Release of All Claims - Alaska

RELEASE OF ALL CLAIMS

(State of Alaska)

1. PARTIES

This Release of All Claims (this "Release") is made and entered into on [__/__/____] by and between:

For purposes of this Release, "Released Parties" means the Releasee(s) named above and each of their respective past, present, and future agents, servants, employees, officers, directors, principals, partners, insurers (including the Insurer), reinsurers, predecessors, successors, heirs, assigns, parent and affiliated entities, attorneys, and representatives.

2. RECITALS

A. On or about [__/__/____], at or near [________________________________] (the "Incident"), the Releasor allegedly sustained bodily injuries, damages, and losses arising out of [describe incident — e.g., motor vehicle collision, premises condition].

B. The Releasor has asserted or may assert a claim for damages against the Releasee(s) arising out of the Incident. The claim is identified as Claim No. [________________________________] under Policy No. [________________________________] issued by the Insurer.

C. The Parties desire to fully and finally compromise, settle, and resolve all claims arising out of the Incident, without further litigation and without any admission of liability.

3. CONSIDERATION

In consideration for this Release, the Releasee(s) and/or the Insurer shall pay to the Releasor the total sum of [AMOUNT IN WORDS] Dollars ($[____]) (the "Settlement Sum"), receipt and sufficiency of which the Releasor acknowledges upon payment. The Releasor agrees that the Settlement Sum constitutes the entire consideration for this Release and that no other promise or inducement has been made.

4. RELEASE OF ALL CLAIMS (KNOWN AND UNKNOWN)

4.1 General Release. In consideration of the Settlement Sum, the Releasor hereby releases, acquits, and forever discharges the Released Parties from any and all claims, demands, actions, causes of action, damages, costs, loss of services, expenses, and compensation of every kind and nature whatsoever, whether in contract or in tort, whether known or unknown, suspected or unsuspected, anticipated or unanticipated, fixed or contingent, that the Releasor now has or may hereafter have arising out of or in any way connected with the Incident, including all known and unknown injuries and all future developments, consequences, or complications thereof. This Release does not purport to discharge rights held independently by a lienholder, subrogee, or other third party.

4.2 Unknown Claims. The Releasor understands and agrees that this Release extends to claims the Releasor does not know or suspect to exist at the time of execution, and that the discovery of additional or different facts or injuries shall not affect the finality of this Release. The Releasor expressly assumes the risk that the injuries or damages may be more numerous or more serious than now known or expected.

5. PERSONS RELEASED / RESERVATION OF CLAIMS

5.1 Persons released. This Release discharges the Released Parties defined in Section 1 and the following additional persons, if any, expressly identified by name and relationship to the Incident: [NONE / NAMES AND ROLES: ________________________________________________].

5.2 Reservation. The Releasor reserves claims against persons not released under Section 5.1. The Parties do not stipulate to a fixed dollar-for-dollar settlement credit against any nonsettling person. Fault allocation and any resulting judgment are governed by applicable law, including AS 09.17.080(a) and (d).

6. NO ADMISSION OF LIABILITY

It is understood and agreed that this settlement is a compromise of a doubtful and disputed claim, that payment is not to be construed as an admission of liability on the part of any of the Released Parties, and that the Released Parties expressly deny liability and intend merely to avoid the expense and uncertainty of litigation.

7. MEDICAL LIENS, SUBROGATION, AND MEDICARE / MEDICAID (MSP) ACKNOWLEDGMENT

7.1 Asserted-Interest Inventory. Identify each asserted interest, holder, amount, dispute status, and proposed payoff, holdback, escrow, or direct-payment instruction in [ATTACHMENT / DETAILS]. Listing an interest does not admit its validity, amount, priority, or allocation.

7.2 Medicare Secondary Payer. The Releasor represents that the Releasor [☐ is / ☐ is not] a Medicare beneficiary and [☐ has / ☐ has not] applied for Social Security disability or Medicare benefits. Identify any Medicare conditional payments, the responsible primary plan, and the final reimbursement amount or pending dispute under 42 U.S.C. § 1395y(b) in [ATTACHMENT / DETAILS]. State the agreed payment or holdback procedure in that attachment. Any future medical expense arrangement requires a separate case-specific determination; this form does not declare a Medicare Set-Aside automatically required.

7.3 Asserted-Interest Resolution. Record each asserted lien, reimbursement, or recovery interest and the agreed payoff, direct payment, holdback, escrow, or dispute procedure in [ATTACHMENT / DETAILS]. No blanket indemnity, defense duty, penalty shift, or attorney-fee obligation is created by this form; any negotiated allocation must be separately stated and reviewed.

8. DERIVATIVE, SPOUSAL, AND CONSORTIUM CLAIMS

If a spouse or another person holds an independent derivative claim arising out of the Incident, that person must be identified below and sign to release that person's own claim. The Releasor's signature alone does not purport to release another person's independent claim.

9. REPRESENTATIONS AND WARRANTIES

The Releasor represents and warrants that the Releasor:

a. has not assigned, pledged, or transferred any claim released herein to any other person or entity;
b. is of legal age and sound mind and competent to execute this Release (see Section 12 if the Releasor is a minor or incapacitated person);
c. has read this Release in full, understands its terms, and signs it voluntarily;
d. has had the opportunity to consult with independent legal counsel of the Releasor's choosing; and
e. is not relying on any statement or representation not contained in this Release.

10. CONFIDENTIALITY (OPTIONAL)

☐ The Parties agree to keep the terms and amount of this settlement confidential, except as required by law, for tax or lien-resolution purposes, or to enforce this Release.

11. GOVERNING LAW

This Release shall be governed by and construed in accordance with the laws of the State of Alaska, without regard to its conflict-of-laws principles. If any provision is held unenforceable, the remaining provisions shall continue in full force and effect.

12. MINOR'S COMPROMISE / OTHER CAPACITY REVIEW

☐ The Releasor is a minor. This Release is executed by [NAME OF PARENT / GUARDIAN], as [parent / guardian] of [MINOR NAME], and is subject to and conditioned upon court approval pursuant to Alaska R. Civ. P. 90.2(a). It is not effective as to the minor unless and until the court approves it.

☐ The Releasor is an adult whose capacity or representative authority requires review. Authorized representative, source of authority, and any required approval: [________________________________]. Do not execute for that adult until the authority and procedure are confirmed.

Court / Case No. (if approved): [________________________________]

13. EXECUTION

IN WITNESS WHEREOF, the Releasor has executed this Release of All Claims on the date set forth below.

RELEASOR

Signature: _______________________________
Printed Name: [________________________________]
Date: [__/__/____]

STATE OF ALASKA
[________________] JUDICIAL DISTRICT

Before me, the undersigned authority, personally appeared [________________________________], who is known to me or who produced [________________________________] as identification, and who acknowledged before me that he/she executed the foregoing Release of All Claims freely and voluntarily for the purposes therein expressed.

Sworn to and subscribed before me this [____] day of [____________], [____].

_______________________________
Notary Public
My Commission Expires: [__/__/____]

Sources and References

• AS 09.17.080 — Fault allocation and several liability: https://www.akleg.gov/basis/statutes.asp?media=print&secStart=09.17.080&secEnd=09.17.080
• Alaska R. Civ. P. 90.2 — Settlement of a minor's claim: https://courts.alaska.gov/rules/docs/civ.pdf
• Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b): https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395y&num=0&edition=prelim