Settlement Disbursement Sheet: Contents, Template & Requirements
The settlement disbursement sheet is the document that turns a settlement agreement into a payment plan: it itemizes every dollar, identifies every payee, and carries the client's signature that authorizes the disbursement to proceed. Bar rules in most states require it before any funds leave the trust account.
What is a settlement disbursement sheet?
A settlement disbursement sheet is the itemized accounting of how a settlement's gross proceeds are allocated among all payees — attorney fee, case costs, each lien payoff, and the client's net proceeds. The client signs it before disbursement begins, confirming they understand and agree to the allocation. It is a required compliance document in most U.S. jurisdictions and must be retained in the client file.
What a disbursement sheet must contain
Every field below should appear on a complete settlement disbursement sheet. The math must be exact: every line's deduction from the gross settlement must equal the client's net proceeds to the penny.
| Field | Required? | Notes |
|---|---|---|
| Gross settlement amount | Required | The total amount the defendant agreed to pay |
| Attorney contingency fee | Required | Typically 33–40%; must match the signed fee agreement |
| Case costs and expenses | Required | Filing fees, expert fees, investigation, medical records |
| Co-counsel / referral fee splits | If applicable | Required only when applicable |
| Medical lien holder — treating physicians | Required | Each provider listed with name and payoff amount |
| Medical lien holder — hospitals / facilities | Required | Each facility listed separately |
| Medicare conditional payment | Required | Statutory; must be confirmed with the BCRC/CRC |
| Medicaid reimbursement | Required | If applicable in the state of treatment |
| ERISA / private insurer subrogation | If applicable | If applicable; ERISA plans have strong subrogation rights |
| Client net proceeds | Required | Must equal gross minus all above deductions |
| Client acknowledgment signature | Required | Most bar rules require signed client consent |
Why the disbursement sheet matters
Bar compliance
Rule 1.15 and its state equivalents require attorneys to provide clients with a full accounting of funds held in trust. The signed disbursement sheet is the primary documentation for satisfying this requirement. In a bar audit, it's one of the first documents requested.
Client transparency
The disbursement sheet is often the first time a client sees exactly where their settlement money is going. A clear, itemized sheet prevents disputes about fee amounts, lien deductions, and net proceeds — the most common sources of post-settlement client complaints.
Lienholder protection
A complete disbursement sheet proves that every lienholder was paid the confirmed amount. Without documentation, a lienholder disputing the payoff amount has no evidence to work from — and the firm has no defense. The signed sheet with confirmed amounts is the paper trail that resolves disputes.
Malpractice defense
If a client later disputes their net proceeds, a signed disbursement sheet showing their acknowledgment of every deduction before disbursement is a strong defense against malpractice claims. Without it, disputes become credibility contests.
Free disbursement sheet template
Disbo provides a free, downloadable settlement disbursement statement template. It covers all required fields — attorney fee, case costs, each lien payoff, and client net proceeds — and includes a client signature line. Download it from the settlement statement template page and adapt it to your firm's format.
Download Free TemplateAuto-generated in Disbo
In Disbo, the disbursement sheet is generated automatically from the settlement statement and lien resolution data — no manual re-entry required. The attorney reviews, adjusts if needed, and the sheet is ready for client signature. Once signed, payment execution is a single authorized action.
See It in a DemoAlso in this guide: Paying medical liens · Disbursement timeline · Net-to-client calculator · Full guide hub →
Settlement disbursement sheet FAQ
A settlement disbursement sheet (also called a settlement statement or disbursement statement) is the document that itemizes how the gross settlement amount is allocated to each payee. It shows the attorney fee, each lien payoff, case costs, and the client's net proceeds — and the client signs it to acknowledge the breakdown before any payment is released.
In most U.S. jurisdictions, yes. Model Rule of Professional Conduct 1.15(d) requires attorneys to promptly render a full accounting of any funds held on behalf of a client. State rules typically require the firm to provide the client with a written statement of the financial terms of the settlement before disbursement. Retaining a copy of the signed statement in the client file is standard practice for bar compliance.
A complete disbursement sheet includes: the gross settlement amount, the attorney contingency fee (amount and percentage), itemized case costs and advanced expenses, each lien payoff with the lienholder's name and amount, co-counsel or referral fee splits (if applicable), any other deductions, and the client's net proceeds. The math should be verified so that gross settlement minus all deductions equals client net proceeds exactly.
Yes. Disbo parses the settlement statement and pre-populates the disbursement sheet with each payee and amount. The attorney reviews and adjusts as needed, then the sheet is ready for client review and signature — without manual re-entry of numbers from the settlement document.
The terms are often used interchangeably, but they can refer to slightly different documents. A settlement statement may refer to the broader agreement between plaintiff and defendant (what the defendant agreed to pay). A disbursement sheet or disbursement statement specifically refers to the internal accounting document that allocates the settlement proceeds among payees. Some firms use both terms to mean the same document; others maintain them separately.
Disbo provides a free downloadable settlement statement template that covers all required fields. You can access it on the settlement statement template page. In Disbo, the sheet is generated automatically from the settlement data, so no manual template is needed.
Stop building disbursement sheets by hand.
Disbo generates the disbursement statement automatically from the settlement data — ready for client review in minutes.