PERSONAL INJURY SETTLEMENT AGREEMENT

AND MUTUAL RELEASE

(State of Tennessee)

[// GUIDANCE: This template is drafted for use in Tennessee personal-injury matters.
• Square-bracketed ALL-CAPS placeholders must be completed or deleted.
• Bracketed guidance comments should be deleted before execution.
• Section cross-references update automatically in most word-processing programs if you use built-in heading styles.]

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

1.1 Title. Personal Injury Settlement Agreement and Mutual Release (this “Agreement”).

1.2 Parties.
(a) “Claimant”: [CLAIMANT FULL LEGAL NAME], [an individual / a minor, by and through [PARENT/GUARDIAN NAME]] with a principal residence at [ADDRESS].
(b) “Released Parties”: [DEFENDANT FULL LEGAL NAME], a [STATE OF ORG] [ENTITY TYPE] with its principal place of business at [ADDRESS], together with its past, present, and future parents, subsidiaries, affiliates, officers, directors, managers, shareholders, employees, agents, insurers, reinsurers, successors, and assigns (collectively, the “Released Parties”).

1.3 Effective Date. This Agreement is effective as of [EFFECTIVE DATE] (the “Effective Date”).

1.4 Recitals.
WHEREAS, Claimant alleges personal injuries arising out of an incident that occurred on or about [INCIDENT DATE] in [COUNTY], Tennessee (the “Incident”);
WHEREAS, Claimant has asserted or may assert claims, demands, actions, or causes of action (“Claims”) against Released Parties arising out of or related to the Incident;
WHEREAS, Released Parties deny liability but desire to compromise and settle all Claims; and
WHEREAS, the parties intend this Agreement to constitute a full, final, and complete settlement of all Claims on the terms and conditions set forth herein.

NOW, THEREFORE, in consideration of the mutual covenants, releases, and payments contained herein, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

II. DEFINITIONS

For purposes of this Agreement, capitalized terms have the meanings set forth below; terms defined in other Sections have the same meaning throughout this Agreement.

“Action” means any lawsuit, arbitration, administrative proceeding, or governmental investigation arising out of or related to the Claims.

“Agreement” has the meaning given in Section 1.1.

“Approval Order” means (i) for an adult Claimant, a court order dismissing the Action with prejudice; or (ii) for a minor Claimant, a final, non-appealable order of a Tennessee court approving this settlement pursuant to Tenn. Code Ann. § 29-34-105 and any applicable local rules.

“Claimant” has the meaning given in Section 1.2(a).

“Effective Date” has the meaning given in Section 1.3.

“Incident” has the meaning given in the Recitals.

“Medicare” includes Medicare Parts A, B, C, and D.

“Medicare-Covered Expenses” means any past or future medical expenses for which Medicare is, or may be, a secondary payer under 42 U.S.C. § 1395y(b).

“Settlement Amount” means the total consideration payable by or on behalf of Released Parties to Claimant under Section III.1, not to exceed [NUMERICAL AMOUNT] U.S. Dollars ([AMOUNT IN WORDS]).

“Structured Settlement” means periodic payments funded through an annuity contract as elected in Section III.2.

“Tennessee Court” means the Circuit or Chancery Court of [COUNTY], Tennessee, or such other Tennessee state court of competent jurisdiction mutually selected by the parties.

III. OPERATIVE PROVISIONS

III.1 Payment of Settlement Amount.
(a) Lump-Sum Option. Subject to Section III.3, Released Parties shall pay the Settlement Amount to Claimant (or to the Clerk of Court if required) within [__] business days after the later of (i) Claimant’s delivery of properly executed settlement documents, or (ii) entry of the Approval Order.
(b) Payment Instructions. Payment shall be made by [wire transfer / cashier’s check] to [PAYEE NAME] pursuant to written instructions delivered by Claimant’s counsel at least [__] business days before the payment date.

III.2 Structured Settlement (Optional).
[// GUIDANCE: Delete Section III.2 if no structured settlement is contemplated.]

