General Information
IMPORTANT: This is an application for a Claims-Made and Reported Policy. The Policy issued by Lawyers’ Mutual Insurance Company EXCLUDES coverage for your prior acts. This means that the Company will not defend or indemnify you for any claim arising out of an act, error or omission which occurred prior to the Policy effective date. However, prior acts coverage is available upon request and approval with submission of proof of current coverage.
This Policy WILL NOT PROVIDE COVERAGE for any actual or potential CLAIMS KNOWN to any applicant/insured PRIOR TO THE INCEPTION OF THIS POLICY, including matters disclosed on this application. Any such claims should be reported to your current carrier prior to expiration of your current Policy.
Name(s) of California State Bar Certified lawyer referral service(s) you are seeking coverage for:
Areas of Practice
Please ensure that your areas of practice percentages total 100%.
Provide a brief description for each of the firm’s areas of practice denoted with an * (asterisk).
Claims Experience
One of our Underwriters will follow up with you for additional information.
Limits & Deductibles
What was the Applicant Lawyer’s gross revenue from legal services for each of the last three years?
Upon approval of this LILP Application, the Limits of Liability for the LILP policy will be $100,000 each claim/$100,000 annual aggregate with a $250 per claim deductible. No additional limit or deductible options will be available.
Firm Management
Disclosure & Signature
The forgoing responses are true and complete. Applicant understands that the Company will rely upon the accuracy of this application and that the Company retains the right to rescind any Policy which is issued based upon an application containing false or incomplete information. Applicant hereby authorize the release and exchange of information involving underwriting and claims matters between the Company and our past and present carriers and appoints the Company our attorney-in-fact for obtaining such information. Applicant hereby authorizes the State Bar of California to release information to the Company concerning membership, certifications, and disciplinary proceedings. Applicant agrees any person or organization furnishing information to the Company pursuant to this authorization will not be liable for furnishing such information, even if the information is inaccurate or untrue.
THIS APPLICATION WILL BE CONSIDERED ONLY IF ALL QUESTIONS ARE ANSWERED, LETTERHEAD IS ATTACHED, AND THE APPLICATION IS SIGNED AND DATED BY AN OWNER, PARTNER OR OFFICER OF THE APPLICANT FIRM. APPLICANT MUST REPORT ANY CHANGES IN THESE ANSWERS OF WHICH IT BECOMES AWARE AFTER SIGNING THIS APPLICATION BUT BEFORE THE EFFECTIVE DATE OF THE POLICY. IF APPLICANT BECOMES AWARE OF ANY ACTUAL OR POTENTIAL CLAIM AFTER SIGNING THIS APPLICATION AND BEFORE THE EFFECTIVE DATE OF THE POLICY, SUCH ACTUAL OR POTENTIAL CLAIM WILL NOT BE COVERED UNDER THIS POLICY.
For clarification, please contact our underwriters at 1-800-252-2045