Personal Injury Settlement Agreement - Tennessee

PERSONAL INJURY SETTLEMENT AGREEMENT

(Tennessee – Governed by State Tort Law)

TABLE OF CONTENTS

1. Document Header
2. Definitions

3. Operative Provisions
   3.1 Settlement Payment & Timing
   3.2 Conditions Precedent & Subsequent

4. Representations & Warranties

5. Covenants & Restrictions
6. Default & Remedies

7. Risk Allocation
   7.1 Mutual Release & Covenant Not to Sue
   7.2 Limitation of Liability
   7.3 Medicare/Medicaid & Other Liens

8. Dispute Resolution

9. General Provisions
10. Execution Block
11. Exhibits & Schedules

1. DOCUMENT HEADER

Agreement Title: Personal Injury Settlement Agreement and Mutual Release

Effective Date: [● MM/DD/YYYY] (“Effective Date”)

Parties:
(a) [Plaintiff Full Legal Name], an individual having a principal residence at [ADDRESS] (“Releasor”); and
(b) [Defendant/Insurer Full Legal Name], a [STATE OF FORMATION] [corporation/LLC/individual] with a principal place of business at [ADDRESS] (“Releasee”).

Recitals

A. A dispute has arisen out of an incident that occurred on or about [DATE OF ACCIDENT] in [CITY/COUNTY, Tennessee] (the “Incident”), resulting in personal injuries and damages alleged by Releasor (collectively, the “Claims”).
B. The Parties desire to resolve all matters arising from or related to the Incident without the expense and uncertainty of litigation.
C. In consideration of the mutual covenants herein and other good and valuable consideration, the sufficiency of which is acknowledged, the Parties agree as follows.

2. DEFINITIONS

“Agreement” means this Personal Injury Settlement Agreement and Mutual Release, including all Exhibits and Schedules.

“Confidential Information” has the meaning set forth in Section 5.3.

“Court” means the exact tribunal identified in the completed Approval and Case-Control Schedule, if court action is required.

“Gross Settlement Amount” means the total consideration payable to Releasor under Section 3.1.

“Recovery Interest” means a lien, reimbursement, subrogation, assignment, benefit-recovery, attorney, governmental, or other asserted interest identified in the completed Recovery-Interest Schedule.

“Minor” means any person who has not attained eighteen (18) years of age.

“Parties” means Releasor and Releasee, and “Party” means either of them.

“Structured Settlement” has the meaning set forth in Section 3.1(b).

3. OPERATIVE PROVISIONS

3.1 Settlement Payment & Timing

(a) Lump-Sum Settlement. Releasee shall pay to Releasor (or to Releasor’s counsel in trust) the lump-sum amount of [US $________] (the “Gross Settlement Amount”) no later than [NUMBER] business days after (i) complete execution of this Agreement by all Parties and (ii) satisfaction of all Conditions Precedent in Section 3.2. Payment shall be made by [wire transfer/check] payable to “[LAW FIRM] Trust Account f/b/o [Releasor]”.

(b) Structured Settlement (if elected). In lieu of part or all of the lump-sum payment, the Parties agree to fund a structured settlement annuity (the “Structured Settlement”) with the terms set forth in Exhibit A. The Structured Settlement shall comply with:
(1) the claimant-specific tax classification and written tax advice attached to Exhibit A;
(2) the current Tennessee and other applicable rules for any later transfer of payment rights identified by counsel; and
(3) the exact annuity, assignment, ownership, beneficiary, security, payment, fee, and transfer documents reviewed for this settlement.

3.2 Conditions Precedent & Subsequent

(a) Approval and Capacity Gate. Complete Exhibit B for a minor, incapacitated person, estate, fiduciary, disputed capacity, death claim, guardianship/conservatorship, or other settlement requiring approval or additional authority. No tribunal, procedure, representative, restricted-funds arrangement, deadline, or order is assumed. If Exhibit B states that approval is required, funding is contingent on the exact Approval Order identified there.

(b) Recovery-Interest Resolution. The Parties shall complete the Recovery-Interest Schedule in Section 7.3, identify the law and evidence for every asserted interest, and state the approved holdback, direct-payment, compromise, dispute, or release procedure. No category is presumed to exist, be waivable, or be resolved by a private representation alone.

