Legal UIM Document

LEGAL UIM DOCUMENT

This Underinsured/Uninsured Motorist Settlement Agreement and Release (the "Agreement") is made and entered into as of Effective Date: by and between Claimant Name: , Claimant Address: and Insurer Name: , Insurer Address: Policy No.: Claim No.: .

RECITALS

WHEREAS, on or about , Claimant was involved in a motor vehicle collision (the "Accident") resulting in alleged bodily injury and/or property damage; and

WHEREAS, Claimant asserted claims for recovery under Uninsured/Underinsured Motorist coverage provided by Insurer under the policy identified above; and

WHEREAS, the parties desire to settle and compromise all claims, disputes and potential claims arising from the Accident, subject to the terms and conditions set forth herein.

NOW, THEREFORE, in consideration of the mutual covenants, promises and the payment described below, the parties agree as follows:

1. DEFINITIONS

For purposes of this Agreement, the following terms have the meanings set forth below: "Claimant" means the person identified as Claimant Name in this Agreement; "Insurer" means the entity identified as Insurer Name; "Released Claims" means all claims, demands, causes of action, obligations, liens, actions, and liabilities of every kind and nature, known or unknown, suspected or unsuspected, asserted or unasserted, arising out of or in any way connected with the Accident, including claims under Uninsured/Underinsured Motorist coverage.

2. SETTLEMENT PAYMENT

In full and final settlement of all Released Claims, Insurer shall pay to Claimant the gross sum of $ (the "Settlement Amount"). The Settlement Amount shall be payable by Insurer as follows: Payment Method: . Payment Due Date: . The parties acknowledge and agree that performance of Insurer's payment obligation is an essential term of this Agreement.

3. RELEASE AND COVENANT NOT TO SUE

Upon receipt of the Settlement Amount, Claimant, on behalf of Claimant and Claimant's heirs, executors, administrators, agents, attorneys, successors, and assigns, does hereby fully release, acquit and forever discharge Insurer, and each of its past and present parents, subsidiaries, affiliates, agents, servants, employees, representatives, attorneys, insurers and assigns, from any and all actions, causes of action, suits, debts, judgments, claims and demands whatsoever, in law or in equity, whether known or unknown, suspected or unsuspected, which Claimant now has or may hereafter have against the Released Parties arising out of or related to the Accident.

This release is intended to be a full and final release of the Released Claims and includes, without limitation, claims for negligence, breach of contract, bad faith, and any statutory claims relating to the Accident.

4. REPRESENTATIONS, WARRANTIES AND COVENANTS

Claimant represents and warrants that Claimant is the sole owner of any claims being released, that there are no liens, subrogation claims or assignments known to Claimant except as disclosed in writing to Insurer, and that Claimant has not previously assigned the Released Claims to any other person or entity. Claimant covenants not to file, initiate or prosecute any action or claim against the Released Parties for the Released Claims.

5. SUBROGATION, LIENS AND ALLOCATION

Claimant agrees to cooperate with Insurer to resolve any valid subrogation interests or liens asserted by health care providers, insurers or other third parties. Any portion of the Settlement Amount required to satisfy valid, outstanding liens shall be paid in accordance with applicable law or as otherwise agreed in writing. Claimant shall promptly notify Insurer of any lien or claim affecting the Settlement Amount.

6. CONFIDENTIALITY

The parties agree that the terms, amount and existence of this Agreement shall be confidential and shall not be disclosed to any third party except to the extent disclosure is required by law, to enforce this Agreement, to obtain legal or tax advice, or as required by a court of competent jurisdiction. Breach of this confidentiality provision shall entitle the non-breaching party to seek injunctive relief in addition to any other remedies at law or in equity.

7. TAXES

Each party shall be responsible for its own tax reporting and liabilities arising from the receipt of the Settlement Amount. Claimant acknowledges that Insurer is not responsible for any tax consequences of this settlement and Claimant agrees to indemnify Insurer for any tax penalties, interest, or liabilities attributable to Claimant's actions or misstatements.

8. INDEMNIFICATION

Claimant agrees to indemnify, defend and hold harmless Insurer from and against any and all claims, demands, suits, losses, liabilities, costs and expenses (including reasonable attorneys' fees) arising from any breach of Claimant's representations, warranties or covenants contained in this Agreement or from any claims asserted by third parties that result from Claimant's acts or omissions related to the Accident.

9. NOTICES

Notice to Claimant:

Notice to Insurer:

All notices required or permitted under this Agreement shall be in writing and shall be deemed delivered when delivered personally, sent by nationally recognized overnight courier, or three (3) business days after deposit in the United States mail, postage prepaid, addressed to the party at the address set forth above or such other address as either party may designate in writing.

10. GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the state identified for governing law: , without regard to its conflict of law principles.

11. ENTIRE AGREEMENT

This Agreement constitutes the entire agreement and understanding between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, negotiations, representations and understandings, whether written or oral.

12. SEVERABILITY

If any provision of this Agreement is held to be invalid, illegal or unenforceable, the remaining provisions shall continue in full force and effect and the parties shall negotiate in good faith to replace the invalid, illegal or unenforceable provision with a valid provision that most closely approximates the parties' intent.

13. AMENDMENT; WAIVER; COUNTERPARTS

No amendment, modification or waiver of any provision of this Agreement shall be effective unless in writing and signed by both parties. No failure or delay by either party in exercising any right under this Agreement shall operate as a waiver. This Agreement may be executed in counterparts, each of which shall be deemed an original but all of which together shall constitute one and the same instrument.

14. ADDITIONAL ACKNOWLEDGMENTS

Claimant acknowledges that Claimant has read this Agreement, has had the opportunity to consult with legal counsel, and fully understands its terms, effect and legal consequences. Claimant acknowledges that the consideration provided under this Agreement is fair and adequate.

Describe any known liens, encumbrances or third-party interests affecting settlement proceeds:

Structured Settlement Election: I elect to receive the Settlement Amount as a structured settlement pursuant to a separate agreement to be negotiated and executed by the parties. If a structured settlement is elected, payment timing and mechanics shall be governed by the separate structured settlement agreement.

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