LAWPRO - E&O Insurance - Claim Notice Report

Claim Notice Report (Step 1 of 3) (Aussi disponible en française)

If you do not receive a confirmation number, we did not receive your notice, and it is imperative that you contact the Claims Coordinator.

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Submit this form on your own behalf or on behalf of another lawyer if you:

Are aware of a claim;
Are aware of any potential errors or omissions that may lead to a claim;
Are aware of any accusations by a client or other person that could form the basis of a claim; or
Have been asked to give evidence about your file handling or a request for production or court order has been made for your file

Do not use this form to provide notice against another lawyer unless doing so with their knowledge and consent or you are a partner at the firm when the lawyer worked at the time of the error. In circumstances where you are reporting a matter in your capacity as a partner at the firm where the lawyer worked at the time of the error, advise the lawyer in question that you have reported the matter.

Complete as much of the form as possible at this time. Do not delay submitting notice of a claim or potential claim for any reason. Take any necessary steps to protect your and LAWPRO's interests with respect to any deadline in the interim.

* mandatory field

I am providing notice of a claim or a potential claim *
against me on behalf of another lawyer

FILER INFORMATION

    I am*
     Current or former partner of the Insured LAWYER
     Current or former employer of the Insured LAWYER
     Employee of the Insured LAWYER
     Claims Administrator at the Insured LAWYER's current or former firm
     Executor/Administrator of the Insured Lawyer's Estate
     Other, please specify:

Your LSO Number (if applicable):

Your Last Name:*

Your First and Middle Name(s):*

Telephone Number:*
- - ext.

E-mail: A confirmation e-mail will be sent to this address

    Country:

    If other, please specify:

     Mailing Address:

City:

Firm Name (if applicable):

INSURED INFORMATION

Insured LAWYER Last Name: *

Insured LAWYER First and Middle Name(s): *

- - ext.

E-mail: A confirmation e-mail will be sent to this address

     Country: *

     If other, please specify:

     Mailing Address: *

City: *

Firm Name on date of alleged error: *

Name of the Managing Partner and/or Shareholder(s) of the Insured's current law firm/law corporation:

CLIENT/CLAIMANT INFORMATION

2. Claimant Last or Corporate Name: *

Claimant First Name:

3. Self-Represented?
Yes No

CLAIM INFORMATION

4. Date on which the alleged error or omission occurred: *

5. Date on which you first became aware of the claim or potential claim against you: *

6. Did the claim or potential claim arise out of the provision of pro bono services? *

Yes No

7. How did you become aware of the claim or potential claim? *

8. Has a proceeding been commenced against you? *

Yes No

9. Does your firm carry excess insurance? *

Yes No Don't know

10. Area of Practice:

11. Your status on the date on which the alleged error or omission occurred?
     Sole Practitioner
     Partner in Firm
     Employee in Firm
     Associate in Firm
     Employed-Education
     Employed-Government
     Employed Other
     Employed-In-House Counsel
     Unknown

DESCRIPTION OF CLAIM

12. Describe fully the circumstances giving rise to the claim. To the extent known, include relevant dates: *
      We recommend you save the content using Notepad or Microsoft Word as a text file in your computer first,
      and then copy the content and paste into the text area below.

      Note: You will have the opportunity of uploading documents in Question 13.

13. Do you have Pleadings, Motion Records and/or Notice Letters related to the possible/alleged error? *

Yes No

14. As our claims document handling process is electronic, we strongly encourage you to upload all relevant documentation regarding the claim. If you are unable to attach the above-noted document(s) electronically, please indicate below the method by which you are planning to send them: *
e-mail fax same-day courier overnight courier All relevant documents attached
No relevant documents to provide

Next steps:

Note that you must first 'Review' your Claim Notice form before being able to SUBMIT it online.
Click 'Review' to see a summary of your entries before submitting your Claim Notice form; OR
Click 'Reset' to abandon your entries and start over; OR
Click 'Cancel' to exit the Claim Notice form.

*E-mail:*
*Fax:*	*1-800-286-7639 Attn.: Claims Coordinator*

*Courier:*	Attn: Claims Coordinator LAWPRO 250 Yonge Street, Suite 3101 P.O. Box 3 Toronto, ON M5B 2L7