INSURANCE ESTIMATE FOR LAWYERS

Please answer the following. We will provide a quote estimate and details of the coverage to your preferred contact method.

Full Name*
Practice Name*
Practice Address*
Street Address Address Line 2
Work City & State*
Work County & Zip Code*
Work Phone*
Work Email*
Insurance History
Please answer the following.
Current Carrier*
Current Expiration Date*
Date Format: MM slash DD slash YYYY
Prior Acts Date*
Date Format: MM slash DD slash YYYY
Current Limits*
Current Deductible ($)*
Attorney Information
This section is about the attorneys in your firm. Please answer the following.
Total Number of Attorneys in the Firm*
Total Number of Full-Time Attorneys in the firm*
Total Number of Part-Time Attorneys in the firm*
Area of Practice Information
Indicate the area of practice in percentage in the following areas. Percentage total must equal 100%. If none, please indicate 0 for 0%.
Admiralty Law (%)*
Plaintiff (%)*
Defense (%)*
Administrative Law (%)*
Antitrust/Trade Regulation (%)*
Bankruptcy/Collection (%)*
Business Transactions & Contracts (%)*
Civil Rights (%)*
Class Actions (%)*
Commercial Litigation (%)*
Plaintiff (%)*
Defense (%)*
Construction/Building Contracts (%)*
Corporate General (%)*
Criminal (%)*
Family Law (%)*
Employment Law (%)*
Plaintiff (%)*
Defense (%)*
Environmental Law (%)*
Government Contract Work (%)*
Healthcare (%)*
Immigration and Naturalization (%)*
Intellectual Property (%)*
Copyright (%)*
Patent/TM (%)*
International Law (%)*
Mediation & Arbitration (%)*
Personal Injury (%)*
Plaintiff (%)*
Defense (%)*
Natural Resources (%)*
Securities or Bonds (%)*
Real Estate (%)*
Commercial (%)*
Foreclosure (%)*
Land Use & Zoning (%)*
Residential (%)*
Title (%)*
Workers Compensation (%)*
Plaintiff (%)*
Defense (%)*
Tax Opinions (%)*
Other (%)*
Area of Practice Percentage Total Must Equal 100%
Additional Questions
Any professional liability claims or incidents reported against any of the attorneys listed, prior partners or associates in the last 5 years?*
Provide loss runs*
How many suits for fees have you filed against your clients in the last two (2) years?*
Have any of the firm’s attorneys been the subject of any disciplinary action, for any reason other than non-payment of dues, within the last ten (10) years?*
Any professional liability claims or incidents reported against any of the attorneys listed, prior partners or associates in the last 5 years?*
We may need additional information to provide an estimate.
Provide loss runs*
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INSURANCE ESTIMATE FOR LAWYERS

Please answer the following. We will provide a quote estimate and details of the coverage to your preferred contact method.

Insurance History

Attorney Information

Area of Practice Information

Additional Questions