PERSONAL INJURY SETTLEMENT AGREEMENT AND MUTUAL RELEASE

(State of Vermont)

TABLE OF CONTENTS

1. Document Header.............................................................1
2. Definitions..................................................................2
3. Operative Provisions.........................................................4
4. Representations & WarrantIES................................................6
5. Covenants & Restrictions.....................................................7
6. Default & Remedies...........................................................8
7. Risk Allocation.............................................................10
8. Dispute Resolution..........................................................12
9. General Provisions..........................................................13
10. Execution Block............................................................15

[// GUIDANCE: Pagination references may be updated during final formatting.]

1. DOCUMENT HEADER

1.1 Title

Personal Injury Settlement Agreement and Mutual Release

1.2 Parties

This Personal Injury Settlement Agreement and Mutual Release (the “Agreement”) is entered into as of [EFFECTIVE DATE] (the “Effective Date”) by and between:

1. [CLAIMANT FULL LEGAL NAME], an individual with an address at [ADDRESS] (“Claimant”); and
2. [DEFENDANT FULL LEGAL NAME], [entity type, if applicable] with an address at [ADDRESS] (“Defendant”).

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

1.3 Recitals

A. Claimant alleges that on or about [INCIDENT DATE] Claimant sustained personal injuries and damages (the “Incident”) allegedly caused by Defendant’s acts or omissions.
B. The Parties desire to fully and finally settle any and all Claims (as defined below) arising out of or relating to the Incident, without admission of liability, and to avoid the expense and uncertainty of litigation.
C. The consideration provided herein is accepted by each Party in full and complete settlement of all such Claims, subject to the terms and conditions below.

NOW, THEREFORE, in consideration of the mutual covenants and agreements set forth herein and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties agree as follows:

2. DEFINITIONS

For purposes of this Agreement, the following capitalized terms shall have the meanings set forth below. Defined terms include grammatical variations and shall apply equally to the singular and plural forms thereof.

“Approval Order” means a final, non-appealable order issued by a Vermont state court approving this Agreement in connection with a Minor Settlement, if applicable.

“Claim(s)” means any and all past, present, or future claims, causes of action, complaints, petitions, demands, damages, debts, liens, obligations, liabilities, warranties, costs, expenses, attorney fees, or losses of whatever kind or nature, whether known or unknown, asserted or unasserted, suspected or unsuspected, fixed or contingent, in law or in equity, arising out of or in any way connected with the Incident.

“Confidential Information” has the meaning set forth in Section 5.2.

“Defendant” has the meaning assigned in Section 1.2.

“Effective Date” has the meaning assigned in Section 1.2.

“Installment Payment Schedule” means the payment schedule set forth on Exhibit B, if the Settlement Amount is structured.

“Minor” means a person who has not yet reached the age of majority under Vermont law as of the Effective Date.

“Minor Settlement” means any settlement on behalf of a Minor that is subject to court approval under applicable Vermont statutes or court rules.

“Party” or “Parties” has the meaning assigned in Section 1.2.

“Released Party(ies)” means Defendant and its past, present, and future parents, subsidiaries, affiliates, owners, shareholders, members, partners, officers, directors, managers, employees, insurers, reinsurers, attorneys, agents, representatives, predecessors, successors, and assigns.

“Releasing Party(ies)” means Claimant and, where applicable, Claimant’s heirs, representatives, guardians, conservators, executors, administrators, successors, and assigns.

“Settlement Amount” means the total consideration of [US $____] to be paid by or on behalf of Defendant, inclusive of all damages, costs, interest, liens, attorney fees, and expenses.

“Structured Settlement Protection Act” means Vermont’s statute regulating the transfer of structured settlement payment rights, together with any implementing regulations, as amended from time to time.

3. OPERATIVE PROVISIONS

3.1 Settlement Payment

3.1.1 Lump-Sum Payment. Unless Section 3.1.2 applies, Defendant shall pay the Settlement Amount to Claimant (or to Claimant’s counsel per written instructions) within [__] business days after both (a) execution of this Agreement by all Parties and (b) receipt of any required court approvals.
3.1.2 Structured Settlement. Where the Parties elect a structured payment arrangement:
a. The Settlement Amount shall be funded through an annuity contract issued by a qualified assignment company acceptable to Claimant.
b. Exhibit B shall set forth the Installment Payment Schedule, payees, dates, and guarantees.
c. The Parties shall comply with all requirements of the Internal Revenue Code § 104(a)(2) and the Structured Settlement Protection Act.
[// GUIDANCE: Delete Section 3.1.2 if no structure is contemplated.]

