Attorney Lien Notice

NOTICE OF ATTORNEY'S LIEN

Charging Lien / Notice of Representation

[LAW FIRM LETTERHEAD]

DATE: [________________________________]

VIA: Certified Mail, Return Receipt Requested
AND: Regular Mail / Email

TO:

Insurance Company:
[COMPANY NAME]
[CLAIMS DEPARTMENT]
[ADDRESS]
[CITY, STATE ZIP]

Claim Number: [________________________________]
Insured: [________________________________]
Date of Loss: [________________________________]

AND/OR:

Adverse Party/Counsel:
[NAME]
[ADDRESS]
[CITY, STATE ZIP]

RE: NOTICE OF ATTORNEY'S LIEN

Dear Sir or Madam:

Please be advised that this firm represents [CLIENT NAME] in connection with injuries and damages sustained on [DATE OF INCIDENT]. This letter serves as formal notice of our representation and our attorney's lien on any recovery.

I. NOTICE OF REPRESENTATION

This firm has been retained to represent the above-named client for all claims arising from the referenced incident. All communications regarding this matter should be directed to this office. Please do not contact our client directly.

Please update your records to reflect the following:

Attorney: [________________________________]
Firm: [________________________________]
Address: [________________________________]
Phone: [________________________________]
Fax: [________________________________]
Email: [________________________________]
File Reference: [________________________________]

II. NOTICE OF ATTORNEY'S LIEN

Pursuant to applicable state law, please be advised that this firm claims an attorney's lien on any and all proceeds, settlements, judgments, or awards arising from our client's claims against your insured and/or arising from policies of insurance issued by your company.

Statutory Authority

This lien is claimed pursuant to:

☐ [STATE] [STATUTE NUMBER] (Attorney's Charging Lien Statute)
☐ Common law attorney's lien
☐ Contract between attorney and client (retainer agreement)
☐ Other: [________________________________]

Scope of Lien

This lien attaches to:

☐ Any settlement, judgment, or award paid to or on behalf of our client
☐ Any payment under liability policies issued to your insured
☐ Any payment under our client's own UM/UIM coverage
☐ Any payment under our client's MedPay/PIP coverage
☐ Any other compensation arising from this claim

Amount of Lien

This lien secures payment of:

☐ Attorney's fees as provided in our retainer agreement with our client
☐ Costs and expenses advanced on behalf of our client
☐ Any amounts owed by client to this firm arising from this representation

III. DEMAND FOR ACKNOWLEDGMENT

To ensure protection of this lien, we request that you:

1. Acknowledge receipt of this Notice of Attorney's Lien in writing.

2. Note in your file that no settlement payment should be made without including this firm as a co-payee or without our written consent.

3. Direct all settlement drafts as follows:
   - Make payable to: [CLIENT NAME] and [LAW FIRM NAME]
   - Mail to: [LAW FIRM ADDRESS]

4. Contact this office before making any direct contact with our client regarding settlement or payment.

IV. WARNING

YOU ARE HEREBY WARNED that any settlement made or payment issued directly to our client, without protection of this attorney's lien, may result in:

(a) Liability to this firm for the amount of our lien;

(b) Double payment obligation (to both our client and this firm);

(c) Claims for tortious interference with contract;

(d) Such other relief as may be available at law or in equity.

Do not issue any payment or settlement draft to our client individually without the express written consent of this firm.

V. CLAIM SUMMARY

For your records, please note the following regarding our client's claim:

Type of Claim:
☐ Bodily Injury
☐ Property Damage
☐ Uninsured/Underinsured Motorist
☐ Medical Payments / PIP
☐ Other: [________________________________]

Injuries Claimed: [________________________________]

Treatment Status:
☐ Ongoing treatment
☐ Treatment completed
☐ Maximum medical improvement reached

Demand Status:
☐ Demand forthcoming
☐ Demand enclosed
☐ Previously submitted on [DATE]

VI. REQUEST FOR INFORMATION

To evaluate our client's claims, please provide the following:

☐ Confirmation of coverage for date of loss
☐ Policy limits (BI/PD/UM/UIM/MedPay)
☐ Copy of declarations page
☐ Claim number assignment
☐ Adjuster name and contact information
☐ Copy of insured's statement (if taken)
☐ Copy of police report (if obtained)

VII. CONTACT INFORMATION

Please direct all communications to:

[ATTORNEY NAME]
[LAW FIRM NAME]
[ADDRESS]
[CITY, STATE ZIP]

Phone: [________________________________]
Fax: [________________________________]
Email: [________________________________]

File Reference: [________________________________]

VIII. CONCLUSION

Thank you for your attention to this matter. Please acknowledge receipt of this Notice of Attorney's Lien within ten (10) days.

Very truly yours,

[SIGNATURE]

[ATTORNEY NAME]
Attorney for [CLIENT NAME]
[STATE BAR NUMBER]

cc:
☐ [CLIENT NAME]
☐ File

ACKNOWLEDGMENT OF ATTORNEY'S LIEN

TO: [LAW FIRM NAME]
FROM: [INSURANCE COMPANY/ADVERSE PARTY]
DATE: ______________

I/We acknowledge receipt of the Notice of Attorney's Lien dated [DATE] regarding the claim of [CLIENT NAME].

I/We acknowledge that:

☐ Any settlement payment will be made payable to both [CLIENT NAME] and [LAW FIRM NAME].

☐ No payment will be issued to [CLIENT NAME] individually without written consent from [LAW FIRM NAME].

☐ This acknowledgment has been noted in our claim file.

Claim Number: [________________________________]

Adjuster Name: [________________________________]

Adjuster Signature: _________________________________

Date: _________________________________

Phone: [________________________________]

Email: [________________________________]

NOTICE OF ATTORNEY'S LIEN - FILED WITH COURT

[COURT CAPTION]

[COURT NAME]
[COUNTY], [STATE]

[CLIENT NAME],
Plaintiff,

v. Case No. [________________]

[DEFENDANT NAME],
Defendant.

NOTICE OF ATTORNEY'S LIEN

TO ALL PARTIES AND THEIR ATTORNEYS OF RECORD:

PLEASE TAKE NOTICE that the undersigned attorney hereby claims a lien pursuant to [STATE STATUTE] upon any verdict, judgment, settlement, or other recovery in this action.

This lien is claimed for:

1. Attorney's fees under the contingency fee agreement between attorney and plaintiff;

2. All costs and expenses advanced on plaintiff's behalf; and

3. Any other amounts owed by plaintiff to the undersigned arising from this representation.

All parties and their insurance carriers are hereby notified that any payment made directly to plaintiff, without satisfaction of this lien, may subject the payor to double liability.

DATED: [________________________________]

[SIGNATURE]

[ATTORNEY NAME]
Attorney for Plaintiff [CLIENT NAME]
[ADDRESS]
[PHONE]
[STATE BAR NUMBER]

CERTIFICATE OF SERVICE

I hereby certify that on [DATE], I served a copy of the foregoing Notice of Attorney's Lien on all parties by:

☐ First-class mail
☐ Electronic filing system
☐ Personal service
☐ Email

to the following:

[LIST OF PARTIES/COUNSEL SERVED]

[SIGNATURE]

[ATTORNEY NAME]

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