Is an electronic signature valid?

Yes. Electronic signatures are legally valid in the United States when they meet ESIGN (15 U.S.C. §7001) and applicable state UETA standards; ensure intent, consent, attribution, and retention to establish enforceability.

Do I need a notary or witness?

Not always. Requirements depend on state law and whether the assignment must be recorded or used to clear a lien. Check local rules and use notarization where recordation or added evidentiary weight is needed.

How do I fix a mistake after signing?

Prepare a corrective amendment or mutual rescission signed by all parties. For clerical errors, attach a signed addendum describing the correction and effective date to avoid disputes.

Can the assignor revoke the assignment?

Revocation ability depends on the agreement language and consideration. Include express revocation terms or conditions; absent consent, unilateral revocation is generally not effective post-assignment.

What about HIPAA and medical records?

When medical information is shared to support the claim, include HIPAA-authorized releases and obtain a BAA if a vendor processes PHI; retain records per 45 CFR §164.530(j).

Who receives the executed copies?

Provide signed originals or certified electronic copies to the assignor, assignee, counsel for each party, any lienholder identified, and the settlement or escrow agent handling funds.

Electronic Signature
Templates
Legal
Legal PI Assignment Agreement

Legal PI Assignment Agreement

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

LEGAL PI ASSIGNMENT AGREEMENT

This Assignment Agreement (the Agreement) is made as of Effective Date: by and between Assignor Name: , an individual residing at Assignor Address: (Assignor), and Assignee Name: , Entity Type: Individual Corporation LLC Partnership , with principal address Assignee Address: (Assignee). Assignor and Assignee are individually referred to as a Party and collectively as the Parties.

RECITALS

WHEREAS, Assignor is the injured party and has asserted or may assert a claim for personal injuries arising from the incident described as Claim Description: occurring on Date of Injury: in the matter captioned Case Name: , Court/Jurisdiction: , Claim Number (if any): .

WHEREAS, Assignor wishes to assign to Assignee certain rights to recover proceeds from such personal injury claim as security for consideration to be provided by Assignee, and Assignee is willing to accept such assignment on the terms and conditions set forth in this Agreement.

WHEREAS, the Parties intend that this Agreement memorialize the assignment, the consideration for the assignment, the duties of each Party with respect to pursuit and disposition of recovery, and the procedures for remittance of proceeds.

NOW, THEREFORE

In consideration of the mutual covenants and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties agree as follows:

1. DEFINITIONS

For purposes of this Agreement: (a) "Assigned Rights" means Assignor's present and future right, title and interest in and to any and all recovery, settlement proceeds, judgments, causes of action, claims, or proceeds resulting from or relating to the Claim described above; (b) "Proceeds" means any monies or other consideration actually received by Assignor or such Party from any settlement, judgment, award, compromise, or other disposition of the Claim; and (c) "Costs" means reasonable litigation costs, court costs, and documented disbursements paid by Assignee on behalf of Assignor in connection with the prosecution of the Claim.

2. ASSIGNMENT

Assignor hereby irrevocably assigns, transfers and conveys to Assignee all Assigned Rights, whether now existing or hereafter arising, to the extent necessary to secure the obligations described in Section 3. This assignment includes the right to receive, collect, endorse and take possession of Proceeds to the extent of Assignee's interest under this Agreement.

3. CONSIDERATION; OBLIGATIONS

As consideration for the assignment, Assignee shall provide to Assignor the following (select applicable): Advance Amount: and/or Fee Percentage: % of net recovery. Assignee's obligation to provide such consideration shall be set forth in a separate written disbursement schedule attached or agreed contemporaneously to this Agreement.

Upon receipt of any Proceeds, Assignor shall promptly remit to Assignee an amount equal to Assignee's interest under this Agreement, less any agreed items to be deducted prior to remittance, within Remittance Period (days): days of receipt. If Proceeds are received jointly in Assignor's and another's names, Assignor shall endorse or otherwise execute any documentation reasonably necessary to effectuate collection and remittance to Assignee.

4. REPRESENTATIONS AND WARRANTIES

Assignor represents and warrants that: (a) Assignor is the sole owner of the Assigned Rights as of the Effective Date; (b) the Assigned Rights are not subject to any prior assignment, lien, pledge, security interest, or encumbrance except as disclosed in Prior Liens/Encumbrances: ; (c) Assignor has full authority to execute and deliver this Agreement and to perform its obligations hereunder; and (d) there are no actions, claims, or proceedings pending that would impair Assignor's ability to transfer the Assigned Rights other than those disclosed in Pending Actions: .

Assignee represents and warrants that it has full corporate or individual power and authority to enter into this Agreement, that any funds advanced will be used as stated to prosecute or secure the Claim, and that it will act in good faith in collection and remittance of Proceeds.