3.2 Liens and Subrogation Interests

Claimant shall be solely responsible for identifying, satisfying, and resolving all medical liens, subrogation interests, and reimbursement claims, including without limitation Medicare, Medicaid, TRICARE, ERISA, or private insurer liens. Claimant shall indemnify and hold harmless the Released Parties from any failure to satisfy such obligations in accordance with Section 7.3.

3.3 Conditions Precedent

Defendant’s payment obligations are expressly conditioned upon:
a. Execution of this Agreement by all Parties;
b. Receipt of an Approval Order for any Minor Settlement; and
c. Receipt of all dismissal documents described in Section 6.3.

3.4 Taxes

Each Party shall be responsible for its own tax obligations, if any, arising from payments made pursuant to this Agreement. No Party makes any representation regarding the tax treatment of the Settlement Amount.

4. REPRESENTATIONS & WARRANTIES

4.1 Mutual Authority. Each Party represents and warrants that it has full power and authority to enter into this Agreement and to carry out the transactions contemplated herein.

4.2 Absence of Other Assignments. Claimant represents and warrants that Claimant has not assigned or otherwise transferred any Claim or right released herein to any third party.

4.3 No Reliance. Each Party represents and warrants that, in executing this Agreement, it is relying solely on the terms of this Agreement and the advice of its own counsel, and not on any statement or representation of the other Party not expressly set forth herein.

4.4 Adequate Consideration. Each Party acknowledges that the consideration exchanged is fair, reasonable, and adequate.

4.5 Minor Settlement (if applicable). Claimant’s parent, legal guardian, or conservator represents and warrants that:
a. He or she has the legal capacity and authority to enter into this Agreement on behalf of the Minor; and
b. All actions necessary to obtain court approval will be diligently pursued and completed.

4.6 Survival. The representations and warranties set forth in this Section 4 shall survive the Effective Date.

5. COVENANTS & RESTRICTIONS

5.1 Dismissal of Litigation

Within [__] business days after Defendant’s satisfaction of Section 3.1, Claimant shall file a stipulation of dismissal with prejudice in any litigation arising from the Incident (the “Stipulation of Dismissal”).

5.2 Confidentiality

Unless disclosure is required by law or court order, or for tax or accounting purposes, the Parties shall keep the terms of this Agreement and the Settlement Amount strictly confidential (“Confidential Information”). A disclosing Party shall provide prompt written notice to the other Party prior to any compelled disclosure.

5.3 Non-Disparagement

Neither Party shall make statements, written or oral, that disparage or harm the reputation of the other Party in connection with the Incident or this Agreement. This covenant shall not limit truthful statements made under oath or as otherwise required by law.

5.4 Cooperation

The Parties shall execute and deliver any documents and perform any acts reasonably necessary to effectuate the purposes of this Agreement.

6. DEFAULT & REMEDIES

6.1 Events of Default

The occurrence of any of the following shall constitute an “Event of Default”:
a. Failure of Defendant to timely make any payment when due;
b. Failure of Claimant to timely file the Stipulation of Dismissal; or
c. Any material breach by a Party of its representations, warranties, or covenants herein.

6.2 Notice and Cure

The non-defaulting Party shall provide written notice of the Event of Default. The defaulting Party shall have ten (10) business days to cure monetary defaults and fifteen (15) business days to cure non-monetary defaults.

6.3 Remedies

a. If Defendant defaults and fails to cure, Claimant may reinstate any dismissed litigation or initiate new proceedings to enforce this Agreement, and Defendant shall be liable for the unpaid balance of the Settlement Amount, plus interest at []% per annum, and reasonable attorney fees.
b. If Claimant defaults and fails to cure, Defendant may seek specific performance and shall be entitled to return of any Settlement Amount previously paid, plus interest at []% per annum, and reasonable attorney fees.
c. All remedies herein are cumulative and not exclusive.

