Form Wlmapp 007 PDF Details

Navigating the intricacies of professional liability insurance is a crucial aspect for law firms in Wisconsin, and the Wlmapp 007 form plays a pivotal role in this process. This comprehensive form is designed specifically for lawyers joining a firm during the policy period who were not initially named in the firm's policy application. It requires detailed information about the lawyer's professional history, including any previous professional liability claims or suits made against them, awareness of potential claims, as well as their affiliations with previous law firms. Furthermore, the form probes into whether the lawyer being added has been involved in mergers or acquisitions, requires prior acts coverage, has faced disciplinary actions, or has been refused insurance in the past. It also delves into potential conflicts of interest by checking if the lawyer holds any stock, financial interests, or positions as an officer or director in client institutions. This information is not only vital for the insurance underwriting process but ensures that law firms are adequately protected against the risks associated with professional liability. Completing the Wlmapp 007 form accurately is a testament to a firm's commitment to transparency and risk management, highlighting the importance of this documentation in maintaining the integrity and financial stability of legal practices in Wisconsin.

QuestionAnswer
Form NameForm Wlmapp 007
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesWILMIC_addition al_lawyer wisconsin lawyers mutual insurance company additional lawyer application form

Form Preview Example

 

 

Wisconsin Toll Free: 800.373.3839

 

 

 

 

Office: 608.824.1700

 

 

Fax: 608.824.1701

725 HEARTLAND TRAIL, SUITE 300

E-mail: wilmic@wilmic.com

MADISON, WI 53717

Web Site: www.wilmic.com

LAWYERS PROFESSIONAL LIABILITY INSURANCE

 

Additional Lawyer Application

This Application is for a Claims Made and Reported Insurance Policy

Please complete this application for each lawyer who joins your firm during the policy period and was not named in your policy application.

Firm Name: ____________________________________________________________________________________________

Lawyer's Name: ________________________________

Lawyer State Bar Number: ______________________________

Lawyer status:

Full-Time

Part-time ____________________ hours per month

Please use the following designations:

 

 

“O” Officer, Director, or Shareholder

“E” Employed lawyer

“P” Partner

 

“C” Of Counsel or Part-time lawyer

Date Lawyer Joined Firm ________________________

Designation ___________________________________________

Year Admitted to Wis. Bar _______________________

Years in Practice ________________________________________

1. Has any professional liability claim or suit ever been made against the lawyer named above?

□ Yes

Please attach explanation.

□ No

2.Is the lawyer named above aware of any professional liability claim or any claim incident, act or omission that a reasonably prudent lawyer might expect to be the basis of a claim or suit?

□ Yes Please attach explanation.

□ No

3. Is the lawyer named above a former shareholder or partner in any previous law firm?

□ Yes Please identify firm(s).

□ No

4.If the answer to question 3 is yes:

Is the lawyer named above aware of any professional liability claim or any claim incident, act or omission in any previous firm that a reasonably prudent lawyer might expect to be the basis of vicarious liability to this lawyer?

□ Yes Please attach explanation.

□ No

5.If the lawyer named above was affiliated with other firms during the past five years, list the name of each firm and the years the lawyer was affiliated with each firm.

6.Is the lawyer named above currently a member of any law firm?

□ Yes Please identify firm(s).

□ No

WLMAPP-007 (01/03)

1

 

□ No Please attach explanation.

7.Does adding the lawyer named above to your firm involve either a merger or acquisition of that lawyer's practice with yours?

□ Yes Please attach explanation.

□ No

8.For the lawyer named above, do you want your current policy to provide prior acts coverage for professional services this lawyer rendered prior to joining your firm?

Yes Additional premium will be charged.

No No premium will be charged for the remainder of this policy period.

9.Has the lawyer named above ever been subject to disciplinary action or reprimand?

□ Yes Please attach explanation.

□ No

10. Has the lawyer named above ever been canceled or refused insurance by any insurance carrier?

□ Yes Please attach explanation.

□ No

11. Does the lawyer named above serve as an officer or director of any institution that is also a client of your firm?

□ Yes Please attach explanation.

□ No

12.Does the lawyer named above hold any stock or have any financial interest in any institution that is also a client of your firm?

□ Yes Please attach explanation.

□ No

13.Does the lawyer named above currently have lawyers professional liability insurance?

Yes ________________________________________________ (name of insurance carrier)

No

14.Has the lawyer named above been interviewed by someone in your firm for the purpose of identifying possible conflicts of interest?

□ Yes

Representation

The above information has been reviewed and is certified to be correct.

We understand that the information submitted on this application becomes a part of the policy for professional liability insurance and is subject to the same terms and conditions.

_______________________________________

_______________________________________

__________________

(signature of owner, partner or officer of the firm)

(signature of lawyer named above)

(date)

WLMAPP-007 (01/03)

2

 

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1. When filling out the Form Wlmapp 007, make certain to complete all of the important blank fields in the corresponding part. It will help to facilitate the process, allowing for your information to be handled swiftly and accurately.

Filling out part 1 of Form Wlmapp 007

2. When the last segment is completed, you need to include the required particulars in Is the lawyer named above a former, Yes Please identify firms, If the answer to question is yes, Yes Please attach explanation, If the lawyer named above was, Is the lawyer named above, Yes Please identify firms, and WLMAPP in order to move forward to the 3rd step.

Guidelines on how to fill in Form Wlmapp 007 stage 2

3. The next part should be quite simple, with yours, Yes Please attach explanation, For the lawyer named above do you, services this lawyer rendered, Yes Additional premium will be, Has the lawyer named above ever, Yes Please attach explanation, Has the lawyer named above ever, Yes Please attach explanation, Does the lawyer named above serve, Yes Please attach explanation, Does the lawyer named above hold, of your firm, and Yes Please attach explanation - every one of these empty fields will have to be filled out here.

Filling out segment 3 in Form Wlmapp 007

4. The next section arrives with all of the following fields to complete: Does the lawyer named above, Yes name of insurance carrier No, Has the lawyer named above been, conflicts of interest Yes, No Please attach explanation, Representation, The above information has been, We understand that the information, and signature of owner partner or.

The best ways to fill out Form Wlmapp 007 portion 4

Be very careful while completing We understand that the information and Does the lawyer named above, because this is the part where many people make mistakes.

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