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Personal Injury

Forms
Extensions
 
 
  [.doc]
 
Intake and Client Retention
 
[PI-001] Client Interview Sheet [.doc]
[PI-002] Client Retainer Agreement—Negligence—No Referral [.doc]
[PI-003] Client Retainer Agreement—Negligence—Referral/Division of Fees [.doc]
[PI-004] Judicial Conference Retainer Statement [.doc]
     
 
Investigation and Securing of Medical and Other Records
 
[PI-005] HIPAA Compliant Unlimited Authorization for Plaintiff’s Counsel to
Secure Client’s Records
[.doc]
[PI-006] HIPAA Compliant Limited Authorization Sent by Plaintiff’s Counsel to
Defense Counsel or Defense Representative to Allow Release of Records,
but without Conversation or Other Communication
[.doc]
[PI-007] Letter from Plaintiff’s Counsel to Doctor’s Office Explaining HIPAA,
Enclosing HIPAA Compliant Authorization, and Detailing What Is Being
Requested
[.doc]
     
 
Automobile Negligence and Insurance Related Forms
 
[PI-DB-450] Notice and Proof of Claim for Disability Benefits (DB-450) [.pdf]
[PI-MV-198C] Request for Copy of Accident Report (MV-198C) (10/05) [.pdf]
[PI-MV-15D] Driver’s Privacy Protection Act (MV-15DPPA) [.pdf]
[PI-NF-2] Application for Motor Vehicle No-Fault Benefits (NF-2) [.pdf]
[PI-008] Underinsured/Uninsured Notification Letter [.doc]
[PI-009] Sample New York No-Fault Computation Sheet [.doc]
[PI-010] Request for Driving Abstract [.doc]
[PI-011] Letter of Representation to Defendant Owner and Driver [.doc]
[PI-012] Pre-Suit Demand Letter for Insurance Information Under Insurance Law
§ 3420(f)(2)(A)
[.doc]
     
 
Commencing the Litigation
 
[PI-UCS-840] Request for Judicial Intervention (UCS-840) [.pdf]
[PI-013] Certificate of Merit (No Issue with Statute of Limitations) for Medical
Malpractice Action
[.doc]
[PI-014] Verified Summons and Complaint in a Medical Malpractice Action
Involving Wrongful Death of an Infant with Attorney Verification
[.doc]
[PI-015] Notice of Commencement of Medical Malpractice Action [.doc]
[PI-016] Verified Summons and Complaint in an Automobile Negligence Case for
Individual Plaintiff and Attorney Verification
[.doc]
     
 
Discovery and Amplification of Pleadings
 
[PI-017] Plaintiff’s Verified Bill of Particulars in a Medical Malpractice Action
Involving Wrongful Death of an Infant
[.doc]
[PI-018] Plaintiff’s Notice of Availability for Physical Examination [.doc]
[PI-019] Plaintiff’s Notice to Admit [.doc]
[PI-020] Plaintiff’s General Combined Demands with a Demand for a Verified Bill
of Particulars on Defendant’s Affirmative Defenses
[.doc]
[PI-021] Plaintiff’s Notice to Produce Documents in a Product Defect Case with
Jurisdictional and Successor Liability Issues as to Certain Defendants
[.doc]
     
 
Trial and Verdict
 
[PI-022] Trial Exhibit List (Internal Use Only) [.doc]
[PI-023] Trial Notebook Index (Internal Use Only) [.doc]
[PI-024] Jury Selection Record (Internal Use Only) [.doc]
[PI-025] Trial Schedule [.doc]
[PI-026] Plaintiff’s Request to Charge in a Medical Malpractice Case [.doc]
[PI-027] Plaintiff’s Request to Charge in a Motor Vehicle Negligence Case [.doc]
[PI-028] Plaintiff’s Proposed Verdict Sheet in a Medical Malpractice Case [.doc]
     
 
Settlement and Closing of Case
 
[PI-029] General Release [.doc]
[PI-030] Standard Stipulation of Discontinuance [.doc]
[PI-031] CPLR 5003-a Letter to Defendant Transmitting Settlement Documents [.doc]
[PI-032] Judicial Conference Closing Statement [.doc]
[PI-033] Client Disbursement Accounting [.doc]

 

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