PERSONAL INJURY SETTLEMENT AGREEMENT
AND MUTUAL RELEASE
(South Carolina – Court-Ready Template)
[// GUIDANCE: This template is intentionally comprehensive. Delete any bracketed instruction or inapplicable provision before final execution.]
TABLE OF CONTENTS
I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block
I. DOCUMENT HEADER
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Parties.
1.1 Injured Party / Releasor: [PLAINTIFF FULL LEGAL NAME], [guardian ad litem/spouse/parent if applicable] (“Releasor”).
1.2 Released Parties: [DEFENDANT FULL LEGAL NAME], its past, present, and future parents, subsidiaries, affiliates, insurers, reinsurers, officers, directors, employees, agents, successors, and assigns (collectively, “Releasees”).
1.3 Releasor and Releasees are collectively the “Parties” and individually a “Party.” -
Recitals.
A. An incident occurring on or about [INCIDENT DATE] in [LOCATION] allegedly caused personal injuries and damages to Releasor (the “Incident”).
B. Releasor asserted claims (the “Claims”), which are or may be the subject of a civil action styled [CASE CAPTION], pending in the [COURT NAME], Case No. [DOCKET NO.] (the “Action”).
C. To avoid the expense, uncertainty, and inconvenience of litigation, the Parties desire to fully and finally settle all Claims upon the terms set forth herein.
NOW, THEREFORE, in consideration of the mutual covenants and payments described below and other good and valuable consideration, the sufficiency of which is hereby acknowledged, the Parties agree as follows. -
Effective Date; Governing Law.
This Agreement becomes effective on the later of (i) full execution by all Parties, (ii) receipt of any required court approval under South Carolina law, or (iii) satisfaction of all Conditions Precedent (the “Effective Date”). This Agreement is governed by the laws of the State of South Carolina without regard to conflict-of-laws principles.
II. DEFINITIONS
For purposes of this Agreement, the following terms have the meanings set forth below. Undefined capitalized terms have the meanings ascribed in context.
“Agreement” – This Personal Injury Settlement Agreement and Mutual Release, including all exhibits and schedules.
“CMS” – The Centers for Medicare & Medicaid Services.
“Confidential Information” – The existence, terms, and amount of this settlement and all related negotiations and communications, except to the extent disclosure is required by law or court order.
“Defense Counsel” – [LAW FIRM], counsel of record for Releasees.
“Medicare Beneficiary” – An individual entitled to Medicare benefits under 42 U.S.C. § 1395 et seq.
“Minor” – Any person who has not attained eighteen (18) years of age under S.C. law.
“Settlement Amount” – The total consideration to be paid by or on behalf of Releasees as described in Section 3.1.
“Structured Settlement” – Periodic payment arrangement compliant with South Carolina structured-settlement requirements and 26 U.S.C. § 104(a)(2).
III. OPERATIVE PROVISIONS
3.1 Consideration; Payment Mechanics.
(a) Releasees shall pay Releasor the aggregate Settlement Amount of $[NUMERIC AMOUNT] (the “Cash Component”) on or before [PAYMENT DATE].
(b) If the Parties elect a Structured Settlement, the periodic payments set forth in Exhibit A (the “Periodic Payments”) shall be funded through an annuity issued by [ANNUITY COMPANY] rated not lower than A- (A.M. Best).
(c) All payments shall be made by wire transfer or certified funds to the trust account of [PLAINTIFF COUNSEL], unless otherwise agreed in writing.
3.2 Conditions Precedent.
(a) Execution of this Agreement by all Parties and counsel.
(b) Receipt of any required court approval pursuant to South Carolina law for settlements involving a Minor or incapacitated person.
(c) Delivery of completed IRS Form W-9 by Releasor’s counsel.
3.3 Release and Discharge.
(a) Upon Releasees’ timely payment of the Settlement Amount, Releasor irrevocably and unconditionally releases and forever discharges Releasees from any and all past, present, or future claims, demands, causes of action, rights, damages, costs, losses, expenses, and liabilities of every kind or nature, whether known or unknown, suspected or unsuspected, in law or equity, relating to or arising out of the Incident or the Action.
(b) The release extends to claims for contribution and indemnity and to liens asserted or assertable by any third party, including medical providers, governmental entities, ERISA plans, or private insurers.
3.4 No Admission of Liability.
This Agreement constitutes a compromise of disputed claims. Releasees expressly deny liability, and nothing herein shall be construed as an admission of fault.
3.5 Confidentiality.
Except as required by law, court order, or to enforce this Agreement, the Parties shall keep Confidential Information strictly confidential. Disclosure to tax advisors, insurers, or counsel is permitted provided such recipients agree to equivalent confidentiality obligations.
IV. REPRESENTATIONS & WARRANTIES
4.1 Authority and Capacity.
Each Party represents that it has full legal right, power, and authority to enter into and perform under this Agreement. If Releasor is a Minor, the undersigned parent, guardian, or guardian ad litem warrants that he or she is legally authorized to bind the Minor and that court approval will be promptly sought.
4.2 No Prior Assignment.
Releasor represents that no Claim subject to this Agreement has been sold, assigned, pledged, or otherwise transferred.
4.3 Liens and Reimbursement Obligations.
Releasor represents that all known liens have been disclosed to Releasees and that, except as listed on Schedule 1, no unpaid liens exist.
4.4 Medicare Status.
Releasor represents and warrants (check one):
☐ Releasor is not a Medicare Beneficiary.
☐ Releasor is a Medicare Beneficiary and will comply with all Medicare Secondary Payer requirements, including any necessary Medicare Set-Aside arrangements.
4.5 Survival.
The representations and warranties in this Article IV survive execution and delivery of this Agreement.
