Questionnaire

Review this website and its resource links to determine what type of claim you may have and fill out the intake form for a free claim review.

The clients for whom we can provide effective counsel are:

  • Employees and individuals who have been denied disability and pension benefits.
  • Employees and individuals who have been denied continued health coverage during periods of family caregiving or following termination of employment.
  • Partners, managers, administrators, and others who need to negotiate executive compensation or severance arrangements, or reasonable exit and non-competition agreements.
  • Former employees who are sued over unreasonable non-competition or “non-compete” agreements.
  • Employees and individuals who have been discriminated against.
  • Reasonable people who have serious problems in the workplace.
  • Whistleblowers (Sarbanes-Oxley, health & safety, and others).

Items marked with an asterisk (*) are required.









* What type of legal problem(s) do you have?










* Have you filed an application for benefits?


Did you recieve a response to the application?


Was your claim denied or terminated?

Does the denial/termination letter state that you may appeal?

Did you file an appeal?


Did you recieve a response to the appeal?



If this is a pension claim, are you seeking a lump sum amount?


For Disability Claims



Are you currently recieving Social Security benefits?

If not, have you applied before?


Are you receiving Workers' Compensation?


If no, have you applied for Workers' Compensation?





Do you anticipate returning to your previous job or any other occupation in the near future?



Are you participating in any vocational rehabilitation or educational program?



Please read the following carefully.

I am submitting this questionnaire and attachments for review by Clark Law Group, PLLC. I understand the following:

  1. That the submission of information is for review only and that there will be no charge for this review.
  2. Clark Law Group, PLLC and I have not entered into an attorney-client relationship and are not acting as my attorney unless and until a formal, written Retainer Agreement has been signed both by me and by a representative of Clark Law Group, PLLC. No decision has yet been made on whether Clark Law Group, PLLC will take my case and there is no guarantee that the firm will accept my case.
  3. Further information may be requested in order for Clark Law Group, PLLC to reach a decision.
  4. It takes time to review the material submitted and to make any reply or decision. Because no attorney-client relationship has yet been established, I will be responsible until I am notified otherwise to meet all necessary deadlines and time frames applicable to my claim; and I acknowledge that I have not received any representations or legal opinions with respect to any time frames or deadlines that may be applicable to my claim.

Contact Our Office

Clark Law Group, PLLC
1100 Connecticut Avenue, NW
Suite 920
Washington, DC 20036
Phone: (202) 293-0015
Fax: (202) 293-0115
Google+
Map/Directions

Contact Us

Clark Law Group, PLLC
1100 Connecticut Avenue, NW
Suite 920
Washington, DC 20036
Phone: (202) 293-0015
Fax: (202) 293-0115
Google+

Clark Weekly

Clark Weekly

Topic of the Week

Health & Safety - How does the law protect you at work

The Occupational Safety and Health Administration (OSHA) publishes rules and enforces the Occupational Safety and Health Act (also OSHA), which protect workers from on-the-job injuries and illness.

Read more...

Blog of the Week

Why the NCAA Should Pay Student-Athletes—And Let Them Unionize

When college sports revenues are as high as they’ve ever been, the failure to pay the athletes is absurd—but not surprising.

Thought for the Week

"Whistleblowers like those being awarded today may be the source of ‘smoking gun’ evidence and indispensable assistance that strengthens the agency’s ability to protect investors and the capital markets."

–Jane Norberg, chief of the SEC’s whistleblower office on a whistleblowing case at JP Morgan

List of the Week

from Workplace Fairness

Top Searches in Health & Safety this week: 

  • Smoking rights in the workplace
  • Workers compensation: What to do 
  • Workplace health and safety protections
  • Infectious diseases in the workplace

 

Top Five News Headlines

  1. Want to be a whistleblower? Read this first
  2. Stop & Shop workers’ strike enters fifth day
  3. Employee privacy in the US is at stake as corporate surveillance technology monitors workers’ every move
  4. McDonald’s retreat on fighting wage increases shows the tide is turning
  5. A key labor moment arrives at the University of Pittsburgh. Will grad assistants vote to join a union?