises from an incident on [__/__/____] at [LOCATION] (the “Incident”). Claimant asserts injury and damages; Defendant denies liability. The Parties wish to resolve only the claims and parties identified in this Agreement, subject to the completed funding, approval, lien, and dismissal schedules.

2. Defined Settlement Scope

“Approval Order” means any court or administrative order that counsel determines is required and identifies in Exhibit D.

“Effective Date” means the last completed event selected in Section 4.

“Released Claims” means only the claims described in Exhibit A through the stated Release Date. It excludes each reserved claim, later event, and enforcement right listed there.

“Released Parties” means only the persons and entities individually named in Exhibit A. A category label must be deliberately reviewed and does not replace a complete list.

“Settlement Amount” means the total consideration stated in Section 3.

3. Settlement Funding

3.1 Total consideration: $[AMOUNT].

3.2 Funding method:

• ☐ Lump sum of $[AMOUNT] due [NUMBER] calendar days after all funding conditions occur.
• ☐ Periodic payments described completely in Exhibit B.
• ☐ Other consideration: [DESCRIPTION].

3.3 Exhibit C states every payee, amount or reserve, method, deadline, escrow condition, lien or reimbursement holdback, attorney fee and cost, and any restricted, trust, or custodial account.

3.4 No receipt is acknowledged until the promised funds or funding instruments are actually delivered.

3.5 No Party relies on this form for tax characterization, reporting, public-benefit eligibility, special-needs planning, annuity security, qualified-assignment treatment, or professional-responsibility advice. Any negotiated position must be documented in Exhibit C after advisor review.

4. Conditions and Effective Date

Select every applicable condition:

• ☐ Signature by all Parties and required representatives
• ☐ Entry of the Approval Order in Exhibit D
• ☐ Completion of the Or. Rev. Stat. § 126.725 minor-settlement route in Section 5
• ☐ Delivery of dismissal papers to escrow
• ☐ Final medical-services lien figures or agreed holdbacks under Exhibit C
• ☐ Final Medicare, Medicaid, benefit-plan, insurer, workers' compensation, child-support, attorney, or other recovery-interest process under Exhibit C
• ☐ Delivery of periodic-payment funding documents
• ☐ Other: [DESCRIPTION]

The Effective Date occurs upon: [IDENTIFY THE LAST REQUIRED EVENT].

If a required condition fails, state what happens to signatures, escrowed documents, funds, deadlines, and pending claims: [TERMS].

5. Capacity and Minor-Settlement Gate

5.1 If Claimant is an adult acting personally with legal capacity, select:

• ☐ Adult Claimant signs personally; no representative authority is asserted.

5.2 If Claimant is a minor, counsel must select and document the correct route:

• ☐ Or. Rev. Stat. § 126.725 route. No conservator has been appointed; the claim amount excluding the items stated in the statute is $25,000 or less; the required affidavit or verified statement is completed; and payment, deposit, notice, withdrawal, and record-retention terms comply with the statute.
• ☐ Other court, conservatorship, protective, or fiduciary route. Exhibit D identifies the proceeding, representative authority, petition, notice, hearing, findings, account or trust, bond, distribution terms, and order required for this settlement.

Or. Rev. Stat. § 126.725 does not impose court approval when its conditions are satisfied; the earlier version of this template incorrectly treated the section as a universal approval requirement. If the statute's conditions are not satisfied, this form does not decide which alternate procedure applies.

5.3 If Claimant lacks capacity, acts through a fiduciary, represents an estate, or may require another approval, Exhibit D must identify every appointment, authority limit, required approval, and distribution restriction. No representative warrants authority beyond the attached order or instrument.

6. Dismissal and Funding Sequence

• ☐ No action is pending.
• ☐ A claimant-signed dismissal is delivered to [ESCROW / COUNSEL] and may be filed only after written confirmation that all funding conditions are satisfied.
• ☐ Funding is delivered to escrow and released only after [EVENT].
• ☐ Other sequence: [TERMS].

