Insurance Release Form Template for Belgium

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Key Requirements PROMPT example:

Insurance Release Form

"I need an Insurance Release Form under Belgian law for a personal injury settlement involving multiple parties, including a primary insurer and two third-party insurers, with the settlement to be paid in installments starting March 2025."

Document background

The Insurance Release Form is a critical document in Belgian insurance practice, used when finalizing insurance claim settlements across various types of insurance coverage. This document, governed by Belgian law and particularly the Insurance Act of 2014, serves as a formal closure mechanism for insurance claims, protecting both the insurer and the insured parties. It is typically used after a claim has been processed and a settlement amount has been agreed upon, but before the final payment is made. The form must be drafted in compliance with Belgian legal requirements, including specific provisions for consumer protection and language requirements given Belgium's multilingual nature. It should clearly state the terms of the settlement, the scope of the release, and any conditions attached to the settlement. The document is particularly important in complex claims involving multiple parties or significant settlements, where clear documentation of the release of liability is essential.

Suggested Sections

1. Parties: Identification of the insurance company, the insured party, and any other relevant parties (including policy numbers and reference details)

2. Background: Context of the insurance claim, including date of incident, nature of claim, and relevant policy details

3. Definitions: Clear definitions of key terms used in the release form, including 'Claim', 'Settlement Amount', 'Released Parties', and 'Released Claims'

4. Settlement Amount: Explicit statement of the settlement amount and payment terms

5. Release and Discharge: Core section detailing the scope of the release, what claims are being released, and confirmation that this is a final settlement

6. No Admission of Liability: Statement that the settlement and release do not constitute an admission of liability

7. Representations and Warranties: Confirmations from the releasing party regarding their authority and understanding of the release

8. Governing Law: Confirmation that Belgian law governs the release and related jurisdictional provisions

9. Signatures: Execution block with date and signature lines for all parties

Optional Sections

1. Confidentiality: Optional section for cases where parties wish to keep the settlement terms confidential

2. Tax Implications: Optional section addressing tax consequences of the settlement, particularly relevant for large settlements

3. Future Claims: Optional section specifically addressing potential future claims, particularly relevant in personal injury cases

4. Return of Documents: Optional section regarding the return or destruction of claim-related documents

5. Medical Reports: Optional section for personal injury cases acknowledging review of medical reports

6. Language Declaration: Optional section for cases where the releasor's primary language is not the document language, confirming understanding

Suggested Schedules

1. Schedule A - Incident Details: Detailed description of the incident or claim being released

2. Schedule B - Settlement Calculation: Breakdown of settlement amount and any deductions

3. Schedule C - Related Claims: List of all related claims or potential claims being released

4. Appendix 1 - Supporting Documents: List of all relevant documents referenced in the release (e.g., medical reports, damage assessments)

5. Appendix 2 - Payment Instructions: Detailed payment information and requirements

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Insurance

Banking and Financial Services

Healthcare

Construction

Manufacturing

Transportation and Logistics

Real Estate

Retail

Professional Services

Automotive

Relevant Teams

Legal

Claims Processing

Risk Management

Compliance

Operations

Customer Service

Document Management

Policy Administration

Underwriting

Corporate Affairs

Relevant Roles

Insurance Claims Manager

Legal Counsel

Risk Manager

Compliance Officer

Claims Adjuster

Insurance Broker

Corporate Counsel

Settlement Officer

Policy Administrator

Insurance Underwriter

Legal Administrator

Risk Assessment Officer

Claims Processing Supervisor

Insurance Operations Manager

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