Title

Insurance Case Evaluation Form

*Name:

*Address:

*City:

*State:

*Zip:

*E-mail address:

*Home Phone:

Business Phone:

Cellular or Pager:

Facsimile:

What type of insurance is involved in you matter?

What is the name and address of the insurance company involved?

Is the insurance policy at issue in your name?
Yes  No  Unknown 

If yes, please provide the name and address of the agent who issued the policy, if known:

Does this matter involve a business you own or run?
Yes  No 

If yes, provide the business name, address, and phone:

Describe your situation, including any relevant dates:

How would you rate your legal needs described here?

Are any other people involved?
Yes  No 

If yes, provide names, addresses (if known), and their relationship to you, if any:

Do you have any documents that could help explain your situation?
Yes  No 

If yes, list those documents and their dates:

Are there other documents that you do not have access to that could be of assistance?
Yes  No 

If yes, list those documents and their dates and locations (if known):

Describe how this situation has impacted you:

Describe what you would like to happen to resolve your issue (your preferred outcome):

Have other attorneys worked on this matter?
Yes  No 

If yes, provide names, addresses, and a brief description of their involvement:

Special concerns:

Where did you hear about this website?

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Kingsley & Kingsley Los Angeles Preeminent Employment lawyers

Kingsley & Kingsley Employment LawyersAt Kingsley & Kingsley, our Los Angeles based employment law firm, our attorneys are committed to protecting the rights of ordinary working people who have been exploited by big business. We have the resources to take on large corporations, yet give our clients personal service.

At Kingsley & Kingsley, our lawyers have over 60 years of collective experience, including service as lead counsel in dozens of class actions, representation in over one hundred jury trials in state and federal courts, and alternative dispute resolution counsel, including representation in arbitrations. We represent clients from communities throughout California. More...

We have recovered millions of dollars!

We represent clients who would otherwise be intimidated by large corporations.  For more information see a sampling of our Success Stories.

Our Los Angeles employment law attorneys serve communities throughout the entire state of California.

Do you wonder whether you have a case? Use our simple and FREE case evaluation form to find out if you a have a case!

 

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