DISCLOSURE STATEMENT

Type of Attorney Fee Agreements:

I have been informed and understand that there are several types of attorney fee arrangements: (1) Time based, (2) Fixed, or (3) Contingent. “Time-based” means a fee that is determined by the amount of time involved such as so much per hour, day, or week. “Fixed” means a fee that is based upon an agreed amount, regardless of the time or effort involved or the result obtained. “Contingent” means a certain agreed percentage or amount that is payable only upon attaining a recovery, regardless of the time or effort involved. I understand that I have that right to choose the type of attorney fee arrangement.

Specially Awarded Attorney Fees:

I have been informed and understand that the Court or an arbitrator may sometimes award attorney fees in addition to the amount of recovery being claimed. I understand that the fee agreement I enter into with my attorney should contain a provision as to how any specially awarded attorney fees will be accounted for and handled.

Expenses:

I have been informed and understand that there may be expenses (aside from any attorney fees) in pursuing my claim. Examples of such expenses are: Fees payable to the court, the costs of serving processes, fees charged by expert witnesses, fees charged for obtaining medical bills and records, fees of investigators, fees of court reporters to take and prepare transcripts of depositions, and expenses involved in preparing exhibits. I understand that an attorney is required to provide me with an estimate of such expenses before I enter into an attorney fee agreement and that my attorney fee agreement should include a provision as to how and when expenses are to be paid.

I understand that the fee agreement should tell me whether a fee payable from the proceeds of the amount collected on my behalf will be based on the “net” or “gross” recovery. “Net recovery” means the amount remaining after expenses and deductions. “Gross recovery” means the total amount of the recovery before any deductions.

The Potential of Costs and Attorney Fees Being Awarded to the Opposing Party:

I have been informed and understand that a court or arbitrator sometimes awards costs and attorney fees to the opposing party. I have been informed and understand that should that happen in my case, I will be responsible to pay such award. I understand that the fee agreement I enter into with my attorney should provide whether an award against me will be paid out of the proceeds of any amount collected on my behalf. I also understand that the agreement should provide whether the fee I am obligated to pay my attorney will be based on the amount of recovery before or after payment of the awarded costs and attorney fees to an opposing party.

Associated Counsel:

I have been informed and understand that my attorney may sometimes hire another attorney to assist in the handling of a case. That other attorney is called an “associated counsel.” I understand that the attorney fee agreement should tell me how the fees of associated counsel will be handled.

Subrogation:

I have been informed and understand that other persons or entities may have a subrogation right in what I recover in pursuing my claim. “Subrogation” means the right to be paid back. I understand that the subrogation right may arise in various ways, such as when an insurer or a federal or state agency pays money to or on behalf of a claiming party like me in situations such as Medicare, Medicaid, workers’ compensation, medical/health insurance, no-fault insurance, uninsured/underinsured motorist insurance, and property insurance situations.

I understand that sometimes a hospital, physician, or an attorney will assert a “lien” (a priority right) on a claim such as the one I am pursuing. Subrogation rights and liens need to be considered and provided for in the fee agreement I reach with my attorney. The fee agreement should tell me whether the subrogation right or lien is being paid by my attorney out of the proceeds of the recovery made on my behalf and whether the fee I am obliged to pay my attorney will be based on the amount of the recovery before or after payment of the subrogation right or lien.