Personal Injury Settlement Agreement - Utah

PERSONAL INJURY SETTLEMENT AGREEMENT

Before signing: Complete every applicable exhibit and obtain any approval needed for a claimant who is a minor, lacks capacity, or signs through a representative. Do not file a dismissal until the agreed funding conditions are met.

1. PARTIES AND INCIDENT

This Personal Injury Settlement Agreement (the “Agreement”) is entered into on [__/__/____] by [CLAIMANT FULL LEGAL NAME], of [ADDRESS] (“Claimant”), and [DEFENDANT FULL LEGAL NAME], a [ENTITY TYPE, IF ANY] of [ADDRESS] (“Settling Defendant”). The persons who will actually fund the settlement are identified in Section 3.

The dispute concerns the incident on [__/__/____] at [LOCATION] described as [BRIEF DESCRIPTION] (the “Incident”). Claimant asserts a claim arising from the Incident; Settling Defendant disputes liability. The parties agree to settle only on the completed terms below, without an admission of liability.

2. RELEASE SCOPE

2.1 Released persons. Claimant releases only the following persons and entities, each identified by legal name and capacity: [________________________________] (the “Released Persons”). A category such as “affiliates” or “insurers” does not add unnamed persons unless they are expressly identified here.

2.2 Released claims. On the Release Date in Section 4, Claimant releases the following claims arising from the Incident, including the stated date range and claim categories: [________________________________]. Select one: ☐ known claims only ☐ known and unknown Incident-related claims specifically described here: [________________________________].

2.3 Reserved rights. The following persons, claims, insurance or benefit rights, reimbursement interests, and other rights are expressly reserved: [________________________________]. Under Utah Code § 78B-5-822, releasing one defendant does not discharge another defendant unless the release provides for that result. This Agreement ☐ does not release any other defendant ☐ expressly releases these additional defendants by name: [________________________________].

2.4 Defendant's release, if negotiated. ☐ Settling Defendant also releases Claimant from the following specified claims arising from the Incident: [________________________________]. ☐ No release by Settling Defendant is agreed.

3. SETTLEMENT PAYMENT AND FUNDING

3.1 Amount and payor. [PAYOR NAME AND CAPACITY] shall pay a total of $[________] (the “Settlement Amount”) by [WIRE / CHECK / OTHER] to [PAYEE AND DELIVERY DETAILS] no later than [____] calendar days after every applicable funding condition in Section 3.3 is satisfied. Any allocation to Claimant, counsel, a lienholder, a restricted account, or another payee appears in Exhibit A. Payment is acknowledged only when the promised funds have cleared or the agreed funding instrument has been delivered.

3.2 Periodic payments, if negotiated. ☐ None. ☐ The parties adopt the signed payment schedule in Exhibit B, identifying each payment date, amount, payee, obligor, funding source, and any assignment documents. Exhibit B controls over a general reference to a “structured settlement.” The parties' tax and benefit advisers must review any proposed treatment; this Agreement makes no representation about tax qualification, public benefits, annuity security, or later transfers of payment rights.

3.3 Funding conditions. Select each condition that applies and attach the specified proof:

☐ All required signatures and identified representative-authority documents have been delivered.

☐ The approval order described in Exhibit C has been entered and its funding instructions can be followed.

☐ The lien, reimbursement, and holdback schedule in Exhibit A has been completed.

☐ A claimant-signed dismissal has been delivered to [ESCROW HOLDER / COUNSEL], with instructions barring filing before written confirmation of funding.

☐ Other: [________________________________].

3.4 Taxes and benefits. No tax allocation or public-benefit result is guaranteed by this Agreement. Any negotiated allocation or reporting position must be written in Exhibit A and reviewed by the parties' advisers.

4. RELEASE AND DISMISSAL SEQUENCE

4.1 Release Date. The release in Section 2 becomes effective only upon [CLEARED LUMP-SUM PAYMENT / DELIVERY OF ALL AGREED FUNDING INSTRUMENTS / OTHER SPECIFIED EVENT: __________] (the “Release Date”). A signature alone does not make the release effective before that event.

4.2 Pending case. ☐ No case is pending. ☐ The case caption, court, and number are [________________________________]. For a pending case, [CLAIMANT / COUNSEL] shall file the agreed dismissal within [____] calendar days after written confirmation of the Release Date. The dismissal shall cover only the Released Persons and released claims unless the parties expressly state a broader scope here: [________________________________]. Filing responsibility and costs: [________________________________].

4.3 Failure to fund. If the Release Date has not occurred by [__/__/____], either party may give written notice and invoke the cure and termination terms in Section 6. Until the Release Date occurs, Claimant retains the claims that Section 2 would otherwise release, subject to any court order or separate signed agreement.

