Lawyer Referral Attorney Application

Lawyer Referral Attorney Application

Personal and Practice Details

Name(Required)

Salutation First Middle Last Suffix

Phone (Primary/Public)(Required)

Phone (Secondary)

Email (Primary)(Required)

Email (Secondary)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

NY Date of Admittance(Required)

NY Registration #(Required)

Are you a member of NYSBA?(Required)

Yes

NYSBA Member ID #

Firm Name(Required)

Website

Are you a trial attorney?(Required)

Yes

Languages Spoken (Other than English)

Is your office ADA accessible?

Yes

Check the box if you offer any of the following to clients:

Evening hours

Home visits

Virtual consults

Select all New York counties you offer services in:(Required)

Please note: The LRIS does not service the following counties: Bronx, Dutchess, Erie, Kings, Monroe, Nassau, New York, Oneida, Onondaga, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Westchester.

Proof of Malpractice Insurance

NOTE: Malpractice insurance in the minimum amount of $100,000 is required of all participants.

Insurance Company(Required)

Amount (per claim)(Required)

Date of Expiry

Amount (aggregate)(Required)

Copy of Insurance Declaration Page

Max. file size: 5 MB.

Areas of Practice, Level I

Areas of Practice, LEVEL I(Required)

Please check the box next to any area of law you offer consultation on.

Other Areas of Practice (Not listed above)

Notes on Areas of Practice

Are you interested in providing services in Level II Areas of Practice?

This includes: Custody, Elder Law, Estates, Farm Bankruptcy, and QRDO's/DRO's

Yes

Areas of Practice, Level II

Please check the box next to any area of law you offer consultation on.

Custody: In the past two years, I have devoted 20% of my practice to custody matters; I have handled 5 custody matters; and I have completed 6 hours of custody-related CLE.

Elder Law: In the past two years, I have devoted 20% of my practice to elder law; I have handled 5 elder law matters; and I have completed 6 hours of elder law-related CLE.

Estates: In the past two years I have devoted 20% of my practice to estate law; I have handled 5 probate or administration of estate matters to completion; and I have completed 6 hours of estate-related CLE.

Farm Bankruptcy: In the past two years I have handled one farm bankruptcy matter to completion and I have completed 6 hours of farm/agricultural related CLE.

QDRO's/DRO's: I have represented clients in at least ten (10) Supreme Court matters in the past five (5) years in which Qualified Domestic Relations Orders/ Domestic Relation Orders were prepared and submitted by the undersigned attorney.

Are you interested in providing services in Level III Areas of Practice?

This includes: Major Criminal, Major Personal Injury, and Medical Malpractice

Yes

Areas of Practice, Level III

I am interested in applying for the subject matter panel(s) checked below.

Major Criminal

Major Personal Injury

Medical Malpractice

Level III areas of practice require additional detail. Please download the following form(s) for each area you've selected, complete the answers, and upload using the field below.

Upload the completed form(s) here

Drop files here or

Max. file size: 5 MB, Max. files: 3.

Certifications and Agreement

Areas of Practice Certification- I certify, under penalty of perjury, that I maintain the expertise listed for each area of practice checked above.

Panelist Agreement- I agree that I:

Am a licensed attorney in good standing with New York State Office of Court Administration.
Have no disciplinary proceedings pending against me or, if there is a disciplinary proceeding pending before either a district or department committee, I have attached an explanation on a separate sheet.
Will notify the LRIS in writing if disciplinary proceedings are brought against me or my attorney status changes with the New York State Office of Court Administration within 30 days.
Will maintain the ongoing professional expertise to handle referred matters competently.
I agree to serve persons referred to me in accordance with the terms of the LRIS Plan.

Services and Fees
Consultations- I agree to:

Grant clients an initial consultation of one-half hour for no more than $35, and this fee may be waived by me.
Provide a free initial consultation in the following areas of practice:
- Personal Injury
- Social Security
- Medical Malpractice
- Veteran and Military Law
- Unemployment
- Worker’s Compensation

LRIS Program Fees- If I am retained by any referred clients, I agree to remit to the LRIS 10% of the entire fee if the fee for any referral case is $500 or more, exclusive of disbursements. I understand that no percentage fee shall be charged if the fee is less than $500. I agree that this fee is owed to the LRIS for any referral case including:

The initial matter referred and any related transaction, proceeding or action
Any other matter which involves the same client and is undertaken within three years of the date of the referral or the initial retention, whichever last occurs.
Any matter referred to me, even if the same client also is referred to me by one or more other sources.
Until the matter is closed by the LRIS and/or the LRIS relieves me of my obligation, even if I am discharged by the client and/or the matter is concluded by another attorney, and even if I do not remain an LRIS participant.

Payments- I agree any fees owed to the LRIS will be remitted within 30 days of receiving case payment. Payment to the LRIS will be submitted via LRIS portal by credit card or mailed by check to:
LRIS Program
C/O NYSBA
1 Elk Street
Albany NY, 12207
Cases- I agree to update the referral case status and payments received via LRIS portal within 10 days of a case’s status changing or receipt of payment.
E&O Insurance- I agree to:

Maintain malpractice insurance at the minimum amount of $100,000
Submit a copy of my malpractice insurance policy with this application
Submit an updated copy of my malpractice insurance policy to lrs@nysba.org annually, within 30 days of policy renewal.

Removal From Program- I understand that my participation in the LRIS can be reviewed at any time. I also understand that I can be removed from the program for reasons including, but not limited to:

Unprofessionalism
Failure to notify the LRIS of
- New York State Office of Court Administration licensing status change
- Disciplinary proceedings
Not maintaining Malpractice insurance
Insufficient program participation
Non-payment of fees
Failure to update the LRIS of case statuses
Additional reasons at the discretion of the LRIS

Acknowledgement- By signing and dating this document, I agree to all Terms and Conditions outlined above. If found to be in violation of the terms and conditions, I can be removed from the LRIS at any time.

Your Signature(Required)

Today's Date(Required)