PERSONAL INJURY SETTLEMENT AGREEMENT

AND MUTUAL RELEASE

(Commonwealth of Virginia)

[// GUIDANCE: Replace all bracketed placeholders before execution. Delete guidance comments in final clean version.]

I. DOCUMENT HEADER

1. Parties
   This Personal Injury Settlement Agreement and Mutual Release (this “Agreement”) is entered into as of [EFFECTIVE DATE] (the “Effective Date”) by and between:
   • [CLAIMANT FULL LEGAL NAME], an individual with an address at [ADDRESS] (“Claimant”); and
   • [DEFENDANT FULL LEGAL NAME], a [ENTITY TYPE & STATE OF FORMATION] with its principal place of business at [ADDRESS] (“Defendant”).

Claimant and Defendant are sometimes referred to individually as a “Party” and collectively as the “Parties.”

2. Recitals
   A. A dispute arose out of an incident that occurred on or about [DATE OF INCIDENT] in [LOCATION] (the “Incident”).
   B. Claimant alleges that Defendant’s acts or omissions caused personal injuries and related damages (the “Action”).
   C. Defendant denies liability but desires to resolve all Claims (as defined below) without admission of fault.
   D. The Parties wish to fully, finally, and forever settle the Action and all related Claims on the terms set forth herein, with the intention that this Agreement be binding and enforceable under Virginia law.

3. Consideration & Mutual Promises
   In consideration of the mutual covenants, releases, and payments described below, and for other good and valuable consideration, the sufficiency and receipt of which are acknowledged, the Parties agree as follows.

TABLE OF CONTENTS

1. Document Header ............................................. I
2. Definitions ................................................. II
3. Operative Provisions ........................................ III
4. Representations & Warranties ................................ IV
5. Covenants & Restrictions .................................... V
6. Default & Remedies .......................................... VI
7. Risk Allocation ............................................. VII
8. Dispute Resolution .......................................... VIII
9. General Provisions .......................................... IX
10. Execution Block ............................................ X

II. DEFINITIONS

The following capitalized terms have the meanings set forth below. Undefined capitalized terms have the meanings ascribed elsewhere in this Agreement.

“Action” – The civil action, pre-litigation claim, or potential lawsuit arising from the Incident.
“Claims” – Any and all claims, demands, causes of action, damages, losses, costs, expenses, and liabilities of every kind, whether known or unknown, suspected or unsuspected, that arise out of or relate to the Incident.
“Court” – The Circuit Court of [CITY/COUNTY], Virginia, or, for minor settlements, any court of competent jurisdiction required to approve this Agreement under applicable Virginia law.
“Effective Date” – As set forth in Section I.1.
“Minor” – A person who has not reached the age of majority under Va. law.
“Released Parties” – Defendant, its past, present, and future parents, subsidiaries, affiliates, insurers, reinsurers, officers, directors, shareholders, employees, agents, successors, and assigns, and any other persons or entities who could be liable for the Claims.
“Settlement Amount” – The total monetary consideration to be paid under Section III.1.
“Structured Settlement” – A periodic payment arrangement complying with applicable state and federal structured-settlement regulations, if elected under Section III.2.

III. OPERATIVE PROVISIONS

1. Payment of Settlement Amount
   (a) Defendant shall pay Claimant the aggregate sum of $[NUMERIC] (“Settlement Amount”) as follows:
   (i) Lump-Sum Cash Payment: $[AMOUNT] payable within [___] business days after the Effective Date; and
   (ii) [Optional] Structured Settlement Payments as detailed in Section III.2.
   (b) All payments shall be made by wire transfer or certified funds to [CLAIMANT’S COUNSEL TRUST ACCOUNT INFORMATION].
   (c) The Settlement Amount is inclusive of all attorneys’ fees, medical liens, costs, and subrogation interests.
   [// GUIDANCE: Insert lienholder identification if any Medicare, Medicaid, ERISA, or private liens exist.]

2. Structured Settlement (Optional)
   (a) If elected, the Parties shall establish a Structured Settlement providing periodic payments set forth in Schedule 1.
   (b) Defendant may assign its payment obligations to a qualified assignment company consistent with Internal Revenue Code § 130 and applicable Virginia structured-settlement regulations.
   (c) Claimant agrees to execute any documents reasonably necessary to effectuate the structured arrangement.

3. Minor Settlement Approval
   (a) If Claimant (or any beneficiary) is a Minor, this Agreement is expressly conditioned on approval by the Court as required by Virginia law.
   (b) The Parties shall cooperate to:
   (i) Petition the Court for appointment of a guardian ad litem (if not already appointed);
   (ii) Obtain judicial approval of the Settlement Amount, the method of payment, and the disposition of proceeds; and
   (iii) Establish any court-ordered trusts, annuities, or custodial accounts.
   (c) If the Court refuses to approve the settlement, this Agreement shall be void ab initio, and neither Party shall be bound hereby.

4. Dismissal of Action
   Within five (5) business days after Claimant receives the Settlement Amount (or the initial payment under a Structured Settlement), Claimant shall file a stipulation of dismissal with prejudice in any pending lawsuit, and shall not refile or prosecute the Action or any Claims.

5. Conditions Precedent
   Defendant’s payment obligations are conditioned on:
   (a) Receipt of an executed IRS Form W-9 from Claimant or Claimant’s counsel;
   (b) Receipt of fully executed originals of this Agreement;
   (c) Court approval, if applicable under Section III.3.