5. COOPERATION; AUTHORITY

Assignor agrees to cooperate fully with Assignee and any counsel designated by Assignee, including executing authorizations, releases, endorsements, and documents reasonably necessary to prosecute the Claim and effectuate this assignment. Assignor grants Assignee a limited power of attorney solely to endorse, collect and receive Proceeds assigned hereunder and to take ministerial actions necessary to effectuate the transfer of funds. Such power is revocable only by mutual written agreement or as set forth herein.

6. INDEMNIFICATION

Each Party shall indemnify, defend and hold harmless the other Party from and against any losses, liabilities, claims, costs, or expenses (including reasonable attorneys' fees) arising from a breach of that Party's representations, warranties or covenants contained in this Agreement, except to the extent such losses arise from the indemnified Party's own gross negligence or willful misconduct.

7. TAXES AND WITHHOLDING

Each Party is solely responsible for reporting its own taxable income and for payment of all taxes legally due in connection with any amounts received under this Agreement. Assignee may withhold amounts required by law and shall provide Assignor with documentation of any amounts withheld.

8. NOTICES

All notices, requests, demands and other communications hereunder shall be in writing and shall be deemed given when delivered personally, sent by nationally recognized overnight courier, or three (3) business days after deposit in the United States mail, postage prepaid, certified or registered, return receipt requested, addressed to the Parties at the addresses below or at such other address as each Party may designate by notice.

Assignor Notices Address Assignee Notices Address

9. DEFAULT; REMEDIES

If Assignor fails to cooperate, misrepresents facts, or refuses to remit Proceeds to Assignee as required, Assignee shall have all remedies available at law or in equity including, without limitation, specific performance, injunctive relief, and the recovery of attorneys' fees and costs incurred in enforcing this Agreement. No single remedy shall be exclusive and the exercise of any remedy shall not preclude pursuit of others.

10. GOVERNING LAW; VENUE

This Agreement shall be governed by and construed in accordance with the laws of the State of Governing State: without regard to conflict of laws principles. The Parties submit to the exclusive jurisdiction of the state and federal courts located in County: for disputes arising out of or relating to this Agreement.

11. ENTIRE AGREEMENT; AMENDMENT; WAIVER

This Agreement constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements and understandings, whether written or oral. This Agreement may be amended or modified only by a written instrument executed by both Parties. No failure or delay by any Party in exercising any right shall operate as a waiver, and any waiver must be in writing.

12. SEVERABILITY; INTERPRETATION

If any provision of this Agreement is held to be invalid, illegal or unenforceable in any respect, such provision shall be severed and the remainder of this Agreement shall remain in full force and effect. The headings in this Agreement are for convenience only and shall not affect interpretation.

13. COUNTERPARTS; EXECUTION

This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument. Signatures delivered by electronic means shall be deemed original signatures for all purposes.

Additional Terms or Notes

Assignor (Print Name):

By (Signature):

Date:

Assignee (Print Name):

By (Signature):

Date:

What the Legal PI Assignment Agreement Is and When It’s Used

A Legal PI Assignment Agreement documents the transfer of rights to a personal injury claim or proceeds from one party (the assignor) to another (the assignee). It records the scope of rights assigned, any retained obligations, consideration exchanged, and allocation of lien or subrogation claims. Typical uses include assignments to medical providers, settlements allocated to third parties, and transfers between plaintiffs and insurers. The agreement clarifies payment routing, tax treatment, and who may enforce the claim while preserving evidence needed for settlement or litigation.

Why a Clear Assignment Agreement Matters for Personal Injury Claims

A properly drafted assignment protects parties by spelling out what is transferred, how proceeds are handled, and which liens or subrogation rights survive. Clear terms reduce disputes, help satisfy medical liens, and support enforceability in settlement and payment processing.

Who Typically Prepares and Signs This Agreement

Each signer should confirm authority to bind their organization and review lien and tax consequences before executing.

Injured party assigning a portion of settlement proceeds to a provider or third party for payment of services.
Medical provider or lienholder accepting assignment to secure payment from a settlement or award.
Attorney or claims administrator documenting allocation, closing instructions, and lien satisfaction.

Representative Signers and Their Roles

Alex Rivera, Counsel

In-house or outside counsel commonly reviews assignability, drafts the assignment language to preserve client confidentiality, and confirms that the assignment does not violate prior retainer agreements or statutory anti-assignment provisions.

Dana Price, Claims Manager

Claims managers or adjusters verify assignment scope, confirm settlement routing, and coordinate lien reduction or payoff instructions to ensure funds the assignee expects are released according to the settlement terms.

Core Elements to Include in a Professional PI Assignment Agreement

A complete agreement clearly identifies parties, scope, consideration, assignment effective date, lien/subrogation treatment, and execution formalities to minimize later disputes.

Parties

Full legal names and entity types for assignor and assignee, including mailing and service addresses to establish identity and contact for notices.

Scope

Describe precisely which claims, causes of action, and settlement proceeds are assigned; exclude or reserve rights where appropriate to avoid ambiguity.

