Release of All Claims

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, liens, subrogation interests, 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.

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. EFFECT ON OTHER TORTFEASORS / RESERVATION OF CLAIMS

Select one:

☐ Reservation (release of settling parties only). This Release discharges only the Released Parties named herein. The Releasor expressly reserves all claims against any other person or entity who may be liable for the Incident. Pursuant to AS 09.16.040, this Release shall not discharge any other joint tortfeasor, but the Releasor's claim against any non-settling tortfeasor shall be reduced to the extent provided by that statute, and the Released Parties are discharged from all liability for contribution.

☐ General release (all tortfeasors). This Release is intended to and does discharge all persons and entities liable or claimed to be liable for the Incident, whether named herein or not.

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 Lien Satisfaction. The Releasor warrants that the Releasor is solely responsible for the payment and satisfaction of all liens, subrogation interests, and claims of every kind — including hospital, physician, health-insurer, ERISA-plan, Medicare, Medicaid, TRICARE, Veterans Affairs, and workers' compensation liens — arising out of or related to treatment for the Incident, out of the Settlement Sum.

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. The Parties have considered and protected Medicare's interests under the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b). Any Medicare conditional payments will be satisfied from the Settlement Sum, and a Medicare Set-Aside arrangement, if required, is described in [________________________________].

7.3 Indemnity. The Releasor agrees to indemnify, defend, and hold harmless the Released Parties from any and all liens, subrogation claims, conditional-payment demands, penalties, and double-damages claims (including those of Medicare/Medicaid) asserted by any person or entity arising out of the Incident or the Releasor's medical treatment.

8. DERIVATIVE, SPOUSAL, AND CONSORTIUM CLAIMS

This Release includes and discharges all derivative claims arising out of the Incident, including any claim for loss of consortium, loss of services, society, or companionship, and any claim for medical or other expenses incurred on behalf of the Releasor. The undersigned spouse, if any, joins in and is bound by this Release as to any such derivative 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 OR INCAPACITATED PERSON'S COMPROMISE

☐ The Releasor is a minor or incapacitated person. This Release is executed by [NAME OF PARENT / GUARDIAN / NEXT FRIEND], as [parent / guardian / next friend] of [MINOR/WARD NAME], and is subject to and conditioned upon approval by a court of competent jurisdiction pursuant to Alaska R. Civ. P. 90.2. This Release shall not be binding on the minor or incapacitated person unless and until so approved.

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 09.16.040 — Release or covenant not to sue; effect on claim and contribution: https://www.akleg.gov/basis/statutes.asp#09.16.040
• AS 09.16.010 — Right of contribution among joint tortfeasors: https://www.akleg.gov/basis/statutes.asp#09.16.010
• Tommy's Elbow Room, Inc. v. Kavorkian, 754 P.2d 243 (Alaska 1988): https://law.justia.com/cases/alaska/supreme-court/1988/s-1662-1.html
• 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://www.law.cornell.edu/uscode/text/42/1395y