IV. REPRESENTATIONS & WARRANTIES

1. Mutual Authority
   Each Party represents that it has full right, power, and authority to enter into and perform this Agreement and that all requisite corporate, partnership, or individual approvals have been obtained.

2. No Assignment
   Each Party represents that it has not assigned or transferred any Claim that is the subject of this Agreement.

3. Independent Counsel
   Each Party represents that it has been advised to seek, and has had the opportunity to obtain, independent legal counsel before executing this Agreement.

4. Understanding & Voluntariness
   Each Party represents that it has read this Agreement in its entirety, understands its terms, and enters into it voluntarily without duress or undue influence.

5. Survival
   The representations and warranties in this Article IV shall survive execution and delivery of this Agreement.

V. COVENANTS & RESTRICTIONS

1. Confidentiality
   Except as required by law or court order, the Parties shall not disclose the terms of this Agreement or the Settlement Amount.
   [// GUIDANCE: Consider adding carve-outs for tax advisors, insurers, and regulatory filings.]

2. Non-Disparagement
   Each Party agrees not to make or publish any statements that disparage the other Party or Released Parties regarding the Incident or this settlement.

3. Liens & Subrogation
   Claimant shall satisfy or resolve all medical, governmental, or private liens and indemnify Released Parties against any lien-holder claims arising from the Incident.

4. Tax Matters
   Claimant acknowledges that Defendant makes no representation regarding the tax treatment of the Settlement Amount and agrees to rely solely on its own tax advisors.

VI. DEFAULT & REMEDIES

1. Events of Default
   (a) Defendant’s failure to timely pay any portion of the Settlement Amount;
   (b) Claimant’s breach of confidentiality, non-disparagement, or dismissal obligations.

2. Notice & Cure
   The non-breaching Party shall give written notice specifying the default. The breaching Party shall have five (5) business days to cure a monetary default and ten (10) business days to cure any other default.

3. Remedies
   (a) Specific Performance – The non-breaching Party may seek an order compelling performance.
   (b) Monetary Damages – Limited to the Settlement Amount plus documented costs, interest, and reasonable attorneys’ fees.
   (c) Rescission – For material, uncured breaches that defeat the essential purpose of this Agreement, the non-breaching Party may elect rescission and restoration of the status quo ante.

VII. RISK ALLOCATION

1. Mutual Release & Covenant Not to Sue
   (a) Claimant, on behalf of itself and its heirs, executors, administrators, successors, and assigns, irrevocably releases and forever discharges the Released Parties from any and all Claims.
   (b) Defendant, on behalf of itself and its affiliates, releases Claimant from any and all claims arising out of or relating to the Incident.
   (c) Each Party covenants not to initiate or maintain any action, suit, or proceeding with respect to released matters.

2. No Admission of Liability
   This Agreement is a compromise of disputed claims; neither Party admits liability, negligence, or wrongdoing.

3. Limitation of Liability
   In no event shall either Party be liable to the other for any amount exceeding the Settlement Amount, except for enforcement of this Agreement.

4. Force Majeure
   Neither Party shall be liable for delay or failure in performance due to acts of God, war, terrorism, pandemic, or government order, provided the affected Party gives prompt notice and resumes performance as soon as reasonably practicable.

VIII. DISPUTE RESOLUTION

1. Governing Law
   This Agreement shall be governed by and construed in accordance with the substantive laws of the Commonwealth of Virginia, without regard to conflicts-of-law principles.

2. Forum Selection
   The Parties consent to the exclusive jurisdiction of the state courts located in [CITY/COUNTY], Virginia for any action to enforce or interpret this Agreement.

3. Arbitration & Jury Trial
   The Parties expressly agree that (i) no arbitration provision applies, and (ii) nothing herein constitutes a waiver of the right to a jury trial.

IX. GENERAL PROVISIONS

1. Amendment & Waiver
   No amendment or waiver of any provision of this Agreement is effective unless in writing and signed by all Parties. A waiver on one occasion is not a waiver on any subsequent occasion.

2. Assignment
   No Party may assign its rights or delegate its obligations under this Agreement without the prior written consent of the other Party, except that Defendant may assign payment obligations in connection with a Structured Settlement.

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

4. Severability
   If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force, and the invalid provision shall be reformed to the minimum extent necessary to render it lawful and enforceable.

5. Integration
   This Agreement constitutes the entire agreement between the Parties regarding its subject matter and supersedes all prior negotiations or agreements, whether written or oral.

6. Counterparts; Electronic Signatures
   This Agreement may be executed in multiple counterparts, each of which is deemed an original, and all of which together constitute one instrument. Signatures delivered by facsimile, PDF, or other electronic means are deemed original signatures.

X. EXECUTION BLOCK

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

[// GUIDANCE: Add additional signature blocks for insurers, guardians ad litem, or parents of minors as necessary.]

NOTARY ACKNOWLEDGMENT (if required)

State of Virginia
County/City of _______

On this _ day of _, 20__, before me, the undersigned notary public, personally appeared ______, known to me or satisfactorily proven to be the person(s) whose name(s) are subscribed to the within instrument and acknowledged that they executed the same for the purposes therein contained.

Notary Public: ___
My Commission Expires: _______

SCHEDULE 1 – STRUCTURED SETTLEMENT PAYMENT SCHEDULE (Attach if applicable)

[// GUIDANCE: Ensure the annuity contract or assignment agreement is attached or referenced herein.]