Consideration

State the dollar amount or method of remuneration being exchanged for the assignment, or confirm nominal consideration where applicable.

Lien/Subrogation

Address existing medical liens, insurer subrogation rights, and obligations to satisfy or allocate lien payoffs from settlement proceeds.

Effective Date

Specify the MM/DD/YYYY effective date and whether assignment is prospective, retroactive, or contingent on settlement.

Execution

Include signature blocks, notarization or witness requirements (if any), and details on delivering or recording the signed instrument.

Step-by-Step: How to Complete and Execute the Agreement

Complete the form in sequence, confirm identities, then sign and deliver or notarize according to jurisdictional requirements.

01

1. Gather documents: Collect the underlying claim file and lien statements.
02

2. Draft terms: Populate parties, scope, consideration, and effective date.
03

3. Review obligations: Confirm lien payoffs and tax implications with counsel.
04

4. Execute and deliver: Sign, notarize if needed, and send counterparts to all parties.

How to Configure an Online Signing Workflow

Set up the document routing and authentication to match the parties’ needs and preserve an audit trail for enforceability.

Field	Configuration
Signer Order	Set sequential or parallel signing based on who must sign first.
Authentication	Use email + SMS code for medium assurance; KBA for higher assurance.
Notifications	Enable automatic reminders and signed copy distribution.
Audit Trail	Capture IP, timestamp, and signature method for each action.

Where to Send and How Signed Copies Are Distributed

Decide destination addresses and delivery order before finalizing the agreement to avoid payment routing errors and ensure lien resolution.

Primary Delivery: Send executed original to assignee for recordkeeping.
Copy to Counsel: Provide signed copies to both parties’ attorneys.
Lienholders Notified: Send copies to lienholders for payoff instructions.
Settlement Agent: Deliver to escrow or settlement agent for disbursement.

Digital Signing and Technical Requirements

Preserve a copy of the signed file and the platform's certificate of completion to meet ESIGN/UETA retention and evidentiary needs.

Document Formats: PDF or DOCX preferred
Authentication: Email + SMS code
Audit Trail: IP, timestamp, actions

Typical Timing and Deadlines to Track

Track execution dates and downstream deadlines such as lien reduction windows, settlement disbursement, and tax reporting to avoid penalties.

Effective Date Deadline:

Determine date the assignment takes effect upon signing or specified event.

Lien Notification:

Notify lienholders promptly to obtain payoff figures before settlement.

Settlement Disbursement:

Coordinate with escrow for the date funds will be released.

Tax Reporting Window:

Provide payee information for 1099 reporting where required.

Record Retention Start:

Begin retention on execution or final disbursement date.

Common Mistakes to Avoid When Preparing an Assignment

Vague scope language that fails to identify the exact claim or date of injury, creating ambiguity about what was assigned.
Failing to address existing medical liens and subrogation, which can cause disputes over settlement allocation.
Using inconsistent party names or incorrect taxpayer IDs, delaying disbursement and 1099 reporting.
Omitting signature formalities or notarization where required, risking unenforceability or creditor challenges.

Risks and Consequences of an Improper Assignment

Assignment Voidable: Court may refuse enforcement

Lien Disputes: Delay or reduction in proceeds

Tax Exposure: Incorrect 1099 treatment

Breach Claims: Contractual liability risk

Regulatory Noncompliance: HIPAA or state privacy fines

Payment Delays: Settlement agent holds funds

eSignature Vendor Pricing and Feature Snapshot

Compare starting price and common feature considerations across providers. signNow is listed first per comparative convention.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes, plan-dependent	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Frequently Asked Questions About Legal PI Assignment Agreements

Answers to common legal and practical questions about validity, signatures, notarization, and post-execution steps.

Need help? Contact support

Is an electronic signature valid?
Yes. Electronic signatures are legally valid in the United States when they meet ESIGN (15 U.S.C. §7001) and applicable state UETA standards; ensure intent, consent, attribution, and retention to establish enforceability.
Do I need a notary or witness?
Not always. Requirements depend on state law and whether the assignment must be recorded or used to clear a lien. Check local rules and use notarization where recordation or added evidentiary weight is needed.
How do I fix a mistake after signing?
Prepare a corrective amendment or mutual rescission signed by all parties. For clerical errors, attach a signed addendum describing the correction and effective date to avoid disputes.
Can the assignor revoke the assignment?
Revocation ability depends on the agreement language and consideration. Include express revocation terms or conditions; absent consent, unilateral revocation is generally not effective post-assignment.
What about HIPAA and medical records?
When medical information is shared to support the claim, include HIPAA-authorized releases and obtain a BAA if a vendor processes PHI; retain records per 45 CFR §164.530(j).
Who receives the executed copies?
Provide signed originals or certified electronic copies to the assignor, assignee, counsel for each party, any lienholder identified, and the settlement or escrow agent handling funds.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now