WE RECEIVED YOUR REQUEST TO JOIN THE SUBOXONE DENTAL LAWSUIT. THESE DOCUMENTS MUST BE COMPLETED TO SIGN UP FOR THE CASE. THERE IS NO COST UNLESS WE WIN.
LAW FIRM RETAINER AGREEMENT
This Retainer Agreement (the “Agreement”) is between (the “Client”), the Dolman Law Group Accident Injury Lawyers, PA and the Law Offices of Jennifer Duffy, APC (“Attorneys”) for legal services relating to use of Suboxone which caused dental damage (the “Matter”) and is valid only if signed by Client and a representative of Attorneys. Client and Attorneys (the “Parties”) understand and agree as follows:
- SCOPE OF SERVICES.
The legal services provided by Attorneys are consultation and investigation and, potentially, litigation of claims Client may have in the Matter. Attorneys’ investigation of this matter may include witness interviews, research, and technical analysis.
Attorneys shall represent Client only in connection with this Matter, and not any counterclaim, individual claim, or appeal, whether related or not to this Matter, except as expressly stated in this Agreement. Under this Agreement, Attorneys agree to represent Client, personally, and not any other individual or entity related to Client. Attorneys’ services do not include tax advice, and Client is urged to seek independent tax advice.
Should Attorneys file a lawsuit on your behalf in this Matter, the lawsuit may be part of a multi-district litigation.
Litigation is, by its nature, uncertain, and Attorneys do not guarantee a particular outcome of any litigation related to the Matter.
2. TIMELINESS OF CLAIMS
Client recognizes that Attorneys must have certain information from Client to determine whether or not Client has a claim. Client understands that if a lawsuit is not filed prior to the expiration of the statute of limitations, Client will lose the right to make a claim and can be forever barred from bringing a lawsuit. By signing this agreement, Client recognizes that their statute of limitations may have already expired and, if it has not, each day that passes brings us closer to the expiration of the statute of limitations. In cases where a Client’s claim arises out of or relates to the use of a pharmaceutical product or medical device, Client agree and understand that the Firm will not be able to file a lawsuit on Client’s behalf or take any action to insure that the time in which to file a claim does not expire until Client have provided (1) medical records establishing their alleged injury and (2) proof that Client used the product that Client alleges caused their alleged injury. Client also understands it will take the Firm a minimum of ninety (90) days after the receipt of such information to evaluate our case, and that should the statute of limitations or any other applicable deadlines including, but not limited to class registration deadlines expire prior to or during that ninety-day period, Client agrees not to hold the Firm and (or their associate counsel) responsible for any consequence related to the expiration of that deadline.
3. CLIENT RESPONSIBILITIES.
Client agrees to cooperate fully with Attorneys and the court in the investigation and in any litigation of this matter—including by providing complete and accurate information that is related to the Matter and within Client’s knowledge, possession, or control.
Client shall follow Attorneys’ instructions to retain, preserve, and provide us all materials that may constitute evidence in this matter, including copies of documents, and shall cooperate with Attorneys in obtaining copies of relevant dental or medical records.. Client shall not dispose of relevant evidence such as prescription boxes, receipts, treatment billing or medical/dental records without first consulting Attorneys.
Client shall be available to communicate with Attorneys on reasonable notice and shall keep Attorneys apprised of Client’s current street address, telephone number, and email address.
Client shall cooperate fully with the court in any litigation of this matter, including by being available to appear at and testify in deposition or court if called upon to do so.
4. ATTORNEY FEES AND COSTS.
Client shall not be obligated to pay any of Attorneys’ fees or costs except out of recovery Attorneys secure on behalf of Client in the Matter.
Recovery may be obtained through resolution of the matter by settlement, judgment, or otherwise. Further, resolution of this Matter may include or consist of non-monetary relief, such as an agreement by a defendant to modify its business practices..
Attorneys’ fees are not fixed by law and are negotiable.
Although determination of an award is in the court’s discretion, the Parties agree that a fair award of attorneys’ fees would be 40% of the total recovery plus reimbursement of all costs and expenses with interest. The Attorneys’ fees shall be shared as follows: Dolman Law Group Accident Injury Lawyers, PA shall receive 50% and The Law Offices of Jennifer Duffy APC shall receive 50%. The fee set forth in this Agreement is not set by law. Attorneys’ compensation will not exceed any limits on compensation imposed by law.
Costs are not deducted from any recovery before calculating the amount of Attorneys’ fees. Costs include, but may not be limited to, filing fees, expert fees, long distance telephone charges, facsimile charges, messenger service fees, photocopy expenses, investigation costs, process server fees, deposition costs, transcripts, database and document management costs, co-counsel fees and travel expenses.
If possible, Attorneys shall obtain reimbursement of costs from defendant. If that is not possible, the Parties agree that any reasonable costs incurred by Attorneys in investigating, filing, or prosecuting a lawsuit that are not paid for by the defendant shall be repaid with any funds from any settlement or judgment that are awarded to Client.