Any dismissal is with prejudice only as to the Released Claims against the Released Parties unless Exhibit A expressly and validly states otherwise. Litigation costs and fees are allocated as follows: [TERMS].

7. Medical-Services Liens and Other Recovery Interests

7.1 Oregon medical-services liens. Or. Rev. Stat. § 87.560 limits covered liens, including by excluding necessary attorney fees, costs, and expenses incurred to secure the recovery. Section 87.565 requires specified filing and service before judgment, award, settlement, or compromise to perfect the covered lien. Counsel must apply the current statutes to each provider, service, notice, payer, and fund rather than using a blanket “all liens” representation.

Exhibit C must record each asserted medical-services lien:

7.2 Other interests. Exhibit C must separately inventory and assign responsibility for every asserted Medicare, Medicaid, insurer, benefit-plan, workers' compensation, child-support, attorney, litigation-funding, assignment, subrogation, reimbursement, or other payment interest.

7.3 No blanket indemnity. An indemnity applies only if Exhibit C identifies the indemnifying person, protected person, specific third-party claim, notice, defense control, settlement consent, exclusions, and liability measure.

8. Release, Reserved Claims, and Other Alleged Tortfeasors

8.1 Claimant release. On the Effective Date and subject to actual funding, Claimant releases the Released Parties from the Released Claims identified in Exhibit A.

8.2 Known and unknown claims. Select and describe the intended result:

• ☐ Only known claims listed in Exhibit A are released.
• ☐ Defined unknown consequences of the Incident are included after counsel review: [TERMS].
• ☐ The following claims, parties, benefits, liens, enforcement rights, later conduct, or time periods are reserved: [TERMS].

8.3 Defendant release:

• ☐ No reciprocal release.
• ☐ Defendant releases Claimant from only these claims: [TERMS].

8.4 Other alleged tortfeasors. Exhibit A identifies every nonsettling person against whom a claim is made and states whether that claim is reserved.

• ☐ Or. Rev. Stat. § 31.815 covenant route selected after counsel review.
• ☐ Section 31.815 covenant route not selected.

If the statutory route is selected, counsel must complete the good-faith covenant terms, the effect on nonsettling persons and contribution, and notice of all covenant terms to every person against whom Claimant makes a claim. This Agreement does not label an ordinary release as a statutory covenant without that analysis.

8.5 No admission. This Agreement compromises disputed claims and is not an admission of liability.

9. Optional Conduct Terms

9.1 Confidentiality:

• ☐ None.
• ☐ Limited to: [INFORMATION / PERSONS / DURATION].

The completed clause must permit disclosures required for legal process, approval, tax or benefit reporting, lien and reimbursement resolution, insurance administration, medical care, government communications, and confidential professional advice. State the remedy, if any, only after counsel reviews proof, causation, and enforceability: [TERMS].

9.2 Non-disparagement:

• ☐ None.
• ☐ Narrow restriction: [TERMS].

The completed clause must not prohibit truthful testimony, legal process, protected government communications, medical care, insurance or benefit administration, or confidential advice.

9.3 Cooperation. Further documents may implement the completed exhibits but may not expand the Released Claims, Released Parties, or payment duties without a signed amendment and any required approval.

10. Default and Remedies

10.1 A material failure to perform an express obligation after its conditions occur is a default. A disputed lien, approval condition, or escrow instruction is not automatically a default unless this Agreement allocates that risk.

10.2 Cure:

• ☐ No contractual cure period.
• ☐ Written notice and [NUMBER] calendar days to cure, except [EXCEPTIONS].

10.3 Select negotiated remedies after counsel review:

• ☐ Action to enforce the Agreement
• ☐ Judgment for an unpaid liquidated amount
• ☐ Contract interest at [RATE] beginning [DATE], supported by [CONTRACT / AUTHORITY]
• ☐ Agreed dismissal or restoration procedure: [TERMS]
• ☐ Other: [TERMS]

10.4 Fees:

• ☐ Each Party bears its own enforcement fees and costs except as a court otherwise awards under governing law.
• ☐ Claim-specific fee provision: [TERMS AND AUTHORITY].

