KANSAS LAWYERS' FUND FOR CLIENT PROTECTION Kansas ...

KANSAS LAWYERS’ FUND FOR
CLIENT PROTECTION
Kansas Judicial Center - Room 374
301 SW 10th Avenue
Topeka, Kansas 66612-1507
Telephone: (785) 296-3229
How to File a Claim
The Kansas Law yers’ Fund for Client Protection (the Fund) was created by the
Kansas Supreme Court to promote public confidence in courts and the legal profession by
reimbursing losses to clients caused by the d ishonest conduct of lawyers licensed to
practice law in Kansas. Reimbursement is limited to losses occurring in the course of a
lawyer-client relationship between the lawyer and the claimant. Rule 227 of the Rules of
the Supreme Court of the State of Kansas governs eligibility and the amount of
reimbursement available.
All reimbursements of losses through the Fund are a matter of grace in the sole
discretion of the Commission administering the Fund and are not made as a matter of
right. The Fund is financed solely by Kansas lawyers. No public funds are involved.
In order to be eligible for consideration for reimbursement:
1. The loss must be caused by the d ishonest conduct of an active m em ber of the
Bar of Kansas and have arisen out of the course of the lawyer-client
relationship between the lawyer and the claimant and by reason of that
relationship. Acts of legal malpractice, negligence or fee disputes are not
covered by the Fund.
2. The claim must be filed no later than one year after the claimant knew or
should have known of the dishonest conduct of the lawyer.
3. Prior to or in conjunction with filing a claim, the claimant must report the
dishonest conduct to a county or district attorney or to the Disciplinary
Administrator, 701 Jackson Street, Topeka, Kansas 66603-3729.
1 Rev. 11/ 03

KANSAS LAWYERS’ FUND FOR CLIENT PROTECTION
STATEMENT OF CLAIM
Please type or print legibly. All questions m ust be answ ered . Attach additional pages as
necessary. Sign the form, have your signature notarized and mail this claim form to the
Client Protection Fund Commission, Kansas Judicial Center - Room 374, 301 S.W. 10th
Avenue, Topeka, Kansas 66612-1507.
1. Name of Claimant(s) __________________________________________
First Middle Last
__________________________________________
First Middle Last
_____ Individual ____ Partnership ____ Corporation _____Other
(Describe if other) ______________________________________________________________
Address:
__________________________________________________________________
Street City State Zip
Phone: ___________________________ ______________________________
Home Number
Business Number
NOTE:
Occupation:
If you have any change of address or telephone number, please advise
the Fund of the change.
____________________________________________________________
____________________________________________________________
EMPLOYER
Social Secu rity No. or Federal Tax Id entification No.: ________________________
Date of Birth: _______________________________________________________
(Please provide the Social Security number and date of birth for each claim ant, if th ere is more than
one.)
2. Lawyer against whom claim is made:
Name: ___________________________________ __________________
Telephone
Address:
____________________________________________________________
Street City State Zip
2 Rev. 11/ 03

Do you (did you) have any family relationship with this lawyer?
Yes _____ No _____ If "yes," what is (was) the relationship?
________________________________________________________________________
Do you (did you) have any business relationship with this lawyer other than the
law yer-client relationship?
Yes _____ No _____ If so, what is (was) the relationship? _______________
________________________________________________________________________
Was any other lawyer also representing you at the time of the incident regarding the
matter in question? Yes ____ No ____ If the answer is "yes":
Name of Lawyer:
Telephone:
Address:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
3. What was the lawyer against whom you are making this claim hired to do? Explain:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Was an action filed in district court? If so, in what court was the action filed and
what was the case number?
________________________________________________________________________
________________________________________________________________________
4. What amount was paid to the lawyer for the services detailed above?
$___________________________________
Attach proof of payment in the form of a cancelled check or receipt. Copies are
acceptable, but please copy both sides of a check. If you do not have proof of
payment, attach a sheet explaining why not.
3 Rev. 11/ 03

5. Do you have a written agreement with the lawyer or others regarding the work that
was to be d one? A written agreement, for example, could be a fee agreement, an
engagement letter, or a settlement agreement.
Yes _____ No _____ (Please attach a copy of any written agreement to this claim.)
6. Did the lawyer do any part of what you hired him or her to do?
Yes _____ No _____
Explain:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
7. Describe the lawyer’s d ishonest conduct relating to this claim, with the earliest
event first:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4 Rev. 11/ 03

8. Please explain the form of your loss (money, securities, or other property, etc.):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
9. State the total amount or value of the loss: $______________________
10. Date the loss occurred: _______________, 20_____
Date that you discovered the loss:
_______________, 20_____
11. Explain how you discovered the loss:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
5 Rev. 11/ 03

