PERSONAL INJURY SETTLEMENT AGREEMENT

AND MUTUAL RELEASE

(West Virginia)

[// GUIDANCE: This template is drafted for use in resolving personal-injury claims governed by West Virginia tort law. It is intentionally comprehensive; delete bracketed text and tailor clauses to the facts of each matter.]

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
   3.1 Settlement Payment
   3.2 Conditions Precedent
4. Representations & Warranties
5. Covenants & Restrictions
6. Default & Remedies
7. Risk Allocation
8. Dispute Resolution
9. General Provisions
10. Execution Block
11. Schedule 1 – Medicare/Medicaid and Lien Affidavit
12. Schedule 2 – Court Approval for Minor (if applicable)

1. DOCUMENT HEADER

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

1. [CLAIMANT FULL LEGAL NAME], [individual/corporate status], whose address is [ADDRESS] (“Claimant”); and
2. [DEFENDANT/RELEASED PARTY FULL LEGAL NAME], [entity type], organized under the laws of [STATE] with its principal place of business at [ADDRESS] (“Released Party”).

The Claimant and the Released Party are each a “Party” and, collectively, the “Parties.”

Recitals

A. Claimant alleges that he/she suffered personal injuries and damages arising out of the occurrence on or about [DATE OF ACCIDENT] in [LOCATION] (the “Incident”).
B. Released Party denies any liability but desires to resolve all claims arising out of or relating to the Incident without admission of fault.
C. The Parties wish to enter into this Agreement to fully and finally settle the Dispute (as defined below) upon the terms set forth herein.

NOW, THEREFORE, in consideration of the mutual promises, payments, and releases contained herein, and for other good and valuable consideration, the sufficiency of which is hereby acknowledged, the Parties agree as follows:

2. DEFINITIONS

For purposes of this Agreement, the following terms shall have the meanings set forth below. Any capitalized term not defined in this Section shall have the meaning given to it elsewhere in this Agreement.

“Agreement” has the meaning set forth in the preamble.
“Claim(s)” means any and all actions, causes of action, suits, debts, dues, sums of money, accounts, reckonings, bonds, bills, covenants, contracts, controversies, agreements, promises, variances, trespasses, damages, judgments, extents, executions, claims, and demands of whatever kind or nature, whether in law, equity, or otherwise, known or unknown, that any Releasing Party ever had, now has, or may hereafter have against any Released Party arising out of or relating to the Incident.
“Closing Date” means five (5) Business Days after the later of (i) full execution of this Agreement, (ii) delivery of a fully completed Schedule 1, and (iii) satisfaction of all Conditions Precedent.
“Dispute” means the Incident and all Claims arising therefrom.
“Released Parties” means the Released Party together with its current and former parents, subsidiaries, affiliates, shareholders, members, managers, partners, officers, directors, employees, insurers, reinsurers, attorneys, agents, successors, and assigns, each in their respective individual and corporate capacities.
“Releasing Parties” means Claimant and his/her/its heirs, executors, administrators, representatives, successors, and assigns.
“Settlement Amount” has the meaning set forth in Section 3.1(a).
“Structured Settlement” has the meaning set forth in Section 3.1(b).

[// GUIDANCE: Add or delete defined terms as required. Keep terms alphabetical.]

3. OPERATIVE PROVISIONS

3.1 Settlement Payment

a. Lump-Sum. On or before the Closing Date, the Released Party shall pay to Claimant the total sum of [US$ _____] (the “Settlement Amount”) by [wire transfer/cashier’s check] payable to “[LAW FIRM TRUST ACCOUNT] F/B/O [CLAIMANT NAME]”.

b. Structured Settlement (if elected). In lieu of, or in addition to, the lump-sum payment above, the Parties agree to fund a periodic-payment annuity (the “Structured Settlement”) with the following terms:

i. Qualified Assignment Company: [NAME].
ii. Funding Amount: [US$ _] payable to [LIFE COMPANY] to purchase an annuity.
iii. Payment Schedule: [e.g., “US$ __ per month beginning [DATE] for life with 20-year guarantee”].