(a) Election. The parties elect to fund [__]% of the Settlement Amount through a Structured Settlement.
(b) Annuity. Released Parties shall assign their periodic-payment obligation to [NAME OF QUALIFIED ASSIGNMENT COMPANY] (“Assignee”), which will purchase an annuity from [ANNUITY ISSUER].
(c) Non-Acceleration; Spendthrift. Claimant agrees that the periodic payments are neither assignable nor subject to acceleration, except as permitted under the Tennessee Structured Settlement Protection Act, Tenn. Code Ann. § 47-18-2601 et seq.
(d) Tax Intent. The parties intend that the Structured Settlement qualify for tax exclusion under I.R.C. § 104(a)(2).

III.3 Conditions Precedent. Released Parties’ obligation to pay the Settlement Amount is conditioned upon:
(a) Claimant’s execution and delivery of this Agreement and any related lien-resolution documents;
(b) entry of the Approval Order;
(c) execution of a stipulation of dismissal with prejudice of the Action; and
(d) satisfaction or waiver of all Medicare, Medicaid, ERISA, TRICARE, or other statutory or contractual liens (“Liens”).

III.4 Dismissal. Within [__] business days after receipt of the Settlement Amount (or the first periodic payment, if structured), Claimant shall file a stipulation or agreed order dismissing the Action with prejudice, each party to bear its own costs.

III.5 No Admission. This Agreement is a compromise of disputed claims; neither the execution nor performance of this Agreement shall be construed as an admission of liability or fault by any party.

IV. REPRESENTATIONS & WARRANTIES

IV.1 Mutual Representations. Each party represents and warrants to the other that:
(a) Authority. It has full legal right, power, and authority to execute and perform this Agreement.
(b) No Reliance. It has not relied upon any statement, promise, or representation not expressly set forth in this Agreement.
(c) No Assignment of Claims. It has not sold, assigned, pledged, or otherwise transferred any Claims or rights released herein.

IV.2 Claimant-Specific Representations. Claimant further represents and warrants that:
(a) Age and Capacity. Claimant is at least eighteen (18) years old and competent to execute this Agreement, or, if a minor, is represented by a duly appointed parent, guardian, or conservator with court authority.
(b) Independent Counsel. Claimant has had the opportunity to consult with independent legal counsel and tax advisors.
(c) Liens. Claimant has fully disclosed all Liens and will cooperate in resolving them.
(d) Medicare Status. Claimant [is / is not] a current Medicare beneficiary. If Claimant is or becomes a beneficiary, Claimant shall take all actions required to comply with the Medicare Secondary Payer Act.

IV.3 Survival. The representations and warranties in this Article IV survive the Effective Date.

V. COVENANTS & RESTRICTIONS

V.1 Covenant Not to Sue. Claimant shall not, directly or indirectly, institute, prosecute, or assist in any Claim against Released Parties arising out of or related to the Incident, except to enforce this Agreement.

V.2 Confidentiality. The parties [elect / do not elect] to keep the terms of this settlement confidential. If elected, the parties shall execute a separate confidentiality agreement with reasonable carve-outs (e.g., tax, legal, or governmental disclosures).

V.3 Public Statements. The parties shall refrain from making any knowingly false or disparaging statements regarding the other relating to the Claims or Incident.

V.4 Cooperation. The parties will cooperate in good faith to obtain the Approval Order, resolve Liens, and consummate the transactions contemplated herein.

VI. DEFAULT & REMEDIES

VI.1 Events of Default.
(a) Payment Default. Failure of Released Parties (or Assignee) to make any required payment within five (5) business days after written notice of non-payment.
(b) Breach of Covenants. Material breach by either party of Article V not cured within ten (10) business days after written notice specifying the breach.

VI.2 Remedies.
(a) Payment Default. Claimant may obtain judgment for the unpaid portion of the Settlement Amount plus (i) interest at [__]% per annum from the date of default until paid, and (ii) reasonable attorney fees and costs incurred in enforcement.
(b) Breach of Covenants. The non-breaching party may seek monetary damages (capped as set forth in Section VII.3) and any other relief available at law or in equity, except that neither party may seek injunctive relief, consistent with the metadata requirement.

