Get Statement Regarding Attorney Fees

Completing the Statement Regarding Attorney Fees is an essential step for attorneys representing claimants in workers compensation cases. This guide will provide clear, step-by-step instructions to assist you in successfully filling out the form online.

Follow the steps to fill out your form accurately and efficiently.

1. Click ‘Get Form’ button to access the Lawyer Fees Statement and open it in your preferred online editor.
2. In the first section, enter your name as the attorney representing the employee or their dependents.
3. In the designated field, state the total amount of attorney's fees you claim and the percentage of the compensation to be recovered for the employee or their dependents.
4. List any offers of settlement made by or on behalf of the employee or their dependents prior to the settlement agreement, along with the corresponding dates.
5. Document any offers of settlement made by the respondent or insurance carrier prior to the agreed-upon settlement, including dates.
6. Indicate the approximate number of hours you spent on legal representation for the employee or their dependents.
7. Declare any novel or difficult legal or factual questions that were involved in your legal representation.
8. List any time limitations imposed in this claim by the employee, their dependents, or due to other circumstances.
9. Provide a summary of any prior occasions when the employee or their dependents were represented by you, along with relevant dates and nature of representation.
10. Indicate the number of years you have been practicing workers compensation law.
11. Specify what percentage of your total practice constitutes representation of claimants, employers, and insurance carriers in workers compensation claims.
12. Finally, review the completed form for accuracy, then save your changes, download, print, or share the form as necessary.

Take the next step in your legal process by completing your documents online today.