Sample Workers Compensation Settlement Agreement

A workers compensation settlement agreement is a legally binding agreement between an injured employee and an employer or their insurance company. The agreement outlines the terms and conditions of the settlement, including any compensation awarded to the employee for their injuries.

To help you better understand what a workers compensation settlement agreement looks like, we`ve put together this sample agreement as a guide.

Sample Workers Compensation Settlement Agreement

This Workers Compensation Settlement Agreement (“Agreement”) is made and entered into by and between [Employee Name] (“Employee”) and [Employer Name] (“Employer”) on the date of [date].

Whereas, the Employee sustained a work-related injury on [date], and the Employer is required to provide workers compensation benefits under [state] law; and

Whereas, the parties have reached an agreement as to the amount of compensation to be paid to the Employee in exchange for a full and final release of all claims related to the injury;

Now, therefore, in consideration of the mutual promises and covenants contained herein, the parties agree as follows:

1. Payment. The Employer agrees to pay the Employee the sum of [amount] as compensation for the work-related injury. The payment shall be made in accordance with [state] law.

2. Release. The Employee agrees to release and forever discharge the Employer from any and all claims, demands, actions, and causes of action arising out of the work-related injury. The release shall be effective upon receipt of the compensation payment.

3. Confidentiality. The parties agree to keep the terms of this Agreement confidential, except as required by law or with the written consent of the other party.

4. No Admission of Liability. This Agreement does not constitute an admission of liability by the Employer.

5. Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of [state].

6. Entire Agreement. This Agreement contains the entire agreement between the parties and supersedes all prior negotiations, agreements, and understandings, whether written or oral.

7. Counterparts. 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.

8. Effective Date. This Agreement shall become effective upon the date of execution by both parties.

In witness whereof, the parties have executed this Agreement as of the date first above written.

[Employee Signature]

[Employee Name]

[Employer Signature]

[Employer Name]

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