12. Has the lawyer told you that he/ she owes you money because of the facts explained
above? Yes _____ No _____ If "yes," give details as to the date, kind of
acknowledgment (for example, phone call or letter), amount of debt admitted, etc.
(Attach a copy of any written acknowledgments):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
13. Provide the names, addresses and phone numbers of anyone who has knowledge
of your loss:
________________________________________________________________________
Name Address Phone
What did this person see or hear?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Name Address Phone
What did this person see or hear?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
List any additional witnesses and the information each witness knows on a
separate sheet.
6 Rev. 11/ 03

14. To whom has this loss been reported?
_____ County Attorney (Name) _____________________________
_____ District Attorney (Name) _____________________________
_____ Disciplinary Administrator
_____ Other (Please identify by name and position)
____________________________________________________________
Attach a copy of your report, if available, and describe any action taken.
________________________________________________________________________
________________________________________________________________________
15. Are there any sources from which this loss, or any part of it, can be reimbursed,
such as insurance, fidelity or surety agreement?
Yes _____ No _____ Don’t Know _____ If "yes," d escribe the source:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
16. Has demand for reimbursement been made from the lawyer? Yes _____ No _____
If "yes," please provide date of demand and response of lawyer. (Please attach
copies of any correspondence or other documents.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
17. Describe any other steps that you have taken to recover this loss from the lawyer
or any other source:
________________________________________________________________________
________________________________________________________________________
7 Rev. 11/ 03

18. To your know ledge, have any civil or criminal actions been filed against the lawyer?
Yes _____ No _____ If "yes," please explain:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
19. Describe the circumstances under which you have been or will be reimbursed for
any part of the claim. Include in your description the amount received or to be
received and the source. Please note that while this claim is pending, you will be
required to notify the Client Protection Fund Commission of any reimbursements
you receive (see statem ent before your signature on the claim form, page 10.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
20. Please provide the Commission any additional information you think is needed to
consider your claim.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
8 Rev. 11/ 03

21. How did you learn about the Lawyers’ Fund for Client Protection?
_____
_____
_____
_____
_____
_____
Disciplinary Administrator
County or District Attorney
Private Attorney
Local Bar Association
Brochure
Other -- Specify _________________________
22. Are you presently being represented by a lawyer concerning this claim?
NOTE: You do not have to have a lawyer to file this claim. If a lawyer does assist
you in filing the claim, please note that Rule 19 of the rules relating to this
Commission states that it is intended law yers w ill "provide assistance as a public
service."
Yes _____ No _____ If "yes," please provide the following information regarding
the lawyer:
NAME:
ADDRESS:
__________________________________________ (____)__________
Telephone
___________________________________________________________
Street City State Zip
23. Have you ap plied or do you intend to ap ply to a Client Protection Fund from
another state or any other state agency for reimbursement of this loss?
Yes _____ No _____
If "yes," please provide the name and address of the fund and a copy of your
application.
Name of Fund
State
Address of Fund
____________________________________________________
____________________________________________________
____________________________________________________
ATTACH ANY DOCUMENTS WHICH YOU BELIEVE
SUPPORT YOUR CLAIM.
9 Rev. 11/ 03

Agreement
By signing and subm itting this Claim Form, I agree to cooperate w ith the Kansas Client Protection Fund
Commission in reference to this claim .
I further agree that if the Kansas Law yers’ Fund for Client Protection (Fund) pays m e for all or any portion
of my loss, then the Fund shall have the first right of recovery of any funds collected from the lawyer who caused
me loss, or from any other party, to the extent of the Fund’s payment to me plus any expenses of recovery.
I further agree that a lien shall exist in favor of the Fund for any amounts paid to me and shall attach to
any m oney or other property payable to me from or on behalf of the lawyer who caused my loss.
Further, if the Fund pays any portion of my loss, I assign to the Fu nd all my rights and rem edies against
the lawyer who caused my loss, his or her legal representative or assign, or an y other person or entity w hich might
be liable for my loss. I promise to cooperate with the Fund in any efforts undertaken to achieve reimbursement
of any amounts paid to me. I agree to report to the Fund any voluntary payment for my loss by the lawyer or any
other person. I also agree to notify the Fund and send a copy of the petition or complaint if any suit is filed to
recover m y loss.
I further agree to the publication of appropriate information about the nature of the claim and the amount
of reimbursement, if reimbursement is made.
By signing I agree to comply with the rules of the Kansas Suprem e Cou rt relating to the Lawyers’ Fund
for Client Protection.
True and Complete Information:
To the best of my knowledge, information and belief, the information contained in this Claim Form and any
documents is true, and I have not knowingly left out any information which might cause the Fund to deny my
claim . I understand that intentionally including false information in this claim or intentionally failing to include
information which migh t cause the Fu nd to deny my claim could cause me to be criminally prosecuted for lying
under oath.
Date: _______________________________
______________________________________________
______________________________________________
Signature of Claimant(s)
_______________________________________________
Title (if ap plicant is other than individual)
State of _________________________ )
) ss.
Cou nty of _________________________ )
Sworn to an d su bscribed before m e this __________ d ay of ____________________________, 20_____.
My Appointm en t Expires: _________________________________
_______________________________________________
Notary Public
10 Rev. 11/ 03