No automatic interest, specific performance, fee shifting, or fixed cure period is created by this form.

11. Risk Allocation

The Settlement Amount is consideration for the Released Claims, not a cap on liability for breach of this Agreement. No force-majeure term excuses funding, approval, escrow, lien, dismissal, confidentiality, or other duties unless the Parties insert a specific counsel-reviewed clause here: [TERMS].

Any indemnity must be completed only in Exhibit C as provided in Section 7.3. There is no general claimant, mutual, affiliate, successor, or insurer indemnity.

12. Governing Law and Disputes

Oregon substantive law governs this Agreement, subject to any valid choice-of-law analysis counsel records here: [TERMS].

Any filing must be made in a court with subject-matter jurisdiction and proper venue. Proposed forum: [COURT / COUNTY], subject to governing law and any Approval Order.

Select one:

• ☐ Court proceedings; no contractual arbitration requirement
• ☐ Mediation before a non-emergency enforcement filing
• ☐ Arbitration under an attached counsel-completed rider

No jury waiver is included. Any proposed waiver requires a separate, conspicuous, claim-specific provision reviewed under current Oregon law.

13. General Terms

13.1 Entire agreement. This Agreement and completed exhibits contain the settlement terms.

13.2 Amendments. An amendment or waiver must be in a record signed by every affected Party and approved through any process required by an Approval Order or governing law.

13.3 Assignment. No assignment or delegation is permitted except as expressly stated in Exhibit B or D or later approved in a signed writing.

13.4 Severability. A provision may be severed only if permitted by governing law and doing so does not materially alter the settlement exchange or release scope.

13.5 Persons bound. Only a signatory and persons or entities that signatory has authority to bind are bound. Exhibit A must identify every intended beneficiary or bound representative, heir, estate, insurer, successor, or assignee.

13.6 Counterparts and signatures. The Parties select:

• ☐ Counterpart and electronic signatures under the completed signing protocol: [TERMS].
• ☐ Wet-ink originals required for: [DOCUMENTS].

13.7 Notices. Required notices are sent by [METHOD] to [ADDRESSES] and become effective upon [DELIVERY EVENT].

14. Signatures

CLAIMANT / RELEASOR

Signature: ______________________________

Name: [NAME]

Date: [__/__/____]

Representative capacity and authority document, if any: [DETAILS]

DEFENDANT / RELEASEE

Signature: ______________________________

Name and title: [NAME / TITLE]

Date: [__/__/____]

INSURER OR OTHER REQUIRED PARTY

Signature: ______________________________

Name, capacity, and authority: [DETAILS]

Date: [__/__/____]

Use a notarial certificate only if counsel, an Approval Order, escrow, or another applicable requirement calls for one.

15. Exhibits

• Exhibit A — Released Parties, Released Claims, Reserved Claims, Other Alleged Tortfeasors, and Any Or. Rev. Stat. § 31.815 Covenant
• Exhibit B — Funding, Periodic Payments, Assignment, Annuity, and Beneficiary Terms
• Exhibit C — Payment Allocation, Fees, Costs, Medical-Services Liens, Other Recovery Interests, Holdbacks, and Any Claim-Specific Indemnity
• Exhibit D — Capacity, Fiduciary Authority, Or. Rev. Stat. § 126.725 Affidavit or Alternate Approval, Restricted Funds, and Distribution Terms
• Exhibit E — Dismissal and Escrow Documents

Sources and Current-Law Notes

• Or. Rev. Stat. § 31.815 — effect and notice rules for a good-faith covenant not to sue or not to enforce judgment involving multiple alleged tortfeasors.
• Or. Rev. Stat. §§ 87.560 and 87.565 — medical-services lien limitations and perfection notice before judgment, award, settlement, or compromise.
• Or. Rev. Stat. § 126.725 — conditions, payment routes, restrictions, and effect of a qualifying settlement agreement signed on behalf of a minor.