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."

The person responsible for the Settlement Sum is [PAYER LEGAL NAME] ("Payer"), whose signature appears below. The Payer is [Releasee / Insurer / Other: __________].

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 Payer shall pay the Releasor or the recipient authorized under Section 12 the total sum of [AMOUNT IN WORDS] Dollars ($[__________]) (the "Settlement Sum") by [PAYMENT METHOD] no later than [__/__/____]. If a court order or other approval is required for a minor or protected Releasor, payment shall instead be due within [____] days after that approval becomes effective, to the recipient or account it authorizes: [PAYMENT DETAILS / NOT APPLICABLE]. This Release takes effect only when the full Settlement Sum has been received in cleared funds by the Releasor or authorized recipient and any required approval under Section 12 has become effective. The Releasor acknowledges receipt and sufficiency of the consideration only upon that 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. Upon effectiveness under Section 3, the Releasor releases the Releasee, the Insurer, and their respective agents, employees, officers, directors, principals, predecessors, successors, assigns, insurers, and reinsurers (the "Released Parties") from claims the Releasor owns arising out of the Incident, whether known or unknown, suspected or unsuspected, fixed or contingent, to the extent those claims may lawfully be released. This Release does not extinguish a lien or an independent claim owned by another person.

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 to resolve those claims arising from the Incident to the extent they may lawfully be released.

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. For a covered negligence claim, Conn. Gen. Stat. § 52-572h allocates recoverable damages by percentages of negligence and subsection (n) reduces the total award by the released person's percentage of negligence as determined under subsection (f). This paragraph does not determine the outcome of a claim based on a different liability theory. A reservation under § 52-572e(b) also does not itself determine whether a person is a joint tortfeasor or is already included among the Released Parties.

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. If Medicare made conditional payments for injury-related items or services, the parties shall identify the payment and reimbursement record, the responsible primary plan, and the agreed resolution procedure under 42 U.S.C. § 1395y(b)(2). This Release makes no representation that Medicare's interests have been resolved without the supporting record. (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 only derivative claims owned by the Releasor. No spouse, family member, dependent, or other claimant's independent cause of action is released by the Releasor's signature. To settle another person's claim, identify that claimant, claim, and consideration in a signed addendum and have that person sign below as an additional Releasor. Any unlisted or unsigned independent claim remains outside this Release.

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. if signing for the Releasor's own claim, is legally competent to execute this Release; if signing for a minor or protected claimant, holds the authority and any approval identified in Section 12;

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. Conn. Gen. Stat. § 45a-631(b) makes a release by both parents, the parent with legal custody, or the guardian or spouse valid and binding on a minor if the amount does not exceed $10,000 in value. Subsection (a) separately restricts a parent, guardian of the person, or spouse from receiving or using more than $10,000 of a minor's property without appointment as guardian of the estate, subject to its custodial-property exception. Before signature, payment, or dismissal, identify claimant status, settlement value, representative authority, any required court or fiduciary approval, and permitted recipient or account. Attach any required order and authority.

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: [__/__/____]

PAYER (accepting the payment obligation in Section 3)

Signature: [________________________________]
Printed name and capacity: [________________________________]
For: [PAYER LEGAL NAME]
Date: [__/__/____]

ADDITIONAL RELEASOR (only if identified in a signed claim addendum)

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
• Conn. Gen. Stat. § 52-572h — Negligence apportionment
• Conn. Gen. Stat. § 45a-631 — Minor's property and release
• Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)
• CMS — Workers' Compensation Medicare Set Aside Arrangements