5. AWARD OF MONETARY SANCTIONS. Sanctions are punitive measures. They are payments that a court orders a party to make, to compensate for extraordinary time spent by the other party’s attorneys compelling the opposing side to do that which they are required to do, but have failed to do. Any sanction award ordered by the court belongs to Attorneys as compensation for such extraordinary time and is not considered a part of the recovery made on behalf of Client. If such an award includes a cost item, such as a filing fee, such costs items shall be credited to Client’s account upon payment thereof.
6. ASSIGNMENT OF CLAIM AND LIEN FOR ATTORNEYS’ FEES.
Client understands that a defendant may make a settlement offer that is favorable to plaintiff but that is contingent on Attorneys’ receiving reduced fees or no fees at all. However, the Parties agree that this contingency fee Agreement is expressly premised on the assumption that Attorneys have a right to attempt to recover attorneys’ fees under fee-shifting laws that provide an attorneys’ fees award if Client prevails. CLIENT HEREBY AGREES TO ASSIGN TO ATTORNEYS ALL RIGHTS THAT CLIENT HAS TO APPLY FOR AND COLLECT ANY ATTORNEYS’ FEES.
Client hereby grants Attorneys a lien on any claims or causes of action that are the subject of Attorneys’ representation under this agreement. The lien to Attorneys shall be for any sums owing to Attorneys for any unpaid costs or attorneys’ fees at the conclusion of Attorneys’ services. The lien shall attach to any recovery Client may obtain, whether by arbitration award, judgment, settlement or otherwise. The effect of such a lien is that Attorneys may be able to compel payment of attorneys’ fees and/or costs from any funds recovered on behalf of Client even if Attorneys has been discharged before the end of the case.
7. CLIENT RECOVERY.
Attorneys shall choose the appropriate jurisdiction in which to file suit, including where Attorneys may be permitted by the court to appear in association with local counsel, even if Attorneys are not admitted to the bar in that jurisdiction.
In addition, Attorneys may, in their sole discretion, associate with and employ other attorneys to assist in the representation of Client. Attorneys reserve the right to allocate Attorneys’ fees among associated or employed attorneys according to Attorneys’ valuation of (i) relative contribution to representation of the claims, and/or (ii) relative sums of each firm’s lodestars (i.e., the total hours spent times the hourly rate of each attorney working on the claims).
8. APPROVAL OF SETTLEMENT.
Attorneys shall obtain Client’s approval before entering into a settlement.
If Attorneys recommend acceptance of a settlement offer, Client shall seriously consider the offer before making a decision to accept or reject it.
Client appoints Attorneys as Client’s attorney-in-fact to execute any and all settlements, drafts, and checks that Client could properly execute, so as to receive in Client’s name, any monies payable to Client; and Client authorizes Attorneys to deposit same in Attorneys’ trust account.
9. TERMINATION, DISCHARGE, AND WITHDRAWAL.
Client may terminate this Agreement at any time. (However, Attorneys still retain the lien on attorneys’ fees discussed in section 4, above.)
If Attorneys file a lawsuit on behalf of Client, they shall represent Client in the lawsuit until a settlement or judgment is reached or until this Agreement is otherwise terminated.
If Attorneys determine, in their sole discretion, that the subject of potential litigation of the Matter has been adequately resolved, that the Matter is not suitable for litigation, or that the filing of a lawsuit is not suitable for any reason, Attorneys may not file a lawsuit and shall notify Client of that determination.
If Attorneys, in their sole discretion, identify circumstances that: (i) present risk of liability or ethical conflict if Attorneys were to continue representing Client; or (ii) could diminish Client’s fitness or effectiveness as plaintiff, Attorneys may elect not to pursue litigation
10. DISPUTES ARE TO BE ARBITRATED. In the event of any dispute or any claim arising out of the representation of Client by Attorneys, such dispute shall be resolved by binding arbitration in front of an arbitrator selected from the panel of arbitrators at J.A.M.S. in Los Angeles, California. This includes any fee dispute, and any claim for breach of contract, negligence, malpractice, breach of fiduciary duty or other wrongdoing. If an arbitrator cannot be agreed upon within 30 days of a demand for arbitration, J.A.M.S. shall assign an arbitrator from its panel.
CLIENT ACKNOWLEDGES THAT ATTORNEYS HAVE EXPLAINED WITH THIS DISCLOSURE PARAGRAPH THAT BINDING ARBITRATION MAY DEPRIVE CLIENT OF RIGHTS CLIENT MIGHT OTHERWISE HAVE INCLUDING, WITHOUT LIMITATION, THE RIGHT TO A JURY TRIAL, THE RIGHT TO APPEAL AND FULL DISCOVERY RIGHTS.
client initials
- INSURANCE. Attorneys’ firm maintains professional liability insurance and errors and omissions insurance coverage.
- ENTIRE AGREEMENT. This Agreement constitutes the entire agreement between the Parties, and supersedes and replaces any other oral or written agreements. It may only be modified in writing.
- COUNTERPARTS, COPIES. This agreement may be executed in counterparts, all of which, taken together, shall be deemed an original. Electronic images of this agreement may be used instead of originals for any purposes.
