The file online option is available for first-party insurance claims only. If you need legal assistance for a third-party claim or another matter, please contact our claims helpline: 800-529-4141 or email@example.com
ATTORNEY'S REPRESENTATION AGREEMENT
(hereafter referred to as “Client” in singular form), whose mailing address: , , does hereby retain and employ Florida Professional Law Group, PLLC, (“Attorneys”), 4600 Sheridan St., Suite 303, Hollywood, FL 33021, as their Attorneys to represent them in their claim for damages against (the “Insurance Company”) or any other person, entity or corporation liable or responsible for damages or insurance benefits resulting from any accident, loss or occurrence that happened on or about at the property located at , , , (the “Property”)Policy No.: ; Claim No.:
Before signing this contract, Client received, read, and understood The Statement of Client’s Rights (“Statement”). Client signed the Statement and received a copy for reference.
If no recovery is made, no attorney's fees are owed by Client.
This employment is on a contingent fee basis.
The Attorney’s fees will be the greater of:
2. If the insurance company will pay them separately, the amount paid to Attorneys by the Insurance Company will be based upon the work they have done in connection with My Claim.
If the claim cannot be settled without filing a lawsuit, then my Attorneys may file a law suit against my insurance company, if they deem it necessary to do so. In that case, Attorneys will try to recover their attorney’s fees from the Insurance Company pursuant to Florida Statutes or another legal basis (“Statutory Fees”). I acknowledge that in cases like this Attorneys routinely charge up to $435 per hour for attorney’s time and up to $125 per hour for legal assistant’s time. However, if no recovery is made, no attorney's fees are owed by Client and Attorneys will not bill me separately.
Attorneys will advance money for costs such as court’s fees, process server fees, loss consultants’ fees, contractors’ fees, estimator’s fees, experts’ fees, computerized legal research (which will be a flat rate of $65.00), court reporter fees and expenses, travel, delivery service, and others required for the resolution of this issue. If there is a mortgage on the Property an additional $195.00 mortgage company processing fee will also apply unless I choose to perform this service on my own and pay Attorneys’ fees and costs directly.
If not paid separately by the Insurance Company, costs shall be deducted from the amount recovered. If there is no recovery, I will not be responsible to re-pay the costs advanced.
My Attorneys and my mortgage company are authorized to communicate and to negotiate with each other. My mortgage company is:
My mortgage payments are current:
If my mortgage payments are not current, I have received notice of foreclosure:
Client agrees to assist in this matter, for example, by appearing at depositions and hearings, if required. I will ask questions and keep my Attorneys informed of all information related to the matter.
Client will be truthful and honest with my Attorneys. Insurance fraud is a crime. Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. Client will not and has not committed insurance fraud.
Endorsement of Checks. Settlement checks may be made payable to me and my Attorneys and my lender. I will endorse any checks so that they can be deposited to my Attorney’s trust account and will assist in obtaining the endorsement of my lender. I authorize my Attorney to endorse the check(s) for me. I grant my Attorneys power of attorney and appoint my Attorneys as my true and lawful attorney in fact to act in my stead to endorse the checks on my behalf for the purpose of depositing the checks in their trust account and disbursing the proceeds according to this Agreement. I indemnify and hold my Attorneys and my Attorneys’ bank harmless for doing so.
If my lender does not release money to pay my Attorneys’ fees and costs, I will pay my Attorneys separately, and directly. If I do not do so, Attorneys may place and enforce a lien upon the Property. The prevailing party shall be entitled to recover attorney’s fees and costs.
No Guaranteed Results. I understand that there are no “guaranteed results.” Attorneys have made no promises about the outcome of my claim.
Once Attorney’s engagement in this matter ends if within 30 days I do not direct my Attorneys to return materials pertaining to the matter, I agree that any materials left with my Attorneys may be retained or destroyed. “Materials” include paper files as well as information in other storage media or formats. Attorneys may make, at their expense, copies of all documents or materials generated or received by them. If I request copies of documents from my Attorneys, copies will be at my expense. Attorneys may share information with other parties or their attorneys, witnesses, the courts, experts and consultants that my Attorneys deem advisable.
