Attorney-Client Agreement

Attorney-Client Agreement 1. That I, the undersigned , (hereafter “Client”) have this day employed the Ogletree Abbott Law Firm, L.L.P., of Houston, Texas (hereafter “Firm”), to represent me in the prosecution of my workers’ compensation claim for income benefits relating to the injury that occurred on or about the date below. 2. Client understands that this agreement does not include legal representation for any other matter, including disputes involving medical services requiring resolution through the Medical Disputes Resolution Process, a third party claim arising out of this injury, negligence, social security disability, professional liability, deceptive trade practice, health insurance, disability insurance, life insurance, wrongful termination or any other matter beyond the Client’s claim for Texas Workers’ Compensation indemnity benefits. Client understands that a separate agreement for legal representation must be signed for all matters beyond the Client’s claim for Texas Workers’ Compensation indemnity benefits. 3. Firm will bill Client for Attorney and legal assistant time at maximum hourly rates approved by the Texas Department of Insurance - Workers’ Compensation Division. Client understands and agrees that the Firm will bill at the maximum hourly rate approved by the Workers’ Compensation Division and that the Firm will bill in .25 hourly increments. Hourly billing approved and ordered by the Division of Workers’ Compensation will be deducted from weekly compensation checks and other payments to Client at no more than 25% of amounts due to Client. If payments to Client permanently cease, no further Attorney’s fees are payable by Client. Client understands and agrees that Firm does not guarantee results and that Attorney’s fees are not dependent on results. Client agrees to timely dispute any unfair or unreasonable Firm charges to the Workers’ Compensation Division. Failure of the Client to timely dispute Firm charges shall be deemed to be Client approval of such charges. 4. Client acknowledges receipt of a copy of this Attorney-Client Employment agreement. By signing this attorney client agreement client offers to employ firm, however, firm must accept offer in writing. Client acknowledges that he / she has been advised not to sign this agreement if he / she has any questions about workers’ compensation attorney’s fees or this Agreement. 5. Client understands and agrees that Client or Firm may withdraw from this representation, at any time, without cause, upon mailing notice to the other party. Client understands that Firm may withdraw before or after a conference or hearing and that the Firm will not continue to represent Client if there is an unfavorable ruling from the Texas Appeals Panel or if the Carrier appeals or gives notice that they will appeal to District Court.

TODAY'S DATE:                day of , 2008.

Client Signature:
Address:
City:	, State: TX AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN UT VA VT WA WI WV WY Zip:
Phone:	-
Email:
Date of Injury:	1 2 3 4 5 6 7 8 9 10 11 12 / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
Social Security Number:	- -
Date of Birth (MM/DD/YYYY):	1 2 3 4 5 6 7 8 9 10 11 12 / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900