7. RISK ALLOCATION

7.1 Mutual Release

a. In consideration of the promises herein, Claimant, on behalf of the Releasing Parties, hereby irrevocably and unconditionally releases and forever discharges the Released Parties from all Claims.
b. Defendant, on behalf of itself and the Released Parties, hereby irrevocably and unconditionally releases Claimant from any claims arising out of the prosecution or settlement of the Incident.
c. The Parties acknowledge that they may later discover facts different from or in addition to those they now know or believe to be true; nonetheless, each Party intends to and does hereby waive and relinquish any right or claim that might arise from such additional or different facts.

7.2 Limitation of Liability

The total liability of Defendant with respect to the Incident shall not exceed the Settlement Amount. In no event shall any Party be liable for consequential, special, punitive, or exemplary damages, except as set forth in Section 6.3.

7.3 Indemnification for Liens

Claimant shall indemnify, defend, and hold harmless the Released Parties from any claims, liens, or demands asserted by any third party arising out of unpaid medical bills, subrogation claims, or other obligations related to the Incident.

7.4 Force Majeure

No Party shall be liable for failure to perform its obligations if such failure results from acts of God, war, terrorism, pandemic, or other causes beyond its reasonable control, provided that the affected Party promptly notifies the other Party and resumes performance as soon as practicable.

8. DISPUTE RESOLUTION

8.1 Governing Law

This Agreement shall be governed by and construed in accordance with the tort and contract laws of the State of Vermont, without regard to its conflict of laws principles.

8.2 Forum Selection

The Parties submit to the exclusive jurisdiction of the state courts located in [COUNTY], Vermont, and waive any objection based on venue or forum non conveniens.

8.3 Jury Waiver

[INTENTIONALLY OMITTED]

8.4 Arbitration

[INTENTIONALLY OMITTED]

9. GENERAL PROVISIONS

9.1 Entire Agreement. This Agreement constitutes the entire agreement between the Parties and supersedes all prior negotiations and agreements, whether written or oral, regarding the subject matter herein.

9.2 Amendments and Waivers. Any amendment or waiver must be in a written instrument signed by all Parties. No waiver of any breach shall be deemed a waiver of any future breach.

9.3 Assignment. No Party may assign or delegate its rights or obligations under this Agreement without the prior written consent of the other Party, except that Defendant may assign payment obligations to a qualified assignment company in connection with a structured settlement.

9.4 Successors and Assigns. This Agreement shall be binding upon and inure to the benefit of the Parties and their respective successors and permitted assigns.

9.5 Severability. If any provision is held unenforceable, the remaining provisions shall remain in full force, and the invalid provision shall be reformed to the limited extent necessary to be enforceable.

9.6 Counterparts; Electronic Signatures. This Agreement may be executed in multiple counterparts, each of which shall be deemed an original, and all of which together shall constitute one instrument. Signatures transmitted electronically (e.g., via PDF or DocuSign) shall be deemed original signatures.

9.7 Interpretation. Headings are for convenience only and shall not affect interpretation. The Parties have participated jointly in the drafting of this Agreement, and no presumption shall arise against any Party by reason of authorship.

9.8 Notices. All notices shall be in writing and delivered by (a) certified U.S. mail (return receipt requested), (b) nationally recognized overnight courier, or (c) email with confirmed receipt, to the addresses set forth below or as updated by notice.

10. EXECUTION BLOCK

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

CLAIMANT

[CLAIMANT NAME]
Date: _______

[If Claimant is a Minor:]

[NAME], as [Parent/Guardian/Conservator] of [MINOR NAME]
Date: _______

DEFENDANT

[AUTHORIZED SIGNATORY NAME]
[Title], [Entity Name]
Date: _______

[// GUIDANCE: Add notary blocks or witness lines if required by Vermont practice or court approval orders.]

EXHIBIT A

(Stipulation of Dismissal with Prejudice)
[Attach jurisdiction-specific dismissal form.]

EXHIBIT B

(Installment Payment Schedule)
[Include only if structured settlement chosen.]

[// GUIDANCE:
1. Ensure lien resolution language complies with Medicare Secondary Payer Act practices.
2. For Minor Settlements, file a petition under the applicable Vermont rule for court approval.
3. If an annuity is used, coordinate with a licensed structured settlement broker and verify compliance with the Vermont Structured Settlement Protection Act before entering any factoring arrangement.
4. Confirm whether local court requires notarization or guardian ad litem report.
]