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Agreement For ReleaseWHEREAS, on or about [Date], [Name], referred to as CLAIMANT, claims to have suffered an injury due to an automobile collision, and further, CLAIMANT alleges that [Name], referred to as SETTLOR, is legally responsible for the injury, and, WHEREAS, [Name], INC, referred to as INSUROR, may provide coverage for the alleged injury by virtue of the issuance of an insurance policy to SETTLOR; and, WHEREAS, SETTLOR disputes such liability in its entirety; and, WHEREAS, SETTLOR and CLAIMANT desire to enter into a settlement of the claims in this matter, and, WHEREAS, [Name] is the spouse of CLAIMANT, and alleges a right to recover compensation for loss of consortium, and SETTLOR disputes such liability in its entirety; and, WHEREAS, SETTLOR, INSUROR, CLAIMANT and CLAIMANT's spouse desire to enter into a settlement of the disputed claims; IT IS AGREED: That the making of this settlement is not an admission of liability or culpability of the SETTLOR, nor an admission of coverage and applicability of an insurance coverage afforded by INSUROR to SETTLOR; INSUROR and SETTLOR shall pay to CLAIMANT upon execution of this agreement: $------- (& no/100 dollars) on account of property damages to TOTALLED AUTOMOBILE; $------- (& no/100 dollars) on account of personal injuries to CLAIMANT, including claims by CLAIMANT's spouse for consortium upon the execution of this agreement; and, INSUROR and CLAIMANT shall pay the sum of $------ (& no/100 dollars) month to CLAIMANT, every days for a term of the life of the claimant. The payments under this release agreement are intended as compensation for injuries or sickness as is provided in 26 USC 104(a)(2) and 26 USC 130(c). CLAIMANT has no right to a lump sum settlement of any kind. Neither INSUROR nor SETTLOR made available to CLAIMANT during negotiations a lump sum payment in lieu of the lump sum and periodic payments provided for herein. In the event of any failure to pay when agreed, time being of the essence, any sums due and unpaid shall bear interest at the highest legal rate until paid. In the event that any installment due is unpaid for more than 30 days, CLAIMANT may declare a default in the agreement. Upon such declaration of default, the CLAIMANT shall be entitled to bring an action and obtain a judgment for the sums unpaid. Such action shall not preclude the right for claimant to sue in the future for any further payments which are unpaid and the rights under this agreement shall not be extinguished in the event that an action is brought to enforce payment of any particular installment or installments. In the event that more than 6 payments are due at any time, the CLAIMANT may sue to recover either: (a) the present value of the remaining payments discounted by 4%; (b) a judgment for those payments due through the commencement of the litigation. Dated: ___________. _________________________ CLAIMANT _________________________ SETTLOR
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