(c) Taxpayer Identification Certification. Releasor shall supply a completed IRS Form W-9 to Releasee or its insurer.

(d) Dismissal of Litigation. Within five (5) business days after receipt of payment in Section 3.1, Releasor shall file a stipulation of dismissal with prejudice in any pending litigation arising from the Incident.

4. REPRESENTATIONS & WARRANTIES

4.1 Authority. Each Party represents that it has full legal right, power, and authority to enter into and perform this Agreement; and, if a corporate entity, that all requisite corporate actions have been duly taken.

4.2 No Assignment. Releasor represents that no part of the Claims has been assigned, pledged, or otherwise transferred to any third party.

4.3 Independent Counsel. Releasor acknowledges having had the opportunity to consult with independent legal counsel of Releasor’s choice, and either has done so or voluntarily elected not to.

4.4 Public-Benefit and Program Status. The Parties completed a dated program-specific review for Medicare, Medicaid, disability, workers' compensation, public benefits, and other applicable programs. Current agency materials and claimant-specific advice are attached at Exhibit [__]. This Agreement does not state that any set-aside, reporting, reimbursement, approval, or allocation is or is not required.

4.5 Truthfulness. The information provided by Releasor to Releasee concerning damages, liens, and the existence of bankruptcy proceedings is true, complete, and accurate in all material respects.

The foregoing representations and warranties shall survive the Effective Date.

5. COVENANTS & RESTRICTIONS

5.1 Non-Disparagement. Each Party covenants that it shall not make any statement, written or oral, intended or reasonably likely to disparage the other Party related to the Incident, except as required by law or court order.

5.2 Cooperation. Releasor shall execute the identified documents and take the agreed actions needed to effectuate the Releases, completed Recovery-Interest Schedule, and any case-specific dismissal.

5.3 Confidentiality. Except as required by law, rule, regulation, or court order, the terms of this Agreement (“Confidential Information”) shall remain confidential. Permitted disclosures include:
(a) to the Parties’ attorneys, insurers, accountants, financial or tax advisors;
(b) as necessary to secure Court approval; and
(c) as otherwise mutually agreed in writing.

5.4 No Admission. Nothing herein constitutes an admission of liability; all such liability is expressly denied.

6. DEFAULT & REMEDIES

6.1 Events of Default. The following shall constitute an Event of Default:
(a) Failure of Releasee to timely fund the Gross Settlement Amount or Structured Settlement;
(b) Failure of Releasor to timely deliver the identified dismissal papers, recovery-interest resolution evidence, or other listed documentation;
(c) Material breach of Section 5 (Covenants & Restrictions).

6.2 Cure Period. The defaulting Party shall have ten (10) business days after receipt of written notice of default to cure the same.

6.3 Remedies. Upon an uncured Event of Default, a Party may pursue only the remedy selected here after current-authority review: ☐ actual damages ☐ specific performance if available ☐ contractually allocated fees if enforceable ☐ other [____________]. Authority, predicates, exclusions, and proof: [________________________________].

7. RISK ALLOCATION

7.1 Mutual Release & Covenant Not to Sue

(a) Release by Releasor. For the Gross Settlement Amount, Releasor releases only the Released Parties and claims completed here: Released Parties by legal name [________________________________]; claim categories and date range [________________________________]; scope ☐ known claims only ☐ known and unknown Incident-related claims after counsel review; reserved claims, persons, benefits, liens, and reimbursement rights [________________________________] (“Released Claims”).

(b) Unknown Claims. No generic statutory or common-law waiver is presumed. Unknown claims are included only if the applicable scope box in subsection (a) is selected after counsel review and the intended consequences are stated in the completed release description.

(c) Mutual Release by Releasee. Releasee, for itself and the Released Parties, releases Releasor from all claims arising from or relating to the Incident, excluding obligations under this Agreement.

(d) Covenant Not to Sue. Each Party covenants and agrees not to commence or maintain any legal or administrative action concerning any Released Claim, except to enforce this Agreement.

7.2 Limitation of Liability

☐ No contractual liability cap. ☐ The Parties adopt the transaction-specific cap in Exhibit [__] after identifying covered duties, cap base, exclusions, nonwaivable claims, remedy interaction, and bargaining record. The Gross Settlement Amount is not automatically the cap.