- NOTICES. Notices of one Party to another under this Agreement may be communicated via e-mail, to the e-mail addresses given with the Parties’ signatures, below.
- BENEFICIARIES. This agreement is meant to bind and benefit the heirs and successors of each of the parties to this agreement and, for Attorneys’ part, a designated assignee.
AGREED,
SIGNATURES TO FOLLOW
Have you taken SUBOXONE more than 6 months?
Have you ever taken another similar drug such as Zubsolz, Belbuca or Subutex?
If yes, state the name of the other drug here
How long have you used SUBOXONE? (number of months and years, for example 5 years and 6 months)
How many times a day do you currently take SUBOXONE?
If you used to take SUBOXONE more frequently than you do now, state the number of times per day you used to take it
Did you first begin using Suboxone because you were trying to stop using opioids or only because of pain management? (opioids or pain)
When did you start taking Suboxone? (month and year)
Have you stopped taking Suboxone?
If you have stopped taking Suboxone, what date did you stop?
How many teeth have been lost, cracked, damaged, deteriorated, crumbled or otherwise compromised?
What dental damage have you suffered after taking Suboxone?
Tooth loss
Tooth cracking
Tooth cavity
Tooth erosion
Tooth crumbling
How often did you visit the dentist before taking Suboxone? (number of times per year)
Please provide your dentists’ information including the name, address and phone number of your dentist(s) who can provide records before using Suboxone and after damage started on your teeth. List all applicable dentists.
DENTIST IMMEDIATELY BEFORE SUBOXONE:
Dentist name
Dentist address
Dentist phone number
DENTIST AFTER TAKING SUBOXONE (CAN BE THE SAME DENTIST, IF APPLICABLE):
Dentist name
Dentist address
Dentist phone number
Dentist name
Dentist address
Dentist phone number
AUTHORIZATION AND RELEASE OF MEDICAL DOCUMENTATION
TO: All Doctors, Dentists, Chiropractors, Hospices, Hospitals (including V.A. and Government Hospitals), Pharmacies and the Custodian of Records and Accounting Departments of any of these facilities including:
__________________________________________________________________________
__________________________________________________________________________
SECTION A: Party Authorized to Receive Disclosed/Released Medical Documentation:
Please be advised that any member, associate or designee of Law Offices of Jennifer Duffy is authorized to inspect, copy, or be furnished all material or information subject to this Authorization and Release of Medical Documentation for the purposes of researching, litigating, negotiating or settling any claim or cause of action on my behalf. Following the release of records, I have a right to inspect the disclosed information. A photocopy of this Authorization shall be considered as effective and valid as the original.
Date(s) of records to be released: _______________________
SECTION B: General Authorization for Disclosure/Release of Medical Documentation:
By signing this document, I hereby voluntarily and expressly authorize the use, copy, inspection, and/or disclosure of my dental or medical records (the term medical also includes dental), including, but not limited to:
- All medical and dental material records, all third-party medical records, all medication/ pharmacy records, all films, scans, photos and video tapes, all pathology/cytology records, all dentists, doctors/nurses handwritten notes, all admission/discharge records, all laboratory and test results, all radiology records, all autopsy records, all billing records, all third party billing records, all VA records, all insurance records, all workers' compensation records, Social Security records, Medicare & Medicaid records, all employment records, all payroll records and all demographic information
SECTION C: Specific Authorization for Disclosure /Release of Dental or Medical Documentation:
By signing this document, I hereby voluntarily and specifically request the use, copy, inspection and/or disclosure of personal health care information including disclosure of:
- ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) OR INFECTION WITH HIV RECORDS
- COMMUNICABLE DISEASE OR NONCOMMUNICABLE DISEASE AS WELL AS SEXUALLY TRANSMITTED DISEASE INFORMATION
- PSYCHIATRIC RECORDS
- ALCOHOL AND/OR DRUG RECORDS
SECTION D: Expiration, Revocation and Possible Re-Disclosure:
This authorization is continuing in nature and is to be supplemented as to all information learned or determined after the date of the signature below. Treatment, payment, participation or enrollment was not contingent on signing this authorization. This authorization shall expire two (2) years from the date of the signature below and is subject to revocation in writing at any time; with the exception and to the extent that disclosure of information has already occurred prior to the receipt of revocation by the above-named providers. To initiate revocation of this authorization, all correspondence will be directed to the specific provider named above. Although the firm receiving documentation pursuant to this authorization may only use or disclose health information for the purposes required by law, regulations, or as reasonable necessary to effectuate the purposes of the authorization, the information may be subject to re-disclosure and the referenced HIPAA privacy rules may not apply in those circumstances.
Printed Name of Patient
Signature of Patient or personal Representative
Date
Date of Birth of Patient
Maiden Name/Former/Alias of Patient
Social Security Number of Patient
By signing this document you agree to the terms of the RETAINER AGREEMENT; that the questionnaire is accurate and you authorize release of your Medical Records pursuant to the attached Authorization and Release of Medical Documentation.
Well done you did it! d