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Lawyers Professional Liability Insurance - Florida Law Firms
   
 
 

Thank you for visiting our website. In just a few short minutes, by completing the questions below, we'll be in a position to provide you a "Non Binding" premium indication for Lawyers Professional Liability Insurance.

Firm Name  
Address  
City   County  
State   Zip Code  
Telephone   Fax  
Email   Website
Requested Effective Date  (mm/dd/yyyy)
Requested Deductible   Requested Policy Limits  
Gross Billings Estimated   Year Firm Established  (yyyy)

Number of Attorneys and Years with Applicant (Note: Part-time is defined as less than 30 hours per week)

# of Years # of Attorneys
 (Excluding "Of Counsel")		 # of Part Time Attorneys
 (Excluding "Of Counsel")
5+
4
3
2
1
< 6 months
     
Total Attorneys
# Counsel  
# Support  

Areas of Practice
Indicate the percentage of gross income for the past fiscal year derived from the following areas of practice:

Administrative Law

%

IP-Domestic Patent Prosecution

 %

Admiralty/Maritime

 %

IP-Foreign Patent Prosecution

 %

Antitrust/Trade Regulation

 %

IP-Patentability Searches

 %

Banking/Saving and Loan

 %

IP-Patent Infringement Searches

 %

Bankruptcy

 %

IP-Intellectual Property Litigation

 %

Civil Rights/Discrimination

 %

IP-Trademark/Copyright Prosecution and Licensing - Domestic

 %

Collection/Repossession

 %

IP-Trademark/Copyright Prosecution and Licensing - Foreign

 %

Commercial Law/Business Trans.

%

Litigation - Commercial

 %

Communications (FCC)

 %

Litigation - Construction

 %

Corporate - General

 %

Litigation - Mediation/Arbitration

 %

Corporate - Formation

 %

Plaintiff Litigation - BI/PD with fees per case less than $50,000

 %

Corporate - Mergers/Acquisitions

 %

Plaintiff Litigation - BI/PD with fees per case more than $50,000

 %

Criminal

 %

Plaintiff - Class Action/Mass Torts

 %

Defense - Class Actions

 %

Plaintiff - Legal Malpractice

 %

Defense - Insurance

 %

Plaintiff - Medical Malpractice

 %

Defense - Legal Malpractice

 %

Plaintiff - Workers Comp.

 %

Defense - Medical Malpractice

 %

Public Utilities

 %

Defense - Workers Compensation

 %

Real Estate - Residential

 %

Employment

 %

Real Estate - Commercial

 %

Entertainment

 %

Securities - Federal

 %

Environmental/ Oil & Gas

 %

Securities - State

 %

ERISA/Pension/Social Security

 %

Securities - Private Placements

%

Estate Planning/Probate/Trust

 %

Securities - Bonds

 %

Family Law

 %

Tax - Preparation

 %

Government - Fed. and State

 %

Tax - Opinions

 %

Government - Municipal (other than Bonds

 %

Tax - General Corporate

 %

Immigration

 %

Other (Please list below)

  

Insurance/Coverage Opinions

 %    

International Law

 %

%

Labor Law - Union

 %

%

Labor Law - Management

 %

Total

100%

 

      

 

Claim History

  

Has any professional liability claim or incident been made against the firm, or any predecessor in business, or any of the past or present lawyers in the firm, during the past 5 years?

 Yes No

If yes, provide details below: (Please include date of error, date reported to insurance carrier, allegations, current reserve and/or any payments, and whether claim is closed or open).

  
   

Disciplinary Action

  

Has any member of the applicant firm been refused admission to practice, disbarred, suspended, reprimanded, sanctioned, or held in contempt by the court administrative body or regulatory body?

 Yes No

If yes, provide details below: (Please include the date of any action).

  
   

Insurance History

Date of First Continuous Claims Made Policy (mm/dd/yyyy)
 
Current Policy
Limit (per claim/aggregate)  Deductible Premium   
Carrier     Retroactive date   (mm/dd/yyyy)
 
Treatment Of Defense Costs
Claim expenses outside limit of liability:  Currently Have 
Deductible does not apply toward claim expenses:  Currently Have 
 
Internal Controls
Dual Docket System? Yes  No
Engagement/Disengagement Letters Used?  Yes  No
Conflict of Interest Avoidance System?  Yes  No
Any suits for fees in the past two years?  Yes  No
 
Other Than Private Practice

Any lawyer of the firm working as in house counsel for corporation, municipal department,

 or board ?  Yes  No
 
Other Professional Capacity

Any lawyer of the firm also a real estate agent/broker, accountant, financial/investment advisor?  Yes  No
 
Additional Information/Comments

That is it! Click below and we'll get back to you shortly.  Thank you.

Phone: 813-865-7790    Fax: 813-200-1224

Completion of this form does not bind coverage.
This is not an Insurance Binder. The information that you have provided to us will be used to
provide a premium indication only. The final premium is subject to underwriting acceptance
and completion of the application and appropriate supplements.

 

 

        

 
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