PERSONAL INJURY SETTLEMENT AGREEMENT
(Utah – Governed by Utah Tort Law)
[// GUIDANCE: This template is drafted for personal injury matters governed by Utah law. It assumes the absence of mandatory arbitration, jury waiver, or injunctive-relief provisions, and that liability is capped at the agreed Settlement Amount. All bracketed items must be customized before use.]
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
This Personal Injury Settlement Agreement and Mutual Release (the “Agreement”) is made and entered into as of [EFFECTIVE DATE] (the “Effective Date”) by and between:
- [CLAIMANT FULL LEGAL NAME], an individual [and natural parent/guardian of Minor, if applicable], residing at [ADDRESS] (“Claimant”); and
- [DEFENDANT FULL LEGAL NAME], a [corporation/limited liability company/individual], organized under the laws of [STATE OF ORGANIZATION] with its principal place of business at [ADDRESS] (“Released Party” and, together with Claimant, each a “Party” and collectively the “Parties”).
Recitals
A. On or about [DATE OF ACCIDENT], Claimant allegedly sustained personal injuries and damages (the “Incident”) for which Claimant asserts the Released Party may be legally responsible (the “Claim”).
B. The Parties desire to settle fully and finally any and all claims arising out of or relating to the Incident on the terms set forth herein, without admission of liability.
C. For valuable consideration, the sufficiency of which is hereby acknowledged, the Parties agree as follows.
2. DEFINITIONS
For purposes of this Agreement, the terms below have the following meanings. Capitalized terms used but not defined shall have the meanings ascribed in the context where first used.
“Agreement” has the meaning set forth in the preamble.
“Claim” means all claims, demands, actions, causes of action, damages, costs, expenses, and liabilities of every kind, known or unknown, arising from or related to the Incident.
“Claimant” has the meaning set forth in the Document Header.
“Court Approval” means entry of an order by a Utah state district court approving this Agreement pursuant to applicable Utah law governing settlements on behalf of minors or incapacitated persons.
“Effective Date” has the meaning set forth in the Document Header.
“Minor” means a person under eighteen (18) years of age.
“Released Parties” means Released Party and its past, present, and future parents, subsidiaries, affiliates, insurers, reinsurers, shareholders, members, officers, directors, employees, agents, attorneys, successors, and assigns.
“Settlement Amount” means the total consideration described in Section 3.1.
“Structured Settlement” means any periodic payment arrangement established under Section 3.2.
3. OPERATIVE PROVISIONS
3.1 Settlement Consideration.
(a) Lump-Sum. Within [__] business days after the later of (i) the Effective Date or (ii) satisfaction of all Conditions Precedent in Section 3.4, Released Party shall pay Claimant [US$ [SUM] (the “Settlement Amount”)] by [wire transfer/cashier’s check] to [PAYEE NAME] at [BANK/ADDRESS].
(b) Inclusive. The Settlement Amount includes all alleged damages (economic, non-economic, punitive), medical liens, attorneys’ fees, and costs.
3.2 Structured Settlement (if elected).
(a) Terms. In lieu of, or in addition to, the lump-sum payment, the Parties agree to fund a Structured Settlement in the aggregate amount of US$ [STRUCTURED SUM], payable pursuant to the schedule set forth in Exhibit A.
(b) Qualified Assignment. The Parties may effect a qualified assignment to [ASSIGNEE], and Claimant shall execute any documents reasonably required to facilitate such assignment.
(c) Compliance. Any Structured Settlement shall comply with Utah’s Structured Settlement Protection Act and applicable federal tax law.
[// GUIDANCE: Delete Section 3.2 if the settlement is lump-sum only.]
3.3 Minor Settlement Approval (if applicable).
(a) Court Approval Required. Because Claimant is a Minor, this Agreement is contingent upon Court Approval.
(b) Restricted Account/Annuity. Upon approval, funds payable to or for the benefit of the Minor shall be deposited into (i) a court-restricted account or (ii) an annuity contract approved by the court.
(c) Guardian ad Litem. Claimant shall petition for appointment of a guardian ad litem if required.
3.4 Conditions Precedent. Released Party’s payment obligation is conditioned upon:
(a) Claimant’s execution and delivery of this Agreement;
(b) Receipt of any Court Approval required under Section 3.3;
(c) Delivery of a filed dismissal with prejudice (or, if no suit filed, a signed covenant not to sue) within [__] days after payment.
3.5 Dismissal of Litigation. Within five (5) business days after receipt of the Settlement Amount, Claimant shall file a dismissal with prejudice of any lawsuit arising from the Claim and provide conformed copies to Released Party.
3.6 Tax Treatment. The Parties intend that any amounts paid hereunder on account of personal physical injuries are excludable from Claimant’s gross income under 26 U.S.C. § 104(a)(2). Claimant shall be solely responsible for any contrary tax result.
4. REPRESENTATIONS & WARRANTIES
4.1 Mutual Representations. Each Party represents and warrants that:
(a) Capacity and Authority. It has full legal right, power, and authority to enter into and perform this Agreement.
(b) No Assignment. It has not sold, assigned, or otherwise transferred any Claim or defense released herein.
(c) Independent Counsel. It has had the opportunity to consult with independent legal counsel and fully understands the terms and consequences of this Agreement.
(d) No Reliance. It has not relied on any representation or statement not expressly set forth herein.
