C&R Agreement

COMPROMISE AND RELEASE AGREEMENT

This Compromise and Release Agreement (the Agreement) is entered into as of the Effective Date set forth below between Claimant Name: (hereinafter "Claimant") and Employer / Insurer Name: (hereinafter "Employer/Insurer"). Effective Date: .

RECITALS

WHEREAS, Claimant alleges that on or about Date of Injury: Claimant sustained certain injuries and has asserted claims arising out of that incident, including Claim or Case No.: .

WHEREAS, Employer/Insurer disputes liability for the claimed damages and has denied or questioned the extent of the compensability and the amount of damages claimed; and

WHEREAS, the parties desire to settle and resolve all disputes, claims, and causes of action between them as set forth in this Agreement in order to avoid the expense, delay and uncertainty of litigation.

NOW, THEREFORE, in consideration of the mutual covenants and promises contained herein, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

In this Agreement, unless the context otherwise requires: (a) "Released Claims" means any and all claims, demands, causes of action, obligations, liabilities, and damages of any kind or nature, whether known or unknown, asserted or unasserted, arising out of or relating to the incident or subject matter described in the Recitals; (b) "Payment Date" means the date on which the Settlement Payment is issued by Employer/Insurer pursuant to Section 2.

2. SETTLEMENT PAYMENT

Employer/Insurer shall pay to Claimant, in full and final settlement of all Released Claims, the total sum of: $ (the "Settlement Payment"). The Settlement Payment shall be payable as follows: .

3. PAYMENT INSTRUCTIONS; TAX TREATMENT

All payments will be made payable to: and sent to: . The parties acknowledge and agree that the tax characterization of any portion of the Settlement Payment shall be determined in accordance with applicable law and that each party shall be responsible for its own tax obligations unless otherwise specified herein: .

4. RELEASE

Upon receipt of the Settlement Payment, Claimant, on behalf of Claimant and Claimant's heirs, executors, administrators, successors and assigns, hereby fully and forever releases and discharges Employer/Insurer and its past and present parents, subsidiaries, affiliates, predecessors, successors, insurers, attorneys, agents, employees and representatives (collectively, the "Released Parties") from any and all claims, liabilities, demands, actions or causes of action of any nature whatsoever, whether known or unknown, suspected or unsuspected, arising out of or in any way connected with the incident described in the Recitals through the Effective Date.

This release includes, but is not limited to, claims for medical expenses, temporary or permanent disability, lost wages, emotional distress, punitive damages, attorney fees, and costs arising from the subject incident.

5. NO ADMISSION OF LIABILITY

The parties expressly agree that this Agreement and the actions taken in accordance with it do not constitute an admission of liability, fault, or wrongdoing by any party, and such matters are expressly denied. This Agreement is entered into for the purpose of compromise and avoidance of litigation.

6. REPRESENTATIONS AND WARRANTIES

Each party represents and warrants to the other that it has full authority to enter into this Agreement, that no other person or entity's consent is required for its execution, and that the person executing this Agreement on behalf of any party is duly authorized to do so. Claimant represents that Claimant has not assigned any of the Released Claims to any third party.

Claimant acknowledges that Claimant has been advised of the right to consult with and obtain the advice of legal counsel of Claimant's choice concerning this Agreement, and either has consulted counsel or knowingly waived that right: Counsel Name: .

7. COOPERATION

The parties agree to cooperate and execute such further instruments and documents and to take such further actions as may be reasonably necessary to effectuate the terms and intent of this Agreement.

8. CONFIDENTIALITY

The terms and amount of this Agreement shall be kept confidential by the parties and shall not be disclosed to any third party except as required by law or to the parties' accountants, attorneys, or insurers who agree to maintain confidentiality. Exceptions to confidentiality: .

9. INDEMNITY

Claimant shall indemnify and hold harmless the Released Parties from and against any claims by third parties arising from any act or omission of Claimant occurring prior to the Effective Date and relating to the matters released herein, except where prohibited by law.

10. NOTICES

Notices shall be delivered in writing by hand delivery, nationally recognized overnight courier, or certified mail (return receipt requested), and shall be effective upon receipt.

11. AMENDMENTS; WAIVER

No amendment, modification, or waiver of any provision of this Agreement shall be effective unless in writing and signed by both parties. The waiver of any breach or default shall not constitute a waiver of any subsequent breach or default.

12. COUNTERPARTS

This Agreement may be executed in two or more counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument. Signatures transmitted by electronic means shall have the same force and effect as original signatures.

13. SEVERABILITY

If any provision of this Agreement is held to be invalid, illegal or unenforceable in any respect, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby.

14. GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of without giving effect to conflict of law principles that would result in the application of the laws of another jurisdiction.

15. ENTIRE AGREEMENT

This Agreement constitutes the entire agreement and understanding between the parties concerning the subject matter hereof and supersedes any and all prior or contemporaneous understandings, agreements, negotiations and representations, whether written or oral, regarding such subject matter.

MISCELLANEOUS

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