7.3 Medicare/Medicaid & Other Recovery Interests

Before funding, the Parties shall complete a written recovery-interest schedule identifying every asserted Medicare, Medicaid, medical-provider, benefit-plan, insurer, attorney, governmental, or other claim; its basis and status; any holdback or direct payment; the responsible person; and required proof of resolution. No blanket indemnity applies. Any claim-specific indemnity must identify the claim, indemnifying and protected persons, notice, defense control, settlement authority, exclusions, and liability measure. A private allocation does not alter an obligation imposed directly by governing law.

8. DISPUTE RESOLUTION

8.1 Governing Law. This Agreement and any dispute arising hereunder shall be governed by and construed in accordance with the laws of the State of Tennessee, without regard to conflict-of-laws principles.

8.2 Forum Selection. ☐ No contractual forum clause. ☐ The Parties adopt Exhibit [__] after counsel confirms subject-matter jurisdiction, personal jurisdiction, venue, pending-case procedure, claimant capacity, approval route, and enforceability.

8.3 Arbitration & Jury Trial. ☐ No arbitration agreement or pre-dispute jury waiver. ☐ A separately reviewed arbitration or jury provision is attached as Exhibit [__], with the claims, forum, rules, costs, discovery, remedies, review, conspicuous assent, and current enforceability analysis completed.

8.4 Equitable Relief. No injunction, specific-performance, or bond result is promised. A Party may request only relief supported by the completed dispute, controlling authority, court rules, and evidence.

9. GENERAL PROVISIONS

9.1 Amendments & Waivers. No amendment or waiver shall be binding unless in a written instrument signed by both Parties. A waiver on one occasion is not a waiver on any future occasion.

9.2 Assignment & Delegation. No Party may assign its rights or delegate its obligations without the prior written consent of the other Party, except that Releasee may assign rights to an insurer or structured-settlement obligor.

9.3 Successors & Assigns. This Agreement binds and benefits the Parties and their respective successors and permitted assigns.

9.4 Severability. If a provision is held invalid or unenforceable, the effect on the remainder and any permissible severance or reformation will be determined under controlling law; this clause does not authorize a court to rewrite the bargain.

9.5 Entire Agreement. This Agreement constitutes the entire agreement between the Parties regarding its subject matter and supersedes all prior or contemporaneous oral or written agreements.

9.6 Counterparts; Electronic Signatures. The Parties select ☐ wet-ink originals ☐ counterparts ☐ identified electronic platform [____________]. Counsel shall confirm consent, attribution, authentication, retention, approval-order, fiduciary, insurer, annuity, court, and transaction-formality requirements. This clause alone does not determine legal effect.

9.7 Headings & Construction. Headings are for convenience only and shall not affect interpretation. “Including” means “including without limitation.” The Parties jointly drafted this Agreement, and no presumption shall arise against either Party.

9.8 Notices. All notices shall be in writing and deemed given when (i) delivered by hand with signed receipt; (ii) sent by nationally-recognized overnight courier with tracking; or (iii) deposited in the U.S. mail, certified, return-receipt requested, postage prepaid, in each case addressed to the receiving Party at the address set forth below (or as updated by notice).

9.9 Taxes. Each Party remains responsible for obligations imposed directly on it by controlling tax law. The completed tax-classification schedule records the advice, forms, reporting, withholding, allocation, and payor responsibilities; no private allocation changes a nonwaivable public-law duty.

10. EXECUTION BLOCK

IN WITNESS WHEREOF, the Parties hereto have executed this Personal Injury Settlement Agreement and Mutual Release effective as of the Effective Date.

RELEASOR

[PLAINTIFF NAME]

Signature: _________________________________
Printed Name: ______________________________
Date: _____________________________________

RELEASEE

[DEFENDANT/INSURER NAME]

By: _______________________________________
Name: _____________________________________
Title: _____________________________________
Date: _____________________________________

11. EXHIBITS & SCHEDULES

• Exhibit A – Structured Settlement Terms (if applicable)
• Exhibit B – Capacity, Representative, Approval, Restricted-Funds, and Order Control
• Exhibit C – Stipulation of Dismissal with Prejudice
• Schedule 1 – Lien Resolution Statement

© [YEAR] [LAW FIRM OR PREPARER]. All rights reserved. This template is provided for general informational purposes and must be tailored by a licensed Tennessee attorney to specific facts and circumstances.