Tragic Injury Intake

Client Information
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Identification of Parties. This agreement is made between Roland Witherspoon Law attorneys, licensed in Colorado, Texas, with "of-counsel" in Arizona, Georgia, Michigan, Missouri, North Carolina, Florida, Ohio, and Illinois, or local counsel or referral counsel or associated counsel in other jurisdictions and any referral attorneys "Attorney" or the “Firm” and

Settlement and Deposit. The attorney will not settle the Client's claim without the approval of the Client. The Client authorizes the Attorney to sign and deposit any settlement on their behalf into the Attorney’s trust account.

Non-Solicitation. I have not been solicited, coerced, promised money, or anything of value by Roland Witherspoon Law attorneys, licensed in Colorado, Texas, with "of-counsel" in Arizona, Georgia, Michigan, Missouri, North Carolina, Florida, Ohio, and Illinois, or local counsel, referral counsel, associated counsel in other jurisdictions, or its agents, employees, or representatives. I chose Roland Witherspoon Law attorneys, licensed in Colorado, Texas, with "of-counsel" in Arizona, Georgia, Michigan, Missouri, North Carolina, Florida, Ohio, and Illinois, or local counsel, referral counsel, or associated counsel in other jurisdictions, of my own free will, voluntarily, and without compensation, promise of compensation, or anything else of value.

Attorney's Fees - Contingency Contract. The Attorney agrees to waive hourly fees of $450, and instead pursue the Client’s claim on a contingency basis. The contingency upon which compensation is to be paid is the collection of monies following settlement or award on the claim or claims set forth above and the amount of such compensation which is to be paid by the Client to the Firm shall be on the gross amount recovered as follows: Our firm fee is 35% of the amount of any offer of settlement made before a lawsuit is filed; 40% of the amount of any offer of settlement or verdict after the lawsuit has been filed but before sixty (60) days of the first trial setting; 45% of any settlement or recovery made for the client within sixty (60) days of the first trial setting and thereafter excluding any appeals or post-trial work. The Attorney does not handle appeals. Appeals must be filed 30 days after the jury trial.

Deferred Payment. If payment of all or any part of the amount to be received will be deferred (such as in the case of an annuity, a structured settlement, or periodic payments), the "total amount received," for purposes of calculating the Attorney's fees, will be the initial lump-sum payment plus the present value, as of the time of the settlement, final arbitration award, or final judgment, of the payments to be received thereafter. If the payment is insufficient to pay the Attorney's fees in full, the balance will be paid from subsequent payments of the recovery before any distribution to the Client.

Assignment of Payment/Power of Attorney. In consideration of services or to be rendered under this agreement, the Client agrees to assign to the Attorney all monies paid by the insurance company on account of claims submitted for services rendered by the Attorney, whether submitted by the Client or the Attorney. The Client authorizes payment directly to the Attorney for services rendered and gives the Attorney power of attorney for the purpose of signing the Client’s signature on settlement checks and depositing proceeds into the Attorney IOLTA. These provisions shall be canceled upon completion of services. The Client grants the Attorney limited power of attorney for all purposes related to this claim. The Attorney may sign any and all documents on behalf of the client as “attorney-in-fact.” The Client expressly provides the Attorney power of attorney for all purposes related to this lawsuit, including medical authorizations, releases, affidavits, and other forms related to HIPAA.

Case Costs. The Attorney will advance all "case costs" and will recoup all costs advanced. Case costs will be deducted from any settlement or award after attorney’s fees are subtracted. The Client is still responsible for the Client’s own "personal expenses" (e.g.: medical bills, liens, other party costs, etc.). Upon final disposition of the case, the Client agrees to pay a $250.00 case cost fee, which covers the cost, but is not limited to copies, postage, police reports, etc.

Liens/Discharge. The Client hereby grants to the Attorney a lien for Attorney's fees and costs advanced on all claims and causes of action that are the subject of the representation of the Client under this agreement and on all proceeds of any recovery obtained by any means. The Client will be obligated to pay the Attorney out of the recovery Attorney's fees for all services provided and to reimburse the Attorney out of the recovery for all costs advanced if the Attorney is discharged. The Client understands that the Attorney is not financially responsible or liable for any outstanding liens, medical expenses, loans, etc.

Entirety/Modification. This agreement contains the entire agreement of the parties. No other agreement, statement, or promise made on or before the effective date of this agreement will be binding on the parties. This agreement may be modified only by an instrument in writing by both parties.

Effective Date of Agreement. The effective date of this agreement will be the date when, having been executed by the Client, one copy of the agreement is received by the Attorney. The Client has read this agreement carefully and understands the terms hereof.

By completing this Intake Form online, I represent that I am the person completing the form, or have the authority to complete the said form, and that all information is true, correct, and completed to the best of my knowledge. I have read and agreed to all disclosures. I am aware that I will receive a copy of my intake at the email address that I have provided herein. I acknowledge that I have been informed that Roland Witherspoon Law attorneys are licensed in Colorado, Texas, with "of-counsel" in Arizona, Georgia, Michigan, Missouri, North Carolina, Florida, Ohio, and Illinois, or local counsel, referral counsel, associated counsel in other jurisdictions.