Legal Bodily Injury Settlement Agreement

LEGAL BODILY INJURY SETTLEMENT AGREEMENT

This Legal Bodily Injury Settlement Agreement (Agreement) is entered into as of the Effective Date: by and between Claimant Name: whose primary address is Claimant Address: and Defendant Name: , represented for settlement purposes by Insurer or Representative: whose primary address is Defendant Address: .

RECITALS

WHEREAS, on or about the date of the incident, Incident Date: , at or near Location of Incident: , Claimant sustained bodily injuries alleged to have been caused by the acts or omissions of the Defendant; and

WHEREAS, Claim Number or File Number: , and the parties desire to fully and finally resolve and settle all disputes, claims, causes of action, and demands arising out of or relating to the incident without further litigation, trial or admission of liability.

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

1. SETTLEMENT CONSIDERATION

1.1 Settlement Amount. Defendant agrees to pay to Claimant the total gross settlement amount of $ (Settlement Amount), subject to the allocations and deductions set forth in this Agreement.

1.2 Method of Payment. Payment shall be made as follows (select one or describe terms): Lump sum Structured settlement
If structured settlement is selected, Structured Terms:

1.3 Payment Date or Schedule. Payment shall be made no later than , or in accordance with the schedule described above. Payment shall be made by check or wire to Payee Name: .

2. RELEASE AND COVENANT NOT TO SUE

2.1 General Release. Upon receipt of the Settlement Amount in accordance with this Agreement, Claimant, on behalf of Claimant and Claimant's heirs, executors, administrators, agents, attorneys, insurers and assigns, fully and forever releases and discharges Defendant, Defendant's affiliates, insurers, predecessors, successors, assigns, agents, employees, officers, directors and any related persons or entities (collectively Released Parties) from any and all claims, demands, causes of action, suits, obligations, losses, liabilities, costs and expenses of every nature and description, whether known or unknown, suspected or unsuspected, arising out of or relating to the Incident, including but not limited to bodily injury, emotional distress, loss of consortium, medical expenses, and past and future damages.

2.2 Covenant Not to Sue. Claimant covenants and agrees not to commence, prosecute or maintain any action or proceeding against any of the Released Parties for any claim released herein, and acknowledges that this covenant is material consideration for the Settlement Amount.

3. NO ADMISSION OF LIABILITY

The parties agree that this Agreement is a compromise of disputed claims and that the payment and other actions provided for herein shall not be construed as an admission of liability, fault or wrongdoing by any party, all such liability being expressly denied.

4. ALLOCATION, ATTORNEY FEES AND LIENS

4.1 Allocation. The parties agree that the Settlement Amount shall be allocated among medical expenses, attorney fees, and claimant damages as follows: Allocation details: . Such allocation is for settlement administration and tax reporting only.

4.2 Adjustment for Liens. To the extent that valid medical liens, statutory obligations, subrogation claims or other third-party claims exist against the Settlement Amount, Claimant shall secure, satisfy or resolve such liens prior to or promptly upon receipt of settlement proceeds and shall hold Defendant harmless from claims by such third parties except as otherwise agreed in writing.

5. REPRESENTATIONS AND WARRANTIES

5.1 Claimant represents and warrants that Claimant has read this Agreement, has the capacity to enter into it, has been advised of any applicable statute of limitations, and has not previously assigned, conveyed, or transferred any right, claim or cause of action released by this Agreement. Claimant further represents that there are no pending claims known to Claimant other than as disclosed in Known Medical Providers or Liens.

5.2 Defendant represents and warrants that it has the full authority to enter into this Agreement and to make the payments and other promises set forth herein without further approval, other than as disclosed to Claimant.

6. DISMISSAL OF LITIGATION

6.1 Dismissal. Upon receipt of payment required under this Agreement, Claimant shall promptly execute and file with the appropriate tribunal a dismissal with prejudice of any action related to the Incident, with each party to bear its own costs except as otherwise provided herein.

7. CONFIDENTIALITY

7.1 Confidentiality Agreement. The parties agree that the terms, amount, and existence of this settlement shall be confidential and shall not be disclosed to any third party except as required by law or as necessary to effectuate settlement, to secure liens, or to obtain legal or accounting advice. Agree to confidentiality: Yes No

8. TAX MATTERS

The parties acknowledge that tax consequences may arise from this settlement. Claimant is solely responsible for reporting and paying any taxes attributable to the payments received hereunder. Neither Defendant nor any Released Party shall have any liability for Claimant's tax obligations.

9. NOTICES

Notices shall be in writing and deemed delivered when personally delivered, delivered via certified mail, return receipt requested, or sent by nationally recognized overnight courier to the addresses above or to such other address as a party designates in writing.

10. MISCELLANEOUS

10.1 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to conflicts of law principles.

10.2 Entire Agreement. This Agreement contains the entire agreement between the parties concerning the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written.

10.3 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 be affected or impaired.

10.4 Amendments; Waiver. No amendment, modification or waiver of any provision of this Agreement shall be effective unless in writing and signed by the party against whom enforcement is sought. No waiver of any breach shall constitute a waiver of any subsequent breach.

10.5 Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument. Facsimile or electronic copies of signatures shall be deemed originals for all purposes.

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