Legal Malpractice Claim Report Form – Fill Out and Use This PDF

Tracking legal malpractice claims is more critical now than ever before which is why we created the Legal Malpractice Claim Report Form. Our form has been crafted to capture the necessary and important data points related to such a claim, allowing for quick and effective analysis by legal practitioners. It ensures that if a legal malpractice claim appears, it can be identified and addressed quickly with accuracy and efficiency. The data points to be collected have been carefully chosen just sell all stakeholders can be aware of the origins of a claim, no matter how small or large. Employing the Legal Malpractice Claim Report Form puts you in control over your legal team’s success and failure, providing invaluable insights into any professionalism and service potentially being viewed as inadequate or reaping real-time impact. Across the board, it eliminates ambiguity and accurately replenishes detailed statistics so decision makers are equipped with reliable information when called upon to respond.

Legal Malpractice Claim Report Form PDF Details

Legal malpractice claims are an unfortunate reality which every lawyer and law firm should be prepared to handle. As these claims can carry serious financial penalties, it is essential for lawyers to take proactive steps in order to protect themselves from legal malpractice allegations. One such step involves the completion of a legal malpractice claim report form, which serves as a useful tool for informing both the firm's insurer and the court about potential issues concerning their professional conduct. In this blog post, we will discuss what a legal malpractice claim report form is and how it can help attorneys safeguard against unscrupulous or malicious litigation tactics. Read on to learn more!

Question	Answer
Form Name	Legal Malpractice Claim Report Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	375 1662 claims reporting form

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	MISSOURI DEPARTMENT OF INSURANCE,	MAIL TO:
	MISSOURI DEPARTMENT OF INSURANCE,	STATISTICAL SECTION
	FINANCIAL INSTITUTIONS AND PROFESSIONAL REGISTRATION	P.O. BOX 690
	LEGAL MALPRACTICE CLAIM REPORT	JEFFERSON CITY, MO 65102-0690
	LEGAL MALPRACTICE CLAIM REPORT	SEE INSTRUCTIONS ON REVERSE
		SEE INSTRUCTIONS ON REVERSE
	SECTION A
	1. INSURER’S NAME	2. NAIC GROUP AND COMPANY CODE

3. INSURER CLAIM FILE NUMBER

4. INSURED’S CITY, STATE, ZIP CODE

			A. New Claim				C. Corrected New Claim				5.
5.	STATUS OF THIS CLAIM		A. New Claim				C. Corrected New Claim
5.	STATUS OF THIS CLAIM		B. Closed Claim				D. Corrected Closed Claim
			B. Closed Claim				D. Corrected Closed Claim

											6.
6.	STATE

		01 - 1,000,000 or more				03 - 100,000 to 499,999				05 - Less than 49,999	7.
7.	POPULATION CODE	01 - 1,000,000 or more				03 - 100,000 to 499,999				05 - Less than 49,999
7.	POPULATION CODE	02 - 500,000 to 999,999				04 - 50,000 to 99,999
		02 - 500,000 to 999,999				04 - 50,000 to 99,999

8.	HOW MANY LAWYERS WERE			A. One			C. 6 to 30				8.
8.	HOW MANY LAWYERS WERE			A. One			C. 6 to 30
	INSURED ON THE POLICY?			B. 2 to 5			D. Over 30

9.	HOW MANY YEARS HAD THE INSURED BEEN ADMITTED TO						A. Under 4 years			C. Over 10 years	9.
9.	HOW MANY YEARS HAD THE INSURED BEEN ADMITTED TO						A. Under 4 years			C. Over 10 years
	PRACTICE AT THE TIME OF THE ALLEGED ERROR?						B. 4 to 10 years

10.	WHAT TYPE OF LAW OFFICE IS THE			A. Legal Clinic			C. Private Practice				10.
10.	WHAT TYPE OF LAW OFFICE IS THE			A. Legal Clinic			C. Private Practice
	INSURED A MEMBER OF?			B. Legal Aid

11.	WHAT IS THE INSURED’S RELATIONSHIP			A. Free legal service					C. Client other than A or B		11.
11.	WHAT IS THE INSURED’S RELATIONSHIP			A. Free legal service					C. Client other than A or B
	TO THE CLAIMANT?			B. Member pre-paid legal plan					D. Non-client

12.	DID THE CLAIM ARISE AFTER THE INSURED MADE										12.
12.	DID THE CLAIM ARISE AFTER THE INSURED MADE						A = YES			B = NO
	AN ATTEMPT TO COLLECT A FEE?						A = YES			B = NO
	AN ATTEMPT TO COLLECT A FEE?

13.	DID THIS CLAIM ARISE FROM AN AREA OF LAW:						A. Normal to the insured’s practice				13.
13.	DID THIS CLAIM ARISE FROM AN AREA OF LAW:						B. Not normal to the insured’s practice
							C. Not applicable
					14. MO/YR						15. MO/YR
14.	DATE OF OCCURRENCE							15. DATE FIRST REPORTED TO INSURER

SECTION B
											16. MO/YR
16.	DATE THIS CLAIM CLOSED OR DISPOSED

17.	CLAIM DISPOSITION										17.
	A. Before filing suit or demanding hearing						F. During appeal
	B. Before trial or hearing						G. After appeal
	B. Before trial or hearing						G. After appeal
	C. During trial or hearing						H. Claim or suit abandoned
	D. After trial or hearing but before judgment or decision						I. During review panel or non-binding arbitration
	E. After judgment or decision but before appeal

											18.
18.	What amount was paid to the claimant (including the deductible)?										$
											$

											19.
19.	What amount was paid for loss expenses (including the deductible)?										$
											$

											20.
20.	What reserve amount was established for loss payment?										$
											$

											21.
21.	What reserve amount was established for loss expense?										$
											$

											22.
22.	What was the amount of the insured’s deductible?										$
											$

SECTION C
											23
23.	AREA OF LAW (See instructions for code)

											24.