4.2 Claimant’s Additional Representations. Claimant represents and warrants that:
(a) Liens. Claimant shall satisfy or resolve all outstanding medical, subrogation, or statutory liens and indemnify Released Parties therefrom.
(b) Bankruptcy. Claimant is not a debtor in any pending bankruptcy proceeding.
4.3 Survival. All representations and warranties survive the Effective Date and payment of the Settlement Amount.
5. COVENANTS & RESTRICTIONS
5.1 Mutual Release.
(a) Released Claims. Effective upon payment of the Settlement Amount, Claimant irrevocably releases and forever discharges the Released Parties from any and all Claims.
(b) Released Defenses. Released Party releases Claimant from any claims arising out of the Incident.
(c) Unknown Claims. The releases in this Section 5.1 extend to Claims the Parties do not know or suspect to exist, which, if known, might have materially affected their decision to enter this Agreement.
5.2 Confidentiality. Except as required by law or court order, the Parties shall keep the terms of this Agreement confidential. Disclosure to tax advisors, insurers, or as necessary to obtain Court Approval does not violate this Section.
5.3 Non-Disparagement. Each Party agrees not to disparage the other regarding matters released herein.
5.4 Further Assurances. The Parties shall execute and deliver additional documents reasonably necessary to effectuate this Agreement.
6. DEFAULT & REMEDIES
6.1 Events of Default. A Party’s failure to perform any obligation under this Agreement within the time specified constitutes a default.
6.2 Notice and Cure. The non-defaulting Party shall give written notice specifying the default. The defaulting Party has ten (10) business days to cure, unless otherwise stated.
6.3 Remedies.
(a) Payment Default. If Released Party fails to timely pay the Settlement Amount, Claimant may (i) file suit to enforce this Agreement and recover the Settlement Amount plus interest at [__] % per annum from the due date, and (ii) recover reasonable attorneys’ fees and costs.
(b) Breach of Confidentiality. Actual damages and equitable relief (including specific performance) are available for breach of Section 5.2.
6.4 Exclusive Remedies. Except for enforcement of this Agreement, the remedies set forth herein are the sole and exclusive remedies of the Parties with respect to the Claim.
7. RISK ALLOCATION
7.1 Indemnification for Liens and Subrogation. Claimant shall indemnify, defend, and hold harmless Released Parties from any third-party lien or subrogation claim asserted against the Settlement Amount.
7.2 Limitation of Liability. Released Party’s total liability to Claimant relating to the Incident shall not exceed the Settlement Amount.
7.3 No Admission of Liability. This Agreement is a compromise of disputed claims and does not constitute an admission of liability by any Party.
7.4 Force Majeure. No Party is liable for delay or non-performance caused by events beyond its reasonable control, provided it gives prompt notice and resumes performance when feasible.
8. DISPUTE RESOLUTION
8.1 Governing Law. This Agreement is governed by and construed in accordance with the substantive laws of the State of Utah, without regard to conflict-of-law principles.
8.2 Forum Selection. The state courts located in [COUNTY], Utah, have exclusive jurisdiction over any dispute arising from or relating to this Agreement, and each Party irrevocably submits to such jurisdiction.
8.3 No Arbitration; No Jury Waiver. The Parties expressly waive any obligation to arbitrate and do not waive the right to trial by jury, consistent with the Parties’ metadata selections.
9. GENERAL PROVISIONS
9.1 Entire Agreement. This Agreement constitutes the entire agreement between the Parties regarding its subject matter and supersedes all prior negotiations or agreements.
9.2 Amendments and Waivers. No amendment or waiver is binding unless in writing and signed by the Parties. A waiver is effective only for the specific instance and purpose given.
9.3 Assignment. No Party may assign its rights or delegate its duties under this Agreement without the prior written consent of the other Party, except as provided in Section 3.2(b) for a qualified assignment of a Structured Settlement.
9.4 Successors and Assigns. This Agreement binds and benefits the Parties and their respective heirs, executors, administrators, successors, and permitted assigns.
9.5 Severability. If any provision is held invalid or unenforceable, the remaining provisions remain in full force, and the invalid provision is reformed to the minimum extent necessary to make it enforceable.
9.6 Counterparts; Electronic Signatures. This Agreement may be executed in counterparts, each of which is deemed an original, and all of which constitute one instrument. Signatures delivered electronically (e.g., via PDF or e-signature platform) are binding.
9.7 Headings. Section headings are for convenience only and do not affect interpretation.
9.8 Costs and Fees. Except as expressly provided, each Party bears its own attorneys’ fees and costs.
10. EXECUTION BLOCK
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.
[CLAIMANT FULL LEGAL NAME]
Signature: ____
Date: _____
[If Minor:]
[NAME], as Parent/Guardian of [MINOR’S NAME], a Minor
Signature: ____
Date: ________
[DEFENDANT FULL LEGAL NAME]
By: ____
Name: ____
Title: ____
Date: ______
[OPTIONAL NOTARY ACKNOWLEDGMENT BLOCK, IF REQUIRED]
EXHIBIT A – STRUCTURED SETTLEMENT PAYMENT SCHEDULE
[Insert periodic payment table: date, amount, payee, annuity issuer, guarantee provisions, etc.]
[// GUIDANCE:
1. Verify Utah procedural requirements for minor settlements (e.g., petition content, hearing notice, restricted account language) and attach as additional exhibits if necessary.
2. Confirm Medicare/Medicaid lien resolution where applicable.
3. Remove bracketed guidance comments before finalization.
]