Questionnaire

Review this website and its resource links to determine what type of claim you may have and fill out the intake form for a free claim review.

The clients for whom we can provide effective counsel are:

  • Employees and individuals who have been denied disability and pension benefits.
  • Employees and individuals who have been denied continued health coverage during periods of family caregiving or following termination of employment.
  • Partners, managers, administrators, and others who need to negotiate executive compensation or severance arrangements, or reasonable exit and non-competition agreements.
  • Former employees who are sued over unreasonable non-competition or “non-compete” agreements.
  • Employees and individuals who have been discriminated against.
  • Reasonable people who have serious problems in the workplace.
  • Whistleblowers (Sarbanes-Oxley, health & safety, and others).

Items marked with an asterisk (*) are required.









* What type of legal problem(s) do you have?










* Have you filed an application for benefits?


Did you recieve a response to the application?


Was your claim denied or terminated?

Does the denial/termination letter state that you may appeal?

Did you file an appeal?


Did you recieve a response to the appeal?



If this is a pension claim, are you seeking a lump sum amount?


For Disability Claims



Are you currently recieving Social Security benefits?

If not, have you applied before?


Are you receiving Workers' Compensation?


If no, have you applied for Workers' Compensation?





Do you anticipate returning to your previous job or any other occupation in the near future?



Are you participating in any vocational rehabilitation or educational program?



Please read the following carefully.

I am submitting this questionnaire and attachments for review by Clark Law Group, PLLC. I understand the following:

  1. That the submission of information is for review only and that there will be no charge for this review.
  2. Clark Law Group, PLLC and I have not entered into an attorney-client relationship and are not acting as my attorney unless and until a formal, written Retainer Agreement has been signed both by me and by a representative of Clark Law Group, PLLC. No decision has yet been made on whether Clark Law Group, PLLC will take my case and there is no guarantee that the firm will accept my case.
  3. Further information may be requested in order for Clark Law Group, PLLC to reach a decision.
  4. It takes time to review the material submitted and to make any reply or decision. Because no attorney-client relationship has yet been established, I will be responsible until I am notified otherwise to meet all necessary deadlines and time frames applicable to my claim; and I acknowledge that I have not received any representations or legal opinions with respect to any time frames or deadlines that may be applicable to my claim.

Contact Our Office

Clark Law Group, PLLC
1250 Connecticut Avenue, NW
Suite 200
Washington, DC 20036
Phone: (202) 293-0015
Fax: (202) 293-0115
Google+
Map/Directions

Contact Us

Clark Law Group, PLLC
1250 Connecticut Avenue, NW
Suite 200
Washington, DC 20036
Phone: (202) 293-0015
Fax: (202) 293-0115
Google+

Clark Weekly

Clark Weekly

Topic of the Week

Staying Alive: Retirement, Not the End, But A New Beginning

Retirement is probably more complicated now for most of us, but you can still take control of the process, rather than letting it take control of you.

Read more...

Blog of the Week

Jimmy John’s Fired Workers for Making a ‘Disloyal’ Meme. A Court Just Ruled That’s Okay.

Like the non-compete agreements, the July 3 court decision is an unwarranted attack on labor rights, says William B. Gould IV, a labor law professor at Stanford University and former chairman of the federal labor board.

Thought for the Week

"One unnamed American college student told of their overwhelming technology cravings, which they confessed was not too dissimilar from a person suffering from substance abuse. "

–Anonymous

List of the Week

from Intel

 Traveling With Tech Toys: Clearly We're Addicted

  • 77% would be more upset at losing technology than wedding ring
  • 64% said they'd be willing to sacrifice personal appearance for tech
  • 49% say peeping technology Toms are #1 pet peeve when flying

Top Five News Headlines

  1. Six Workers Were Fired For Making This Sandwich Meme
  2. Paid Family Leave is a Work Incentive
  3. From overtime rules to worker protections, 5 ways Trump is shifting labor policy
  4. The probe into Google’s alleged gender pay gap just hit a snag
  5. Retail Workers Union Opposes Amazon's Purchase of Whole Foods