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.


Note: Please do not use an email provided by your employer
If you have difficulty explaining and you have a letter or other document you think will help us, please send a copy to us
(Specify the date you filed your appeal)
(Specify the date you received a response to your appeal)
(Specify the date your appeal is due)

For Disability Claims

(From which are you are seeking benefits)
(list all medical conditions involved)

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
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Contact Us


Clark Law Group, PLLC
Washington, DC
1100 Connecticut Ave, NW
Suite 920
Washington, DC 20036
Phone: (202) 293-0015
Fax: (202) 293-0115
Toll Free: 855-202-0011

Clark Law Group, PLLC
Chicago, IL
150 N. Wacker Drive
Suite 1925
Chicago, IL 60606
Phone: (312) 574-3420
Toll Free: 855-769-7500

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