• Lawyers' Professional Liability Questionnaire

  • Please try to answer all questions to the best of your ability.  This form will allow us to provide you with a few preliminary quotes based on your firm's specifics.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
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  • Areas of Practice

    Please express the firm's areas of practice in gross revenue. Total combined percentage must equal 100%. All percentages should be based off the last fiscal year of practice, rounded to the nearest whole number.
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  • Insurance History

    Please attach a copy of your current Declarations Page & any Endorsements (or the entire policy).
  • Defense Costs (check one)
  • Deductible Type (check one)
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  • Attorney Information

    Answers requiring additional space should be attached as a spearate page.
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  • If there are any IC or OC listed above, is this attorney a prior partner, officer or employee of the applicant firm?
  • If answered YES above, does this attorney carry his/her own individual professional liability insurance coverage?
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  • Additional Firm Information

    Answers requiring addtiional space or explanation should be answered below or attached as a separate page.
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  • Is the firm aware of any circumstances that may give rise to a claim? If so, please attach additional information below.
  • Has any member of the firm been disciplined or denied the right to practice?
  • Has the firm ever been non-renewed, canceled or declined coverage?
  • Of which of the following does the firm's docket system consist?

  • How frequently is the docket system cross-checked?
  • Is the docket system cross-checked by two separate individuals?
  • Is the firm involved in any mass tort or class action work?
  • Is there any one client who represents more than 25% of the firm's gross billing?
  • Are all conflicts disclosed in writing?
  • Of which letters does the firm use for ALL client communication?

  • What type of system is used to prevent a conflict of interest with clients?

  • Does any attorney serve as an outside director or officer and/or have any ownership interest in a client?
  • Are there any predecessor firms of which the current firm has assumed 50% or more of the assets & liabilities?
  • Does the firm have a Legal Administrator?
  • If answered YES above, is he/she a member of the ALA or hold a CLM certificate?
  • Has at least 50% of the firm's attorneys attended CLE in the past (12) months?
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  • Thank you for taking the time to complete this questionnaire.  Someone from our office will be in touch with you as soon as possible.

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