[// GUIDANCE: Ensure compliance with I.R.C. § 104(a)(2) structured-settlement requirements and any West Virginia insurance regulations. Consult a structured-settlement broker.]

c. Liens & Subrogation. Claimant shall be solely responsible for satisfaction or compromise of all valid medical, governmental (including Medicare/Medicaid/CHIP), workers’ compensation, or other liens related to the Incident. At Closing Claimant shall deliver the affidavit attached hereto as Schedule 1.

3.2 Conditions Precedent

The following are conditions precedent to any obligation of the Released Party to fund the Settlement Amount:

1. Delivery of an executed original of this Agreement by all Releasing Parties;
2. Receipt of the affidavit required under Section 3.1(c);
3. [If Claimant is a minor] Entry of a final, non-appealable order by the [NAME] County Circuit Court approving this settlement pursuant to applicable West Virginia law; and
4. No material breach of any representation, warranty, or covenant by Claimant.

4. REPRESENTATIONS & WARRANTIES

4.1 Mutual Representations. Each Party represents and warrants that:

a. Authority. It has full power and authority to enter into and perform this Agreement.
b. No Assignment of Claims. It has not assigned or transferred, nor agreed to assign or transfer, any Claim or right released herein.

4.2 Claimant’s Additional Representations. Claimant further represents and warrants that:

a. Independent Advice. Claimant has had the opportunity to consult with independent legal counsel and, if applicable, tax advisors regarding this Agreement.
b. Medicare/Medicaid Eligibility. Claimant has accurately disclosed his/her current Medicare and Medicaid status in Schedule 1.
c. No Undisclosed Liens. To Claimant’s knowledge, no liens exist other than those listed in Schedule 1.

4.3 Survival. All representations and warranties shall survive the execution and delivery of this Agreement and the payment of the Settlement Amount.

5. COVENANTS & RESTRICTIONS

5.1 Mutual Release. Effective upon payment of the Settlement Amount, the Releasing Parties irrevocably and unconditionally release, acquit, and forever discharge the Released Parties from any and all Claims.

5.2 Covenant Not to Sue. The Releasing Parties covenant that they will not hereafter file, maintain, or voluntarily assist in any legal action or Claim against any Released Party arising out of or relating to the Dispute.

5.3 Non-Admission. Nothing in this Agreement constitutes, nor shall it be construed as, an admission of liability or wrongdoing by any Party.

5.4 Confidentiality. Except to the extent required by law, the Parties shall keep the terms of this Agreement confidential. Permitted disclosures include communications to tax advisors, attorneys, insurers, and courts necessary to enforce or obtain approval of this Agreement.

5.5 Public Statements. Claimant agrees not to publish or cause to be published any statement that disparages any Released Party regarding the Incident.

5.6 Further Assurances. Each Party shall execute and deliver such further documents and take such further actions as may be reasonably necessary to effectuate the purposes of this Agreement.

6. DEFAULT & REMEDIES

6.1 Events of Default. It shall be an Event of Default if either Party fails to perform any material obligation under this Agreement, including but not limited to:

a. Failure by the Released Party to timely fund the Settlement Amount;
b. Breach by Claimant of the covenant not to sue; or
c. Material misrepresentation in Schedule 1.

6.2 Notice & Cure. The non-defaulting Party shall provide written notice specifying the nature of the default. The defaulting Party shall have ten (10) Business Days to cure.

6.3 Remedies. If the default is not timely cured, the non-defaulting Party may:

a. Seek specific performance;
b. Obtain monetary damages, including reasonable attorneys’ fees and costs; and/or
c. Rescind this Agreement (subject to restitution of consideration).

[// GUIDANCE: Because the Agreement is a release, rescission should be narrowly available; consider deleting in uncomplicated matters.]

