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Lawyer Referral Attorney Application
Lawyer Referral Attorney Application
Personal and Practice Details
Name
(Required)
Dr.
Miss
Mr.
Mrs.
Ms.
Mx.
Prof.
Rev.
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)
MM slash DD slash YYYY
NY Registration #
(Required)
Are you a member of NYSBA?
(Required)
Yes
No
NYSBA Member ID #
Firm Name
(Required)
Website
Are you a trial attorney?
(Required)
Yes
No
Languages Spoken (Other than English)
Is your office ADA accessible?
Yes
No
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)
Albany
Allegany
Broome
Cattaraugus
Cayuga
Chautauqua
Chemung
Chenango
Clinton
Columbia
Cortland
Delaware
Essex
Franklin
Fulton
Genesee
Greene
Hamilton
Herkimer
Jefferson
Lewis
Livingston
Madison
Montgomery
Niagara
Ontario
Orleans
Otsego
Oswego
Rensselaer
Saratoga
Schenectady
Schoharie
Schuyler
Seneca
Steuben
St. Lawrence
Sullivan
Tioga
Tompkins
Ulster
Warren
Washington
Wayne
Wyoming
Yates
Select All
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.
Company
Amount (per claim)
Date of Expiry
Copy of Insurance Declaration Page
Max. file size: 5 MB.
Maximum file size - 5 mega bytes.
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.
Administrative Law
Elections
Government
Transportation
Water
Admiralty & Maritime
Agriculture
Animal Law
Arbitration
Aviation
Business & Corporate
Antitrust & Trade Regulation
Banking & Finance
Bankruptcy
Chapter 11 Bankruptcy
Chapter 13 Bankruptcy
Chapter 7 Bankruptcy
Commercial
Contracts
Franchising
Government Contracts
Insurance
Mergers & Acquisitions
Non-profit & Social Enterprise
Securities
Taxation
Telecommunications
Trade Dress
Civil Law
Appeals
Civil Rights
Class Action
Defamation
Disability Rights
Harassment
Legal Malpractice
LGBTQ rights
Libel & Slander
Litigation
Mass Torts
Medical Malpractice
Privacy
Product Liability
Professional Malpractice
Social Security (SSDI)
Torts
Constitutional
Construction
Consumer/Debt
Consumer
Debt Collection
Lemon Law
Criminal
DUI/DWI
Expungement
Federal Crimes
Fraud
Sex Crimes
Sexual Harassment
Traffic Violation
Education
Elder Law
Medicaid & Medicare
Power of Attorney
Wills & Living Wills
Probate
Trusts & Estates
Entertainment, Arts, & Sports
Entertainment
Gaming
Sports
Environmental & Energy Law
Environmental
Energy & Utilities
Natural Resources
Public Utilities
Family Law
Adoption
Child Abuse & Neglect
Child Support
Custody
Divorce & Separation (contested – uncontested)
Domestic Abuse & Violence
Guardianship (child – adult)
Juvenile
Marriage & Prenuptials
Healthcare
Indian & Native Populations
Intellectual Property
Copyright
Intellectual Property
Patent
Trade Secrets
Trademark
Immigration
Asylum
Citizenship
Deportation
International
Internet & Media
Internet
Media
Labor & Employment
Discrimination
Employee Benefits
ERISA
Wrongful Discharge
Pension & Profit Sharing
Retaliation
Severance Agreements
Mediation
Mediation- Divorce
Mediation- Other
Military
Personal Injury
Slip & Fall Accidents
Workers Compensation
Wrongful Death
Real Property
Foreclosure
Land Use & Zoning
Landlord-tenant
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
No
Areas of Practice, Level II
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
No
Areas of Practice, Level III
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.
Major Criminal Form (PDF)
Major Personal Injury (PDF)
Medical Malpractice (PDF)
Upload the completed form(s) here
Drop files here or
Select files
Max. file size: 5 MB, Max. files: 3.
Maximum file size - 5 mega bytes.
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)
MM slash DD slash YYYY