Abacus Law Client In-Take Sheet Sample
Law Area: Insurance

AC Consulting Legal Office Technology & Automation









LAW OFFICE INFORMATION SHEET

Current Date: ____________________

1.
NEW MATTER INFORMATION

Matter Name: __________________________________________________
Claim No.:_____________________________________________________
Policy No.: ___________________________________________________

Attorney: _____________________________________________________
Court Case No.: _______________________________________________

Court: ________________________________________________________
Opened Date: __________________________________________________
Closed Date: __________________________________________________
Re-Opened Date: _______________________________________________


2.
ADDITIONAL MATTER INFORMATION

Claims Handler: _______________________________________________
Abstract: _____________________________________________________
Liens: ________________________________________________________
Major Expense: ________________________________________________
Fast Track: ___________________________________________________
Policy Limits: ________________________________________________
Date of Loss: _________________________________________________
Claims Office: ________________________________________________

3. PLAINTIFF'S ATTORNEY INFORMATION

Last Name: ____________________________________________________
First Name: ___________________________________________________
Firm Name: ____________________________________________________
Address: ______________________________________________________
City/State/Zip: _______________________________________________
Work Phone: (_____)____________________________________________
Fax: (_____)___________________________________________________
Pager/Cell: (_____)____________________________________________

4.
PLAINTIFF'S PERSONAL INFORMATION

Last Name: ____________________________________________________
First Name: ___________________________________________________
Address: ______________________________________________________
City/State/Zip: _______________________________________________
Home Phone: (_____)____________________________________________

Work Phone: (_____)____________________________________________
Fax: (_____)___________________________________________________
Pager/Cell: (_____)____________________________________________

5.
CO-DEFENDANT INFORMATION

Gender (m/f): __________________
Last Name: ____________________________________________________

First Name: ___________________________________________________
Firm Name: ____________________________________________________
Address: ______________________________________________________

City/State/Zip: _______________________________________________
Work Phone: (_____)____________________________________________

Client Name: __________________________________________________

Gender (m/f): __________________
Last Name: ____________________________________________________

First Name: ___________________________________________________
Firm Name: ____________________________________________________
Address: ______________________________________________________

City/State/Zip: _______________________________________________
Work Phone: (_____)____________________________________________

Client Name: __________________________________________________

Gender (m/f): __________________
Last Name: ____________________________________________________

First Name: ___________________________________________________
Firm Name: ____________________________________________________
Address: ______________________________________________________

City/State/Zip: _______________________________________________
Work Phone: (_____)____________________________________________

Client Name: __________________________________________________

6.
DISPOSITION

Amount of Settlement: _________________________________________

Total Hours: __________________________________________________
Suit Life: ____________________________________________________
Legal Allocation: _____________________________________________


7.
CLOSING INFORMATION

Arbitrated: ___________________________________________________

Medralien : ___________________________________________________
Trial: ________________________________________________________
C&R: __________________________________________________________
Stipulation:___________________________________________________
Findings/Award: _______________________________________________
Substitution: _________________________________________________
Endorsed-Filed Dismissal Only: ________________________________
Endorsed-Filed Dismissal and Release: _________________________

Order Approve. 3rd Party C&R:__________________________________



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