7. RISK ALLOCATION

7.1 Mutual Release & Indemnification. The release in Section 5.1 is mutual and is intended to extinguish all liability among the Parties relating to the Dispute. Each Party shall indemnify and hold harmless the other from Claims brought in contravention of this Agreement by the indemnifying Party or its affiliates.

7.2 Limitation of Liability. Except for obligations expressly arising under this Agreement, the maximum aggregate liability of the Released Party to the Claimant shall not exceed the Settlement Amount.

7.3 Force Majeure. No Party shall be liable for delay or failure in performance caused by acts beyond its reasonable control, including acts of God, war, terrorism, or governmental action, provided that such Party gives prompt notice and uses commercially-reasonable efforts to mitigate.

8. DISPUTE RESOLUTION

8.1 Governing Law. This Agreement shall be governed by, and construed in accordance with, the laws of the State of West Virginia without regard to its conflict-of-laws principles.

8.2 Exclusive Forum. Any action to enforce or interpret this Agreement shall be brought exclusively in the Circuit Court of [NAME] County, West Virginia, and each Party hereby submits to the personal jurisdiction of such court.

8.3 Mediation (Optional). Prior to filing suit, the Parties shall attempt in good faith to resolve any dispute through non-binding mediation administered by [MEDIATION SERVICE] in [CITY], West Virginia.

[// GUIDANCE: Arbitration and jury-trial waiver are intentionally omitted per metadata.]

9. GENERAL PROVISIONS

9.1 Entire Agreement. This Agreement constitutes the entire agreement among the Parties with respect to its subject matter and supersedes all prior and contemporaneous understandings.

9.2 Amendments. No amendment or waiver shall be effective unless in writing and signed by all Parties.

9.3 Assignment. Neither Party may assign its rights or delegate its obligations without prior written consent, except that Released Party may assign its payment obligations to a qualified assignment company in connection with a Structured Settlement.

9.4 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 make it enforceable.

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

9.6 Counterparts; Electronic Signatures. This Agreement may be executed in any number of counterparts, each of which is deemed an original, and all of which together constitute one instrument. Signatures delivered via facsimile, PDF, or secure electronic signature platform shall be deemed originals and binding.

10. EXECUTION BLOCK

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

NOTARY ACKNOWLEDGMENT
State of __ )
County of __ ) ss:

On this ___ day of _, 20_, before me, the undersigned, a Notary Public, personally appeared ______, known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument, and acknowledged that he/she/they executed the same.

Notary Public
My commission expires: ____

[// GUIDANCE: West Virginia does not mandate notarization for releases, but notarization enhances enforceability and is recommended, especially for minor settlements.]

11. SCHEDULE 1

Medicare/Medicaid and Lien Affidavit

I, [CLAIMANT/ GUARDIAN NAME], being duly sworn, state:

1. I am [over/under] 65 years of age.
2. I [am/ am not] currently enrolled in Medicare.
3. I [have/ have not] received Medicaid benefits for injury-related expenses.
4. All known liens are listed below (attach additional pages as necessary):

I certify under penalty of perjury that the foregoing is true and correct.

Signature of Affiant
Date: ______

12. SCHEDULE 2

Court Approval for Minor (Complete only if Claimant is a Minor)

1. Petitioner: [PARENT/GUARDIAN NAME] as next friend of [MINOR NAME] (“Minor”).
2. Case No.: [ENTER] in the Circuit Court of [NAME] County, West Virginia.
3. Guardian ad Litem: [NAME], Esq.
4. Proposed Settlement: Lump-Sum US$ _____ and/or Structured Settlement as outlined in Section 3.1(b).
5. Net Proceeds Allocation:
   a. To be deposited into a restricted, interest-bearing FDIC account for the Minor, requiring court order for withdrawal; and/or
   b. Structured Settlement payments directly to the Minor beginning on [DATE].

[// GUIDANCE: Under West Virginia law, settlements on behalf of minors must be approved by the circuit court or fiduciary commissioner. Attach this schedule to the petition for approval and adjust to local practice rules.]

[END OF AGREEMENT]