Release of All Claims - Connecticut

RELEASE OF ALL CLAIMS

(State of Connecticut)

1. PARTIES

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

Releasor: [________________________________], an individual residing at [________________________________] ("Releasor"); and

Releasee(s): [________________________________], residing/located at [________________________________] ("Releasee"), together with the Releasee's insurer, [INSURER NAME] ("Insurer"), Claim No. [____________], Policy No. [____________].

The Releasor and the Releasee are each a "Party" and together the "Parties."

2. RECITALS

A. On or about [__/__/____], at or near [LOCATION OF INCIDENT], an incident occurred in which the Releasor allegedly sustained bodily injury, property damage, and other losses (the "Incident").

B. The Releasor asserts that the Incident and resulting losses were caused by the Releasee. The Releasee denies liability and disputes the nature and extent of the Releasor's alleged damages.

C. The Parties desire to fully and finally compromise, settle, and resolve all disputed claims arising out of the Incident, without further litigation, upon the terms set forth in this Release.

3. CONSIDERATION

In consideration for this Release, the Releasee and/or 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 is the sole and entire consideration for this Release and that no other promise or representation has been made except as expressly stated herein.

4. RELEASE OF ALL CLAIMS (KNOWN AND UNKNOWN)

4.1 General Release. The Releasor, on behalf of the Releasor and the Releasor's heirs, executors, administrators, successors, and assigns, hereby irrevocably and unconditionally releases, acquits, and forever discharges the Releasee, the Insurer, and their respective agents, servants, employees, officers, directors, principals, predecessors, successors, heirs, assigns, insurers, and reinsurers (collectively, the "Released Parties") from any and all claims, demands, actions, causes of action, suits, liens, damages, costs, loss of services, expenses, attorneys' fees, and compensation of every kind and nature whatsoever, in law or in equity, whether known or unknown, suspected or unsuspected, anticipated or unanticipated, fixed or contingent, and whether now existing or arising in the future, which the Releasor now has or may hereafter have arising out of, relating to, or in any way connected with the Incident.

4.2 Unknown Claims Acknowledged. The Releasor understands and agrees that this Release extends to claims the Releasor does not know or suspect to exist in the Releasor's favor at the time of execution, including the consequences of injuries that are presently unknown or that may later develop or be discovered. The Releasor expressly assumes the risk of such unknown claims and intends this Release to be a complete and final bar to all such claims arising from the Incident.

5. EFFECT ON OTHER TORTFEASORS; RESERVATION OF RIGHTS

5.1 Statutory Rule. Under Conn. Gen. Stat. § 52-572e(b), a release by an injured person of one joint tortfeasor "does not discharge the other tortfeasors unless, and only to the extent, the release so provides."

5.2 Reservation (select one).

☐ Release limited to the Released Parties only. This Release discharges only the Released Parties named in Section 4.1. The Releasor expressly reserves all claims and rights of recovery against any and all other persons or entities who are or may be liable for the Releasor's injuries arising from the Incident, including non-settling joint tortfeasors.

☐ Release of all tortfeasors. The Parties intend this Release to discharge all persons and entities liable for the Incident, whether or not named herein.

5.3 Apportionment. The Parties acknowledge that, under Conn. Gen. Stat. § 52-572h, liability among multiple defendants is apportioned according to each party's proportionate share of negligence, and that the Releasor's recovery against any non-settling party may be reduced accordingly.

6. NO ADMISSION OF LIABILITY

This Release is a compromise of disputed claims. Neither the payment of the Settlement Sum nor the execution of this Release shall be construed as an admission of liability or wrongdoing by any Released Party, all such liability being expressly denied.

7. LIENS, MEDICARE / MEDICAID, AND ASSERTED-INTEREST RESOLUTION

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 acknowledges the obligations imposed by the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b), and represents that Medicare's interests have been adequately considered and protected. (Check if applicable.)
☐ The Releasor is a Medicare beneficiary.
☐ The Releasor is not currently a Medicare beneficiary. Expected Medicare enrollment, if known: [DATE / UNKNOWN]. The WCMSA 30-month review criterion is not a liability-settlement safe harbor.
☐ A liability future-medical allocation of [$__________] has been documented after matter-specific legal and medical review. It is not represented as CMS reviewed or approved.

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 AND CONSORTIUM CLAIMS

The Releasor releases, on behalf of the Releasor and the Releasor's spouse, family members, heirs, and dependents, all derivative claims arising from the Incident, including claims for loss of consortium, loss of services, loss of society, and bystander emotional distress. Any spouse asserting a loss-of-consortium claim shall execute this Release in the space provided.

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 is legally competent to execute this Release;

c. has been afforded the opportunity to consult independent legal counsel of the Releasor's choosing and either has done so or has knowingly waived that right;

d. has read this Release in its entirety, understands its terms, and executes it freely and voluntarily, without duress or undue influence; and

e. relies solely upon the Releasor's own judgment and not upon any representation by the Released Parties as to the nature or permanence of the Releasor's injuries.

10. CONFIDENTIALITY (OPTIONAL)

☐ Confidentiality elected. The Parties agree to keep the terms and amount of this settlement confidential and shall not disclose them except as required by law, to professional advisors, or to enforce this Release.

☐ Confidentiality not elected.

11. GOVERNING LAW

This Release shall be governed by and construed in accordance with the laws of the State of Connecticut, without regard to its conflict-of-laws principles. Any dispute arising under this Release shall be brought in the courts of the State of Connecticut.

12. MINOR'S / INCAPACITATED PERSON'S COMPROMISE

Minor or protected claimant gate. Do not rely on a fixed dollar threshold in this form. Before signature, payment, or dismissal, state-specific counsel must identify the claimant status, gross and net settlement, pending-action status, representative authority, required court or fiduciary approval, permitted recipient or account, and current governing authority. Attach the approval order and authority; until all required steps are complete, no release by or for that claimant becomes operative.

Minor's name: [________________________________] Date of birth: [__/__/____]
Parent/Guardian executing on behalf of minor: [________________________________]
Probate Court (if applicable): [________________________________]
Order/Decree date (if applicable): [__/__/____]

13. EXECUTION

The Releasor has read this Release, fully understands it, and signs it voluntarily.

RELEASOR

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

SPOUSE (consortium claim, if applicable)

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

NOTARY ACKNOWLEDGMENT

State of Connecticut )
County of [____________] ) ss.

On this [____] day of [__________], [____], before me personally appeared [________________________________], known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing instrument, and acknowledged that he/she executed the same for the purposes therein contained.

Signature: [________________________________]
Notary Public / Commissioner of the Superior Court
My commission expires: [__/__/____]

Sources and References

• Conn. Gen. Stat. § 52-572e — Release of joint tortfeasor (Justia)
• Conn. Gen. Stat. § 52-572h — Comparative negligence; apportionment (CGA Chapter 925)
• Conn. Gen. Stat. § 45a-631 — Receipt/use of minor's property; release (Justia)
• Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)