5. REPRESENTATIONS AND COOPERATION

5.1 Each signatory represents that the signatory has authority to sign in the capacity stated below. A representative shall identify and attach the order or instrument establishing that authority in Exhibit C. No parent, guardian, fiduciary, or attorney purports to bind a person beyond the authority shown there.

5.2 Claimant identifies in Exhibit A any assignment, pledge, lien, subrogation demand, Medicare or Medicaid interest, benefit-plan claim, attorney claim, or other asserted interest known to Claimant or counsel. This disclosure is not a representation that an unlisted third party has no enforceable rights.

5.3 Each party has had the opportunity to consult independent counsel. The parties shall sign further documents reasonably needed to perform this Agreement, but no later document expands the Released Persons, released claims, or payment obligations unless signed as an amendment under Section 9.

6. DEFAULT AND REMEDIES

6.1 A material failure to perform an express obligation after its conditions are satisfied is a default. The nondefaulting party shall give written notice describing the failure to the address in Section 9. The defaulting party has [____] calendar days after receipt to cure, except for [SPECIFIED EXCEPTIONS: __________].

6.2 If payment is not made after the cure period, Claimant may seek enforcement of this Agreement or terminate it by written notice before payment and pursue any claims not yet released. The parties may specify a negotiated interest rate, fee allocation, or other remedy here after counsel review: [________________________________]. No automatic attorney-fee award, interest rate, damages measure, or equitable remedy is promised by this form.

6.3 If an approval order or funding condition cannot be obtained by [__/__/____], either party may terminate by written notice unless the parties agree in writing to a new date. On termination, any delivered but unfiled dismissal shall be returned or destroyed, subject to an applicable court order.

7. RECOVERY INTERESTS AND RISK ALLOCATION

7.1 Exhibit A must identify each asserted lien, reimbursement or subrogation claim, its basis and status, any holdback or direct payment, the responsible person, and proof required to resolve it. The parties shall specify whether payment is withheld, escrowed, or made directly while a disputed interest remains open. Their private allocation does not change an obligation imposed directly by governing law.

7.2 No general indemnity or settlement-amount cap is created. Any negotiated indemnity must identify the exact third-party claim, indemnifying and protected persons, notice, defense control, settlement authority, exclusions, and liability measure in a signed attachment.

7.3 This Agreement is a compromise of disputed claims. Neither party admits liability, fault, or the amount of any disputed injury.

8. DISPUTES

8.1 Utah substantive law governs this Agreement. An enforcement action may be brought in a court with subject-matter jurisdiction and proper venue. The parties make no advance waiver of jury trial or agreement to arbitrate.

8.2 Unless Section 6.2 or a later signed attachment says otherwise, each party bears its own attorney fees and costs relating to this Agreement, subject to any award a court may make under governing law.

9. GENERAL TERMS

9.1 This Agreement and its completed exhibits are the entire agreement concerning this settlement. An amendment or waiver must be in writing and signed by the affected parties. A waiver applies only to the specific instance stated.

9.2 If a provision is held unenforceable, the remaining provisions continue only to the extent the essential payment and release bargain can still be performed. The parties shall address any material gap in a signed amendment.

9.3 Notices shall be delivered by [METHOD] to Claimant at [ADDRESS / EMAIL] and Settling Defendant at [ADDRESS / EMAIL]. Notice is effective on [DELIVERY EVENT]. A party may change its notice address by written notice.

9.4 This Agreement may be signed in counterparts. The parties shall exchange signed copies by [METHOD]. Any use of electronic signatures or records requires the parties' express agreement and counsel review of applicable law.

10. SIGNATURES

Claimant: [CLAIMANT FULL LEGAL NAME]

Signature: __________________________ Date: [__/__/____]

Representative, if any: [NAME AND CAPACITY]

Signature: __________________________ Date: [__/__/____]

Authority document in Exhibit C: [________________________________]

Settling Defendant: [DEFENDANT FULL LEGAL NAME]

By: _________________________________ Date: [__/__/____]

Name and title: [________________________________]

Additional funding party, if it assumes a payment duty: [NAME / CAPACITY]

By: _________________________________ Date: [__/__/____]

EXHIBIT A — PAYMENT, LIEN, AND RESERVATION SCHEDULE

Reserved rights or special payment allocation: [________________________________]

EXHIBIT B — PERIODIC PAYMENT SCHEDULE (IF ELECTED)

Signed assignment and funding documents attached: [________________________________]

EXHIBIT C — REPRESENTATIVE AUTHORITY OR APPROVAL (IF APPLICABLE)

Claimant's status and representative capacity: [________________________________]

Required order or authority document, court or agency, case number, entry date, and funding instructions: [________________________________]

Attached document: [________________________________]