VI.3 Exclusive Remedy. The remedies in this Article VI are the sole and exclusive remedies for any breach of this Agreement, except as expressly provided in Section VIII.1.

VII. RISK ALLOCATION

VII.1 Mutual Release.
(a) Claimant Release. Upon satisfaction of all conditions precedent and receipt of the Settlement Amount, Claimant irrevocably releases and forever discharges the Released Parties from any and all Claims, whether known or unknown, that Claimant now has or may hereafter have arising out of or related to the Incident.
(b) Released Parties’ Release. Upon entry of the Approval Order, Released Parties release Claimant from any claims for contribution, indemnity, or subrogation arising out of the Incident.

VII.2 Indemnification of Liens. Claimant shall indemnify, defend, and hold harmless Released Parties from and against any Liens, subrogation claims, or reimbursement obligations asserted against Released Parties relating to the Claims.

VII.3 Limitation of Liability. Notwithstanding anything herein to the contrary, the total aggregate liability of each party under or in connection with this Agreement shall in no event exceed the Settlement Amount.

VII.4 Force Majeure. A party is excused from performance to the extent delayed or prevented by an event beyond its reasonable control (e.g., natural disasters, governmental actions, pandemics). Payment obligations are not excused but are tolled during the force-majeure period.

VIII. DISPUTE RESOLUTION

VIII.1 Governing Law. This Agreement, and any dispute arising hereunder, is governed by and construed in accordance with the tort and contract laws of the State of Tennessee, without regard to conflict-of-laws principles.

VIII.2 Forum Selection. The parties irrevocably submit to the exclusive jurisdiction of the Tennessee Court. Each party waives any objection to venue or inconvenient forum.

VIII.3 Arbitration & Jury Trial. The parties agree that (a) no arbitration clause applies, and (b) no contractual waiver of jury trial is intended or effectuated by this Agreement.

IX. GENERAL PROVISIONS

IX.1 Amendment & Waiver. No amendment or waiver of any provision of this Agreement is effective unless in writing and signed by all parties. No waiver constitutes a waiver of any subsequent breach.

IX.2 Assignment. A party may not assign, delegate, or otherwise transfer its rights or obligations under this Agreement without the prior written consent of the other party, except that Released Parties may assign payment obligations to the Assignee under Section III.2.

IX.3 Successors & Assigns. This Agreement is binding upon and inures to the benefit of the parties and their respective successors and permitted assigns.

IX.4 Severability. If any provision of this Agreement is held invalid or unenforceable, the remaining provisions remain in full force to the maximum extent permitted by law.

IX.5 Entire Agreement. This Agreement constitutes the sole and entire understanding between the parties with respect to its subject matter, superseding all prior agreements, negotiations, and representations.

IX.6 Headings. Headings are for convenience only and do not affect interpretation.

IX.7 Counterparts; Electronic Signatures. This Agreement may be executed in multiple counterparts (including by electronic signature or PDF), each of which is deemed an original and all of which together constitute one instrument. Electronic signatures are deemed valid and binding to the fullest extent permitted by applicable law, including Tenn. Code Ann. § 47-10-101 et seq.

X. EXECUTION BLOCK

IN WITNESS WHEREOF, the parties have executed this Agreement as of the Effective Date.

CLAIMANT

Signature: [NAME OF ADULT CLAIMANT]
Date: [DATE]

[// GUIDANCE: If Claimant is a minor:]

Signature: [NAME OF PARENT/GUARDIAN],
Parent/Guardian of [MINOR’S NAME]
Date: [DATE]

RELEASED PARTIES

Signature: [AUTHORIZED SIGNATORY NAME]
Title: [TITLE]
Entity: [DEFENDANT LEGAL NAME]
Date: [DATE]

[// GUIDANCE: Add notarization or witness lines below if required by local court rule or insurer policy.]

[// GUIDANCE: Attach any lien-resolution documents, structured-settlement addenda, or confidentiality agreements as Exhibits A, B, etc. Ensure all exhibits are referenced correctly within the body of the Agreement.]