V. COVENANTS & RESTRICTIONS
5.1 Lien Resolution Covenant.
Releasor shall satisfy or resolve all liens and reimbursement obligations arising from the Incident and shall secure written lien releases within ninety (90) days after receipt of the Cash Component.
5.2 Non-Disparagement.
The Parties agree not to make any statement, written or oral, that disparages the other Party in connection with the Incident or the Claims.
5.3 Court Approval for Minors.
(a) If Releasor is a Minor, the Parties shall jointly submit a petition for approval of this settlement to the appropriate South Carolina court with jurisdiction over minor settlements.
(b) The settlement shall not become final or enforceable until such approval is obtained and any statutory waiting period has expired.
5.4 Structured Settlement Administration.
Releasor shall not assign, commute, accelerate, or otherwise encumber any Periodic Payments, except as permitted by applicable South Carolina law governing structured settlements.
VI. DEFAULT & REMEDIES
6.1 Events of Default.
(a) Failure by Releasees to pay the Cash Component when due.
(b) Failure by Releasor to timely provide lien releases or court approval (if required).
(c) Material breach of confidentiality or non-disparagement obligations.
6.2 Notice and Cure.
The non-breaching Party shall provide written notice specifying the default. The breaching Party has ten (10) business days to cure, except that payment defaults must be cured within three (3) business days.
6.3 Remedies.
(a) Specific performance, injunctive relief, or damages, as appropriate.
(b) If Releasees fail to cure a payment default, Releasor may reinstate the Action solely for the purpose of enforcing payment, and Releasees waive any statute-of-limitations defense arising during the pendency of this Agreement.
(c) Prevailing Party is entitled to recover reasonable attorneys’ fees and costs incurred in enforcing this Agreement.
VII. RISK ALLOCATION
7.1 Indemnification.
(a) Releasor’s Indemnity. Releasor shall indemnify, defend, and hold harmless Releasees from any claim, lien, or liability asserted by any third party, including CMS, Medicaid, or private insurers, arising out of payments made to Releasor under this Agreement.
(b) Releasees’ Indemnity. Releasees shall indemnify Releasor against any claim by their own insurers or reinsurers challenging Releasees’ authority to enter this Agreement.
7.2 Limitation of Liability.
The aggregate liability of Releasees under this Agreement shall not exceed the Settlement Amount, except for breaches of confidentiality or non-disparagement, for which equitable relief is available.
7.3 Force Majeure.
Neither Party is liable for delay or failure to perform due to events beyond its reasonable control, including natural disasters, acts of war, or governmental action; provided that financial inability is not an excusable force-majeure event.
VIII. DISPUTE RESOLUTION
8.1 Governing Law.
South Carolina substantive law governs all disputes.
8.2 Forum Selection.
The state courts of the County of [FORUM COUNTY], South Carolina, have exclusive jurisdiction over any dispute arising from or relating to this Agreement, subject to Section 6.3(b).
8.3 Arbitration.
Not applicable.
8.4 Jury Trial Waiver.
Not applicable.
8.5 Equitable Relief.
Each Party acknowledges that breaches of confidentiality or of the Release may cause irreparable harm and consents to temporary, preliminary, and permanent injunctive relief without the necessity of posting bond.
IX. GENERAL PROVISIONS
9.1 Entire Agreement; Integration.
This Agreement constitutes the entire agreement between the Parties and supersedes all prior understandings relating to the Claims.
9.2 Amendment; Waiver.
No modification is binding unless in writing and signed by all Parties. No waiver is effective unless in writing and shall not be deemed a waiver of subsequent breaches.
9.3 Assignment.
Neither Party may assign this Agreement without prior written consent of the other, except that Releasees may assign to an insurer or structured-settlement obligor.
9.4 Severability.
If any provision is held invalid or unenforceable, the remaining provisions remain in full force, and the invalid provision shall be reformed to the minimum extent necessary to make it valid and enforceable.
9.5 Successors and Assigns.
This Agreement binds and inures to the benefit of 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 one instrument. Signatures transmitted by DocuSign, PDF, or other reliable electronic means have the same effect as originals.
9.7 Headings.
Headings are for convenience only and do not affect interpretation.
X. EXECUTION BLOCK
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.
A. RELEASOR
Signature: _____
Name: [PLAINTIFF NAME]
Title (if any): ___
Date: ________
[If Minor]
Signature: _____
Name: [Parent/Guardian/Guardian ad Litem Name]
Capacity: ☐ Parent ☐ Court-Appointed Guardian ☐ Guardian ad Litem
Date: ______
B. RELEASEES
[DEFENDANT NAME], on behalf of itself and all other Releasees
Signature: _____
Name: [AUTHORIZED SIGNATORY]
Title: _____
Date: ________
C. COUNSEL APPROVAL (Optional but recommended)
By signing below, counsel represent that they have explained this Agreement to their clients, that the Agreement accurately sets forth the Parties’ understanding, and that all necessary advice has been provided.
PLAINTIFF COUNSEL: ____ Date: __
DEFENSE COUNSEL: ____ Date: ___
D. NOTARIZATION / WITNESS ATTESTATION
[// GUIDANCE: South Carolina does not universally require notarization for settlement agreements; however, notarization strengthens enforceability, especially for minor settlements. Insert appropriate acknowledgment blocks if desired.]
EXHIBIT A
Structured Settlement Payment Schedule
[Complete if periodic payments are chosen]
SCHEDULE 1
Known Liens / Reimbursement Obligations
[List all known liens, their amounts, and disposition method]
[// GUIDANCE: Before filing for court approval (if a Minor is involved), attach a petition, medical reports, proposed order, and any trust documents. Ensure compliance with current South Carolina Probate Court rules regarding minor settlement approvals and reporting obligations under Medicare Secondary Payer statutes.]