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Lawyers Professional Liability Insurance
Lawyers Professional Liability Insurance Estimate
Step
1
of
3
33%
Contact Information
Name
(required)
First
Middle
Last
Phone
(required)
Email
(required)
Address
(required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Firm Website
How did you hear about us?
Online (E.g., Google, Bing, etc.)
Received a flyer or postcard
Email
Referral
I'm a past client
Social Media
Other
Details:
Details:
Lawyers Liability Coverage
Do you currently have Professional Liability Insurance?
(required)
Yes
No
Renewal Date of Current Policy
(required)
Prior Acts Date or Years of Continuous Coverage
(required)
Limits Requested
(required)
$100,000 / $300,000
$250,000 / $500,000
$500,000 / $500,000
$500,000 / $1M
$1M/ $1M
$1M / $2M
$2M / $2M
Other
Other Limits Requested:
(required)
Deductible Requested
(required)
$0
$1,000
$2,500
$5,000
$10,000
Other
Other Deductible(s) Requested:
(required)
Are there any additional coverage options you are looking for?
About Your Law Practice
Attorney Roster
(required)
If you are a solo practitioner, list yourself. To add multiple attorneys, select the + symbol at the end of each entry.
Attorney Name
Hours Worked per Week
Hire Date (MM/DD/YYYY)
Add
Remove
Upload Attorney Roster (optional)
If opting to upload an attorney roster, enter "ATTACHED" in the Attorney Name field above.
Drop files here or
Select files
Max. file size: 50 MB.
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Number of Non-Attorney Staff
Areas of Practice
(required)
Percentage(s) must total 100. To add additional areas of practice, select the + symbol at the end of each entry.
Practice Area
Percentage
Add
Remove
Upload Areas of Practice Form (optional)
If opting to upload an area of practice grid, enter "ATTACHED" in the Practice Area field above.
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Select files
Max. file size: 50 MB.
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Most Recent Annual Gross Revenues
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Maximum Single Case Value in Past 24 Months
In the past 5 years, have there been any claims/incidents/grievances against the applicant or any member/past member of the firm or Predecessor Firm?
(required)
Yes
No
Explanation of Claims Made:
(required)
Briefly explain the nature of claim(s)/incident(s)/grievance(s) made. Include the area of practice involved, important dates, and current standing or results of the matter.
Upload Claims Document(s)
If opting to upload claims documents, enter "ATTACHED" in the Claims Explanation field above.
Drop files here or
Select files
Max. file size: 50 MB.
This field is hidden when viewing the form
How many suits has the firm filed against its own clients for the collection of fees in the past 5 years?
Any Additional Notes or Requests
Email
This field is for validation purposes and should be left unchanged.
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