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
1100 Connecticut Avenue, NW
Suite 920
Washington, DC 20036
Phone: (202) 293-0015
Fax: (202) 293-0115
Google+
Map/Directions

Contact Us

Clark Law Group, PLLC
1100 Connecticut Avenue, NW
Suite 920
Washington, DC 20036
Phone: (202) 293-0015
Fax: (202) 293-0115
Google+

Clark Weekly

Clark Weekly

Topic of the Week

Are you a victim of pay discrimination?

The law looks to many factors when determining whether or not pay/compensation discrimination has occurred. Each of these factors is summarized in categories below.

Read more...

Blog of the Week

Trump’s Supreme Court Pick Could Spell a Fresh Hell for Workers’ Rights

Workers and labor unions should be particularly concerned about Judge Kavanaugh’s history of siding with businesses against workers and for pushing a deregulatory agenda.

Thought for the Week

"The majority undoes bargains reached all over the country. … It does so with no real clue of what will happen next—of how its action will alter public-sector labor relations. It does so even though the government services affected—policing, firefighting, teaching, transportation, sanitation (and more)—affect the quality of life of tens of millions of Americans."

–Elena Kagan, dissenting in Janus v. AFSCME

List of the Week

from Workplace Fairness

Top Five Retaliation Search This Week

Retaliation for: 

  • Public Employees
  • Political Activity
  • Workers Compensation
  • Discrimination Claims
  • Unions

Top Five News Headlines

  1. Federal Reserve chair: Decline in worker share of national economy ‘very troubling’
  2. Ann Hopkins, Who Struck an Early Blow to the Glass Ceiling, Dies at 74
  3. Labor Department Removes Rule Forcing Employers to Disclose Anti-Union Deliberations
  4. Who Will Care for the Carers?
  5. It’s Time For Our Elected Officials To Get To Work On Paid Leave