Personal Injury Settlement Agreement - Virginia

PERSONAL INJURY SETTLEMENT AGREEMENT

AND NEGOTIATED RELEASE

(Commonwealth of Virginia)

I. DOCUMENT HEADER

1. Parties
   This Personal Injury Settlement Agreement and Negotiated 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 settle only the claims and parties identified in the completed release schedule below.

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.
“Effective Date” – As set forth in Section I.1.
“Released Parties” – Only the persons and entities listed by legal name in Schedule A.
“Settlement Amount” – The total monetary consideration to be paid under Section III.1.

Scope Gate

This base form is for a competent adult settling the adult's own private personal-injury claim. Stop and use a counsel-approved addendum or different form if the settlement involves a minor, an incapacitated person, an estate or wrongful-death claimant, a class or aggregate settlement, workers' compensation, bankruptcy, public benefits, Medicare or Medicaid interests, a governmental claimant, a structured or periodic payment, a transfer of payment rights, or court approval.

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) Other agreed payment: [DESCRIBE OR STATE NONE].
   (b) All payments shall be made by wire transfer or certified funds to [CLAIMANT’S COUNSEL TRUST ACCOUNT INFORMATION].
   (c) Holdbacks, fees, costs, liens, reimbursement claims, and subrogation interests are handled only as completed in Schedule B.

2. Approval or Special-Process Condition
   This base form assumes no court or agency approval. If counsel identifies any required approval or special process, attach Schedule C stating the condition, responsible filer, required documents, funding sequence, and consequence if approval is denied.

3. Dismissal of Action
   Within [____] business days after [confirmed funding / escrow confirmation / other trigger], Claimant shall deliver or file the dismissal document identified here: [CASE, COURT, DOCUMENT, AND RESPONSIBLE FILER].

4. 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) Completion of every approval or special-process condition stated in Schedule C, if any.

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.

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, Reimbursement Claims, and Holdbacks
   The Parties allocate notice, verification, negotiation, holdback, payment, reporting, and residual-risk responsibilities only as stated in Schedule B. No blanket claimant indemnity applies unless separately drafted after counsel reviews each identified claimant and governing regime.

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. Potential Breach
   A Party asserting breach shall identify the specific unperformed obligation and supporting facts.

2. Negotiated Notice and Cure
   ☐ No contractual cure period. ☐ Cure period: [NUMBER] days after notice delivered by [METHOD], subject to the following exceptions: [DESCRIBE].

3. Remedies
   No remedy, interest rate, fee award, rescission right, injunction, or damages cap is automatic under this Agreement. The Parties select only counsel-approved remedies here: [DESCRIBE OR STATE NONE BEYOND AVAILABLE LAW].

VII. RISK ALLOCATION

1. Mutual Release & Covenant Not to Sue
   (a) In exchange for the completed consideration, Claimant releases each Released Party listed in Schedule A from the Claims described in Schedule A.
   (b) Defendant releases Claimant only from the claims described here: [DESCRIBE OR STATE NO DEFENDANT RELEASE].
   (c) Claims, persons, entities, benefits, liens, reimbursement rights, and obligations listed as reserved in Schedule A or B are not released.

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

3. No Implied Risk Allocation
   This Agreement contains no settlement-amount liability cap, force-majeure excuse, automatic indemnity, or waiver of nonwaivable rights. Any negotiated allocation must be stated expressly and approved by counsel.

VIII. DISPUTE RESOLUTION

1. Governing Law
   Selected governing law, subject to counsel's conflict-of-laws review: [VIRGINIA / OTHER].

2. Forum Selection
   ☐ No contractual forum selected. ☐ Selected forum after jurisdiction and venue review: [COURT AND LOCATION].

3. Procedure Rights
   This Agreement does not require arbitration or waive a jury right unless a separate conspicuous, counsel-approved provision is attached and signed.

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 and Signature Method
   ☐ Wet-ink single original. ☐ Counterparts or electronic signatures authorized by the following counsel-approved term after party, transaction, and platform review: [DESCRIBE].

X. EXECUTION BLOCK

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

SCHEDULE A — RELEASED PARTIES, RELEASED CLAIMS, AND RESERVED MATTERS

SCHEDULE B — FEES, COSTS, LIENS, REIMBURSEMENT CLAIMS, AND HOLDBACKS

SCHEDULE C — APPROVALS AND SPECIAL PROCESSES

☐ None after counsel review.

☐ Required approval or special process: [DESCRIBE CONDITION, FILER, DOCUMENTS, DEADLINE, FUNDING SEQUENCE, AND FAILURE CONSEQUENCE].