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

Paycheck Unfairness

Women earn 77% of what men earn, this is up from 61 cents per dollar of a man's salary 50 years ago. But it's still not nearly enough for any woman earning only a fraction of what men earn for the exact same job.

Read more...

Blog of the Week

The Right Wing Has a Vast, Secret Plot to Destroy Unions for Good. Here’s How to Fight Back.

SPN and ALEC have aggressively pursued so-called “right-to-work” legislation as a means of bankrupting unions and knocking out a key component of their opponents’ get-out-the-vote operation. Twenty-eight states now have these anti-union laws on the books.

Thought for the Week

"Take risks; if you win, you will be happy; if you lose, you will be wise. "

–Unknown

List of the Week

from Athena Doctrine Survey

Men Just Aren't Cutting It: Worldwide Dissatisfaction With Male Behavior

  • Japanese and South Koreans, 79%
  • French, 76%
  • Brazilians, 70%
  • More than two-thirds in Indonesia, Mexico, UK and US  

Top Five News Headlines

  1. Economists lobby for $15 minimum wage
  2. Home care workforce shortage affects caregiving
  3. Trump to nominate management-side lawyer Peter Robb for NLRB general counsel
  4. Fearing revolt from businesses, D.C. to shift focus away from worker protections
  5. House Republicans are trying to block an Obama-era program to track the gender pay gap