STRUCTURED SETTLEMENT PROPOSAL

Tax-Free Periodic Payment Settlement Option

SECTION 1: INTRODUCTION

This proposal presents a structured settlement option for the personal injury claim of:

Claimant: [________________________________]
Date of Birth: [________________________________]
Date of Incident: [________________________________]
Case/Claim Number: [________________________________]

A structured settlement converts a lump-sum settlement into a series of tax-free periodic payments tailored to the claimant's specific needs and circumstances.

SECTION 2: SETTLEMENT SUMMARY

A. Total Settlement Value

B. Payment Components

This proposed settlement consists of:

☐ Lump Sum Cash Payment(s): $[________]
☐ Structured Settlement Annuity: $[________] (cost)
☐ Medicare Set-Aside (if applicable): $[________]

SECTION 3: STRUCTURED SETTLEMENT BENEFITS

A. Tax Advantages

Under Internal Revenue Code Section 104(a)(2):

☐ All periodic payments are 100% federal and state income tax-free
☐ Investment earnings within the annuity grow tax-free
☐ No capital gains tax on appreciation
☐ Tax-free treatment extends for the life of the structure

Example Tax Savings:

B. Financial Security

☐ Guaranteed payments regardless of market conditions
☐ Cannot be lost to bad investments
☐ Protected from creditors in many states
☐ Cannot be spent impulsively
☐ Provides long-term financial stability

C. Flexibility

☐ Payments can be designed for any purpose
☐ Timing and amounts customized to claimant's needs
☐ Can include lump sums at specific intervals
☐ Can increase over time to account for inflation
☐ Can provide lifetime income with period certain

SECTION 4: PROPOSED PAYMENT STRUCTURE

A. Immediate Cash Needs

Lump Sum at Closing:

B. Periodic Payments

Monthly Income:

C. Lump Sum Payments

D. Future Medical Fund (if applicable)

SECTION 5: DETAILED PAYMENT SCHEDULE

Proposed Structure #1: [Name - e.g., "Income for Life"]

Annuity Cost: $[________________________________]

Payment Schedule:

Guaranteed Payments: [____] years
Life Contingent: ☐ Yes ☐ No

Total Guaranteed Benefits: $[________________________________]
Total if Life Expectancy Met: $[________________________________]

Proposed Structure #2: [Alternative Option]

Annuity Cost: $[________________________________]

[Include alternative payment schedule]

Proposed Structure #3: [Medicare Set-Aside Funded]

Annuity Cost: $[________________________________]

MSA Payments:

Total MSA Funding: $[________________________________]

SECTION 6: ANNUITY DETAILS

A. Issuing Company

Annuity Issuer: [________________________________]
Rating: [A.M. Best: ___] [S&P: ___] [Moody's: ___]
State of Domicile: [________________________________]

B. Assignment Company

Qualified Assignee: [________________________________]
This assignment complies with IRC Section 130 requirements

C. Payment Terms

First Payment Date: [________________________________]
Payment Frequency: ☐ Monthly ☐ Quarterly ☐ Annual ☐ Other
Payment Day: [________________________________]
Last Guaranteed Payment: [________________________________]
Life Contingent Payments End: Death of Annuitant

D. Beneficiary Provisions

Primary Beneficiary: [________________________________]
Contingent Beneficiary: [________________________________]

Death Before Guaranteed Period Ends:
☐ Remaining guaranteed payments continue to beneficiary
☐ Commuted value paid to beneficiary/estate

SECTION 7: SPECIAL PROVISIONS

A. Cost of Living Adjustment (COLA)

☐ Not included
☐ Included: [___]% annual increase starting [DATE]

B. Rated Age (if applicable)

Due to claimant's medical condition, a rated age may provide enhanced benefits:

Actual Age: [____]
Rated Age: [____]
Benefit Enhancement: [___]%

C. Acceleration Rights

☐ No acceleration permitted (standard)
☐ Limited acceleration available under [circumstances]

D. Assignment/Sale Restrictions

Payments cannot be sold, assigned, or factored to a third party except as permitted by applicable state structured settlement protection acts.

SECTION 8: COMPARISON ANALYSIS

A. Lump Sum vs. Structured Settlement

B. Long-Term Value Comparison

Assuming [___]% investment return for lump sum:

SECTION 9: MEDICARE SET-ASIDE FUNDING

A. MSA Amount

CMS-Approved MSA Amount: $[________________________________]
OR Calculated MSA Amount: $[________________________________]

B. MSA Funding Options

☐ Option 1: Lump Sum Seed + Periodic Payments
- Initial deposit: $[________]
- Annual payments: $[________] for [___] years
- Total funding: $[________]

☐ Option 2: Periodic Payments Only
- Monthly payments: $[________] for [___] years
- Total funding: $[________]

☐ Option 3: Full Lump Sum Funding
- Single payment: $[________]

C. MSA Administration

☐ Self-administered by claimant
☐ Professional MSA administrator: [________________________________]
☐ Annual reporting to CMS required

SECTION 10: REQUIREMENTS FOR STRUCTURED SETTLEMENT

A. Legal Requirements

☐ Defendant/insurer makes payment to qualified assignee
☐ Qualified assignment under IRC Section 130
☐ Claimant has no constructive receipt of funds
☐ Claimant cannot accelerate, defer, or increase payments
☐ Assignment company funds annuity with rated life insurance company
☐ All parties execute required documents

B. Documentation Required

☐ Settlement Agreement (with structured settlement provisions)
☐ Qualified Assignment Agreement
☐ Annuity Application
☐ Release
☐ W-9 for each payee
☐ Court approval (if minor or incapacitated)

SECTION 11: IMPLEMENTATION TIMELINE

SECTION 12: CLIENT ACKNOWLEDGMENTS

I, [CLIENT NAME], acknowledge and understand:

☐ I have been fully informed about both lump sum and structured settlement options.

☐ I understand that once the structured settlement is funded, I cannot change, accelerate, or cash out the periodic payments.

☐ I understand that the periodic payments are guaranteed by the life insurance company, not by the defendant or my attorney.

☐ I have been advised to consult with a tax advisor and/or financial planner regarding this settlement.

☐ I understand the tax advantages of structured settlements under IRC 104(a)(2).

☐ I have voluntarily chosen to receive a portion of my settlement as a structured settlement.

☐ I have had the opportunity to ask questions and have had all questions answered to my satisfaction.

Client Signature: _________________________________ Date: ______________

Printed Name: _________________________________

SECTION 13: STRUCTURED SETTLEMENT BROKER

Broker Name: [________________________________]
Company: [________________________________]
License Number: [________________________________]
Phone: [________________________________]
Email: [________________________________]

This proposal was prepared by a licensed structured settlement consultant.

SECTION 14: QUOTATION VALIDITY

This quotation is valid until: [________________________________]

Rates are subject to change based on market conditions. Final rates will be locked when the annuity is funded.

SECTION 15: SUMMARY

Settlement Package Summary

APPENDIX A: PAYMENT SCHEDULE (DETAILED)

[Attach complete payment schedule from broker]

APPENDIX B: ANNUITY COMPANY INFORMATION

[Attach annuity company ratings and financial information]

APPENDIX C: SAMPLE DOCUMENTS

[Attach sample assignment and settlement documents]