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

Pay Discrimination

For example, in 2017, women earned 82% of what men earned, according to a Pew Research Center analysis of median hourly earnings of both full- and part-time workers in the United States. Based on this estimate, it would take an extra 47 days of work for w

Read more...

Blog of the Week

Ivanka Trump promised her dad would deliver a great family leave plan. Here’s what we got.

Two years later, the Trump administration is no closer to accomplishing this goal than they were when Ivanka and her father told prospective voters and working parents that they could be trusted to deliver on paid leave and thus deserved their votes.

Thought for the Week

"This Bill of Rights is intended to be more than an extension of our current workplace protections for domestic workers. We see it as a statement of our collective values as Americans, a statement on how we respect all working people, regardless of whether they work in an office or in a home."

–Rep. Pramila Jayapal, Sen. Kamala Harris and NDWA President Ai-jen Poo on a new proposed National Domestic Workers Bill of Rights.

List of the Week

from Workplace Fairness

Top Searches in Discrimination This Week: 

  • Sexual/Gender Discrimination
  • Proving Employment Discrimination
  • Pay Discrimination
  • Religious Discrimination
  • Pregnancy Discrimination

 

Top Five News Headlines

  1. How to respond to a joke about #MeToo
  2. NLRB’s Handling of Joint Employer Petitions: Fodder for Lawsuits
  3. Republicans To Hold Their First Hearing On The Minimum Wage Since Taking The House In 2010
  4. New jobs report shows that the economy is steady but wages are lagging
  5. Despite #MeToo, most women don’t see a change in the workplace