I have not been solicited or coerced by my Attorney or by anyone acting on behalf of my Attorney to sign this agreement. The decision to hire my Attorney was my own.
Conflict of Interest Waiver. I understand that my Attorneys may also represent some of the service providers who are involved with my Claim, such as the restoration company, mold tester, plumber, roofer, etc (“Service Provider(s)”). I understand that my Attorneys may assist and represent the Service Provider(s) in pursuing payment for their services under an assignment of benefits that I may have provided to them. I hereby waive any potential conflict of interest that this may cause. I also understand that my Attorneys will not represent a Service Provider in a dispute against me and will not represent me in a dispute against a Service Provider.
Notice Required by the Florida Bar
(i) The undersigned Client has, before signing this contract, received and read the Statement of Client’s Rights (the “Statement”) and understands each of the rights set forth therein. The undersigned Client has signed the Statement and received a signed copy to refer to while being represented by the undersigned attorney.
(ii) This contract may be cancelled by written notification to the attorney at any time within 3 business days of the date the contract was signed, as shown below, and if cancelled the Client shall not be obligated to pay any fees to the attorney for the work performed during that time. If the attorney has advanced funds to others in representation of the Client, the attorney is entitled to be reimbursed for such amounts as the attorney has reasonably advanced on behalf of the Client.
This Agreement is not effective and my Attorney has not been Retained until this Agreement has been signed by my Attorney.
Printed name: Phone: Email: Date:
The above employment is hereby accepted upon the terms stated herein.
Florida Professional Law Group, PLLC
Name: Marc Ben-Ezra, Esq.
Title: Partner/Managing Attorney
Phone No.: (954) 284-0900
STATEMENT OF CLIENTS' RIGHTS
Before you, the prospective Clients, arrange a contingency fee agreement with a lawyer, you should understand this statement of your rights as Clients. This statement is not a part of the actual contract between you and your lawyer, but, prospective Clients, you should be aware of these rights.
Notice of Representation, Authorization to Communicate, Limited Assignment of Benefits & Instructions Regarding ChecksTo: Insurance Company: Re: Address:Policy No: Client:
Retention: I have retained Florida Professional Law Group, PLLC (“Attorneys”) whose phone number is (954) 284-0900, to represent me in connection with certain claim(s) matter(s) involving the insurance policy related to the property noted above.
Authorization to Communicate: I authorize you to communicate with, disclose information to and negotiate verbally or in writing with my Attorneys.
I also authorize my Attorneys to communicate with, disclose information to and negotiate verbally or in writing with my Insurance Company.
Limited Assignment of Benefits
I/we hereby assign to my/our Attorneys a portion of the insurance policy’s benefits and proceeds. This assignment of benefits is limited to the amount necessary to pay their attorney’s fees for services rendered by them.
Instructions Regarding Proceeds Checks & Direction to Pay:
Florida Professional Law Group, PLLC
4600 Sheridan Street, Suite 303
Hollywood, FL 33021
General Authorization to Communicate
Insurance Company: Address:Policy No: Client:
We have retained Florida Professional Law Group, PLLC (“Attorneys”) whose phone number is (954) 284-0900, to represent us in connection with certain matters involving the insurance policy related to the property noted above.
We hereby authorize you to communicate with, disclose information to, and negotiate verbally or in writing with our Attorneys.
We also hereby authorize our Attorneys to communicate with, disclose information to and negotiate verbally or in writing with our Insurance Company.
Re: Notice of Insurance Claim & Authorization for Florida Professional Law Group, PLLC, to Communicate with Mortgage CompanyProperty Address: Loan Number: Insurance Company: Policy #: Loss Type: Date of Loss:
To Whom It May Concern:
An insurance claim was filed in connection with the insurance policy and property mentioned above (the “Claim”).
Florida Professional Law Group, PLLC4600 Sheridan Street, Suite 303Hollywood, FL 33021.(954)284-0900
Thank you in advance for your anticipated cooperation and assistance,