The County's in house insurance company, managing and investigating all claims for damages filed against County employees, departments and agencies. Indemnification and Release of All Claims.Read our Mutual Release and Settlement Agreement template to understand our law firm's procedure in most settlements. However, before the plaintiffs" claims were dismissed, CapitalSource filed a counterclaim for attorneys" fees based upon the release and indemnification. To file a claim for VA Life Insurance online, you will need to complete VA Form 29-4125e, Claim for One Sum Payment and attach the Veterans death certificate. Below is a sample personal injury release for a written settlement agreement. Typically, the insurance company will give you their own standard release. I agree to release, indemnify, and hold harmless MCPS and DHHS and any of their officers, staff members, or agents from lawsuit, claim, demand, or action. Complete the Claim Statement Form including as much detail as possible. Insurance Application.