Personal Injury Settlement Agreement - Wyoming

PERSONAL INJURY SETTLEMENT AGREEMENT AND RELEASE

Wyoming

I. PARTIES, CLAIM, AND STATUS

This Personal Injury Settlement Agreement and Release (the “Agreement”) is made as of [__/__/____] by and among:

1. Claimant: [FULL LEGAL NAME AND ADDRESS]
2. Paying Party: [FULL LEGAL NAME AND ADDRESS]
3. Other Released Party, if any: [FULL LEGAL NAME AND RELATIONSHIP]
4. Insurer or Administrator, if any: [NAME AND CLAIM NUMBER]

A. Incident and Claim

Claimant asserts claims arising from the Incident. The other Parties deny liability and enter this compromise to resolve the claims identified in this Agreement without an admission.

B. Claimant Status Gate

Select one:

☐ Adult claimant with legal capacity. Claimant is at least age 18 and has not been adjudicated incompetent.

☐ Minor or incompetent claimant. Article IX applies. This Agreement is conditioned on compliance with current Wyoming Uniform District Court Rule 909 and the approval order identified there.

☐ Capacity or representative authority is uncertain. No release or payment will proceed until Wyoming counsel resolves the issue and records the result in Article IX.

II. SETTLEMENT CONSIDERATION

A. Total Consideration

The total settlement consideration is [AMOUNT IN WORDS] dollars ($[____]) (the “Settlement Amount”), allocated for payment as follows:

B. Payment Method

Payment will be made by [WIRE / CHECK / OTHER] to [PAYEE AND VERIFIED DELIVERY INSTRUCTIONS].

Cleared-Funds Date means the date the Settlement Amount required to be delivered directly under this Agreement becomes finally available and is not subject to reversal, except for any amount placed in an agreed holdback under Article VI.

C. Structured or Periodic Funding

☐ No structured or periodic payment is included.

☐ A structured or periodic payment is included solely under the specialist-prepared documents listed in Schedule 1.

This template does not state that a proposed annuity, assignment, tax treatment, or later transfer complies with federal or Wyoming law. Those conclusions must come from the identified specialist documents and current-law review.

III. CONDITIONS AND FUNDING SEQUENCE

A. Conditions Before Funding

The Paying Party's funding obligation is subject only to the conditions checked and completed below:

☐ All required Parties signed this Agreement.

☐ Representative authority documents listed in Schedule 2 were delivered.

☐ Rule 909 court approval and related orders identified in Article IX were entered.

☐ Payee identity and delivery instructions were independently verified.

☐ The claim-resolution and holdback schedule in Article VI was completed.

☐ Other negotiated condition: [DESCRIPTION]

Funding Deadline: [NUMBER] calendar days after [THE LAST SPECIFIED CONDITION / FIXED DATE].

B. No Circular Tender

Any release required before payment is delivered through this signed Agreement. Claimant is not required to file a dismissal before the required Settlement Amount is delivered unless Schedule 3 states a counsel-approved escrow sequence.

C. Failure of a Condition

If a condition cannot be satisfied by [DATE], the Parties will follow this selected result:

☐ Extend by written agreement.

☐ Return tendered documents and terminate this Agreement without a release becoming effective.

☐ Submit the issue to the court in the pending action.

☐ Other: [DESCRIPTION]

IV. RELEASE AND RESERVED MATTERS

A. Released Claims

Upon the Cleared-Funds Date and satisfaction of any Rule 909 approval condition, Claimant releases the Released Parties named in Schedule 4 from claims that:

1. belong to Claimant;
2. arise from the Incident; and
3. fall within the selected scope below.

☐ Claims known on the Effective Date.

☐ Known and unknown claims, including later consequences of injuries arising from the Incident, after specific counsel review.

☐ Limited scope described here: [DESCRIPTION]

B. Released Parties

Only the persons and entities named or objectively identified in Schedule 4 are Released Parties. Delete any category that is not intended or supported by the settlement authority.

C. Reserved Claims and Rights

The following are not released:

This Agreement does not release a claim that Claimant lacks authority to release.

D. Paying Party Release

☐ No release by the Paying Party.

☐ On the Cleared-Funds Date, the Paying Party releases only the claims against Claimant described in Schedule 5.

V. REPRESENTATIONS

Each signing Party represents only that:

1. the signer has authority to bind the named Party;
2. the Party has reviewed the Agreement and signs voluntarily;
3. no assignment of a released claim is known except as disclosed in Schedule 6; and
4. no promise outside this Agreement is being relied upon to define the settlement consideration or release.

Claimant also states that Claimant had the opportunity to obtain independent legal, medical, tax, benefits, and financial advice.

No Party represents that this Agreement produces a particular tax, benefit, lien, reimbursement, insurance, or structured-payment result.

VI. THIRD-PARTY CLAIMS, HOLDING, AND DISTRIBUTION

The Parties and counsel must investigate actual third-party interests rather than assume that every obligation belongs solely to Claimant or that a blanket indemnity resolves it.

A. Holdback

The amount of $[____] will be held by [HOLDER] solely for [IDENTIFIED MATTER] until [RELEASE CONDITION]. Any balance will be distributed to [PAYEE].

B. Limited Reimbursement Term

☐ No indemnity or reimbursement obligation is included.