25.MAJOR ACTIVITY CODE (See instructions for code)

Other (Specify) _______________________________________________________________________________________

25.

26.ALLEGED ERROR OR OMISSION (See instructions for code)

Other (Specify) _______________________________________________________________________________________

FORM PREPARED BY (PLEASE TYPE OR PRINT)	TELEPHONE NUMBER (AREA CODE) NUMBER, EXTENSION

SIGNATURE	DATE

MO 375-1662 (8-06)

LEGAL MALPRACTICE CLAIM REPORT INSTRUCTIONS

SECTION A Complete this section for all claims.

1.INSURER’S NAME - The full and legal name of the insurance company providing the coverage for this claim.

2.NAIC GROUP AND COMPANY CODE - Enter the NAIC four digit group code and the five digit company code for the company listed in Item 1.

3.INSURER CLAIM FILE NUMBER - Enter the company file number for this claim. Both alphabetic and numeric characters are permitted. DO NOT USE HYPHENS, DASHES, SLASHES OR SPACES.

4.INSURED’S CITY, STATE AND ZIP - Enter the city, state and zip code address for the insured against whom this claim was made. “State” is the two letter official postal code; i.e., MO, MA, KY, etc.

5.STATUS OF THIS CLAIM - Use A for each new claim opened and B for each of these new claims which are now closed. Use C if a claim is reopened and D for each of these reopened claims which are now closed.

6.STATE - The two letter official postal code of the state where the claim was made.

7.POPULATION CODE - Enter the two digit code for the city population where the claim was made.

8.thru 13. (Self-Explanatory)

14.DATE OF OCCURRENCE - This date and all other dates are to be reported in the form MM YY.

15.DATE FIRST REPORTED TO INSURER - Use the date format specified in Item 14.

SECTION B Complete this section for each closed claim only.

16.DATE THIS CLAIM CLOSED OR DISPOSED - Use the date format specified in Item 14.

17.CLAIM DISPOSITION - For this claim, enter the alpha code for FINAL method of disposition.

18.thru 22. Round all amounts to the nearest dollar.

SECTION C Complete this section for all claims.

23. AREA OF LAW - Enter the alpha code for which area of law the insured was retained by the client.

A.	Real Estate	N.	Civil Rights and Commission
B.	Estate, Trust & Probate	O.	Consumer Claims
C.	Family Law	P.	Construction (Building Contracts)
D.	Personal Injury/Property Damage-Plaintiff	Q.	Corporate and Business Organization
E.	Personal Injury/Property Damage-Defendant	R.	Environment
F.	Workers’ Compensation	S.	Government Contracts and Claims
G.	Securities (S.E.C.)	T.	Immigration and Naturalization
H.	Patents, Trademarks, Copyrights	U. International Law
I.	Collection and Bankruptcy	V. Labor Law
J.	Taxation	W. Local Government
K.	Criminal	X. National Resources
L.	Admiralty	Y. Business Transactions/Commercial Law

M.Antitrust

24.MAJOR ACTIVITY CODE - Indicate the one major activity which the licensee was engaged in at the time the alleged error occurred.

A.Commencement of action or proceeding (initial pleading, service)

B.Pre-trial, pre-hearing (investigation, subsequent pleading, discovery, motion)

C.Trial or hearing

D.Post trial or hearing

E.Appeal activities

F.Preparation, transmittal or filing of documents other than pleadings

G.Settlement and negotiation

H.Exparte (noncontested) proceedings, i.e., adoption and probate

I.Investigation, other than litigation

J.Tax reporting or payment

K.Title opinion

L.Other written opinion

M.Consultation or advice

N.Recommendation of or referral to another professional including another lawyer

O.Other (Please specify on front)

25.ALLEGED ERROR OR OMISSION - Indicate the one alleged error or omission which is the most significant to the cause of the claim being made.

A.	Failure to calendar properly	L.	Failure to understand or anticipate tax consequences
B.	Failure to react to calendar	M.	Failure to know or properly apply to law
C.	Failure to know or ascertain deadline correctly	N.	Failure to follow client’s instructions
D.	Failure to file documents where no deadline is involved	O.	Failure to obtain client’s consent or to inform client
E.	Procrastination in performance of services or lack of follow-up	P.	Improper withdrawal from representation
F.	Error in mathematical calculation	Q.	Conflict of interest
G.	Lost file, document or evidence	R.	Libel or slander
H.	Clerical error	S.	Malicious prosecution or abuse of process
I.	Error in public record search	T.	Violation of civil rights
J.	Planning or strategy error	U.	Fraud
K.	Inadequate discovery of facts or inadequate investigation	V.	Other (Please specify on front)

MO 375-1662 (8-06)

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2. Once your current task is complete, take the next step – fill out all of these fields - E After judgment or decision but, What amount was paid to the, What amount was paid for loss, What reserve amount was, What reserve amount was, What was the amount of the, SECTION C, AREA OF LAW See instructions for, MAJOR ACTIVITY CODE See, Other Specify, ALLEGED ERROR OR OMISSION See, Other Specify, FORM PREPARED BY PLEASE TYPE OR, TELEPHONE NUMBER AREA CODE NUMBER, and SIGNATURE with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

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Legal Malpractice Claim Report Form – Fill Out and Use This PDF

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