Personal injury settlement statement: Fill out & sign online

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01. Edit your personal injury settlement statement online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

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03. Share your form with others

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Click ‘Get Form’ to open the Personal Injury Settlement Statement in the editor.
Begin by entering your name and the date at the top of the form. This personalizes the document and ensures clarity.
Fill in the Gross Settlement amount, which represents the total settlement before any deductions.
Detail all expenses in their respective fields, including Attorney Fee, Outstanding Expenses, and various costs such as Court Costs and Medical Records. Ensure accuracy for each entry.
Calculate Total Expenses by summing all listed expenses. Enter this amount in the designated field.
Review Medical Liens and enter any applicable amounts from Exhibit A. This is crucial for understanding your financial obligations.
Finally, confirm your Client’s (Net) Share of Recovery by subtracting Total Fee, Expenses, and Medical Liens from Gross Settlement. Ensure you understand all deductions before signing.

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