☐ The limited reimbursement obligation in Schedule 7 applies only to the identified third-party matter, only after notice and an opportunity to participate in the response, and is not a duty to defend unrelated claims.

VII. PENDING ACTION AND DISMISSAL

☐ No action is pending.

☐ An action is pending as identified in Article I. After the Cleared-Funds Date and satisfaction of any approval condition, the Parties will execute and file the dismissal or other closing document described in Schedule 8.

No dismissal procedure, prejudice term, cost allocation, or retained-jurisdiction result is implied by this template. Schedule 8 must use the current rule and order applicable to the actual court and action.

VIII. CONFIDENTIALITY AND COMMUNICATIONS

A. Confidentiality

☐ No contractual confidentiality obligation.

☐ The confidentiality terms in Schedule 9 apply, subject to listed disclosures for legal compliance, tax and financial advice, insurers, benefit programs, lien resolution, court approval, enforcement, and persons identified there.

B. Non-Disparagement

☐ No non-disparagement term.

☐ The narrow, mutual term in Schedule 9 applies to the speakers, subject matter, exceptions, and remedy stated there.

No confidentiality or non-disparagement term restricts truthful statements required by law, subpoena, court order, or the Rule 909 approval process.

IX. MINOR OR INCOMPETENT CLAIMANT — RULE 909

Complete only if Article I identifies a minor or incompetent claimant.

A. Proceeding and Representative

B. Rule 909 Packet

☐ Petition discloses the claimant's age and sex, claim, incident facts, persons involved, settlement calculation, and information needed to evaluate fairness.

☐ Personal-injury information addresses the nature and extent of injury and whether it is temporary or permanent, with a succinct medical-issues statement.

☐ Attorney employment, relationship, compensation source, and expected compensation are disclosed.

☐ Required representative attendance, supporting reports, service, and copies are addressed.

☐ Proposed counsel fees and expenses are presented for approval or fixing by the court.

☐ Distribution directs the balance to a qualified conservatorship of the estate, consistent with the court's order.

C. Effect

For a protected claimant, no release, discontinuance, final distribution, or attorney-fee deduction becomes effective merely through private signatures. The operative terms are subject to the court's Rule 909 orders.

X. BREACH AND ENFORCEMENT TERMS

A. Negotiated Notice

☐ No contractual cure period.

☐ Before an enforcement filing, written notice describing the alleged breach must be delivered to [RECIPIENT] at [ADDRESS], with [NUMBER] days to respond, except when emergency relief or a filing deadline requires earlier action.

B. Available Relief

The enforcing Party may request relief available under this Agreement and applicable law. This Agreement does not automatically award specific performance, statutory-rate interest, attorney fees, costs, punitive damages, or a stipulated judgment.

☐ The Parties negotiated the limited remedy terms in Schedule 10 after Wyoming counsel review.

C. No Settlement-Amount Liability Cap

The Settlement Amount is consideration for the release; it is not an automatic cap on liability for a later breach of this Agreement.

XI. GENERAL TERMS

1. Entire Agreement. This Agreement and its completed schedules state the settlement terms.
2. Amendment. An amendment must be in a writing signed by the Parties affected.
3. No Admission. Settlement is a compromise and not an admission of liability.
4. Severability. If a provision is unenforceable, the remainder remains effective to the extent consistent with the settlement bargain and any required court order.
5. Governing Law. Wyoming law governs, subject to any federal or other law that cannot be displaced by agreement.
6. Forum. No exclusive forum is selected unless Schedule 10 identifies a court with a grounded basis and the Parties expressly agree.
7. No Automatic Fees or Indemnity. No prevailing-party fee, blanket lien indemnity, force-majeure excuse, or general liability cap applies unless a completed schedule states a narrow counsel-reviewed term.

Electronic Records and Signatures

Select one:

☐ The Parties agree to conduct this settlement transaction by electronic means. Electronic records and signatures may be used subject to Wyo. Stat. §§ 40-21-105 and 40-21-107 and other applicable law.

☐ Wet-ink signatures are required.

Electronic transmission does not by itself prove signer identity, authority, receipt, or satisfaction of a separate court-order requirement; preserve the agreed verification record.

XII. SIGNATURES

Each signer confirms review of the completed Agreement and schedules and signs in the stated capacity.

Claimant

Signature: ____________________________________

Printed Name: [NAME]

Date: [__/__/____]

Claimant Representative, if applicable

Signature: ____________________________________

Printed Name and Capacity: [NAME / CAPACITY]

Authority Document or Order: [REFERENCE]

Date: [__/__/____]

Paying Party

Signature: ____________________________________

Printed Name: [NAME]

Title / Capacity: [TITLE]

Date: [__/__/____]

Other Released Party, if required

Signature: ____________________________________

Printed Name and Capacity: [NAME / CAPACITY]

Date: [__/__/____]

SCHEDULE INDEX

Current-law verification note: the current Uniform Rules for District Courts PDF states that Rule 909 was amended April 21, 2026, effective June 22, 2026. Wyoming's current official Title 40 PDF contains the electronic-transaction consent and recognition provisions quoted above. The bill-index results for § 40-21-107 were loose matches and supplied no later amendment requiring an overlay to the current official title text.