The Law Office of Randy Evan McDonald, LLC
Licensed in the District of Columbia and State of Maryland
6305 Ivy Lane • Suite 240 • Greenbelt, MD 20770
(301)560-1440 (office) • (301)710-0450 (fax) • (240)491-7609 (cell)
RETAINER AGREEMENT
This Agreement is to confirm with you,
, of
, Client, the terms of your legal
​​representation by The Law Office of Randy Evan McDonald, LLC , Lawyer, of 1001 L Street,
Client requests and authorizes Lawyer to represent Client in all legal matters arising from the automobile accident
claim or any other claim related to Client’s injuries resulting from the automobile accident on
Client and Lawyer make this agreement on the following basis:
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Lawyer agrees to exercise his best efforts and professional ability and will consult with Client on an ongoing basis regarding major decisions relating to this matter, including trial or settlement.
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Client agrees to cooperate with Lawyer and assist Lawyer with preparation of the case.
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Client agrees to pay Lawyer's fee for professional services as follows: 33.333% of any amount recovered prior to a lawsuit being filed in this representation or 40% of any amount recovered after a lawsuit is filed. Further, if, at the time the case is settled or a judgment is paid Client owes Lawyer for any expenses or other items, Lawyer may deduct that sum from the amount to be paid to Client. The percentage of recovery or settlement will be calculated before outstanding medical bills, expenses and costs of suit are deducted. This case is under the above-referenced contingency agreement. However, both Lawyer and Client agree that if the case were not a contingency case, the appropriate hourly rate for Lawyer is $500 per hour.
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The parties agree that if Client makes no recovery, Client owes Lawyer nothing for legal services.
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Both Lawyer and Client reserve the right to terminate this contract at any time.
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In the event that the relationship is terminated by either party, Client and Lawyer agree that Lawyer will be entitled to 10% of any recovery or settlement once any medical bills or records are ordered by the Lawyer or a tag trace is conducted or a police report or body worn camera footage are ordered or liens sought from health insurers – including but not limited to Medicare and Medicaid. In the event that the relationship is terminated by either party, Client and Lawyer agree that Lawyer will be entitled to 33.333% of any recovery or settlement once a demand has been sent to any insurance company or other entity on Client’s behalf.
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Client authorizes Lawyer to share information with insurance companies and medical providers and lien holders to the extent necessary to pursue or resolve the claim.
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This agreement represents the full agreement between Client and Lawyer. No other agreement, written or oral, exists, and discussions between Client and Lawyer that are not set forth in this agreement are not part of this agreement.
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​Lawyer accepts said employment and is authorized to effectuate a settlement or compromise, subject to Client approval, or to institute such legal action, or actions as may be advisable in Lawyer’s judgment in order to enforce the client’s rights.
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This agreement does not include any legal services to be rendered in the event of an appeal, regardless of who files the appeal. Lawyer is not required to represent Client in an appeal. In the event of an appeal, the parties agree to make a separate agreement for the appeal. If no agreement is made between the parties and Lawyer continues to represents Client on appeal, this agreement shall be in effect.
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Client agrees that Client had a relationship with Lawyer that pre-dates the accident OR Client made the initial/first contact to Lawyer OR Client authorized Lawyer to make the first contact with Client.
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Lawyer will advance all reasonable and necessary expenses associated with Client’s case. Costs of litigation and/or advancement of claim are the responsibility of Client, and Client shall be obligated to pay any and all expense incurred which relate to the prosecution of this case. Expenses include, but are not limited to, copies of medical records, police reports, depositions, investigative fees, photocopying, postage, filing fees of the court, expert witness fees, court reporter and videographer fees, travel expenses, private process service, and any other expenses necessary for the proper handling of Client’s matter. If there is a recovery, these expenses will be deducted after the contingency fee is calculated and will be reimbursed to Lawyer out of any financial recovery obtained on Client’s behalf. Lawyer shall have a lien on said claim, suit or recovery for said fees and expenses.
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Associate counsel may be employed at the discretion and expense of the attorney. Employment of counsel may include sharing of attorney’s fee at no additional cost to Client.
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Lawyer makes no warranties as to the outcome of this matter, and all expressions made by the firm or the Lawyer or staff that relate thereto are matters of opinion only.
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If Client and Lawyer agree to change any term in this agreement, the agreed-to change must be in writing and signed by both parties.
I,
, Client, acknowledge that I have read this agreement
fully, nderstand its terms and conditions and agree to all terms and conditions without reservation. I received
a copy of the agreement when I signed it.
Randy Evan McDonald
Time of Accident
LIMITED POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that I,
desiring to execute a Limited Power of Attorney, have made constituted and appointed, and by these presents, do make, constitute, and appoint, The Law Office of Randy Evan McDonald, LLC, my Attorney-in-Fact, for me and in my name, place and stead, to do and perform all acts, deeds, matters and things whatsoever concerning my property and personal affairs necessary and desirable, in the judgment of my said Attorney-in-Fact, as fully and every one of the following matters:
1. SETTLEMENT OF PERSONAL INJURY CLAIMS arising out of the accident of
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To execute any and all checks including, but not limited to, the settlement check and PIP checks on my behalf.
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To execute any and all documents necessary to promptly handle and resolve the claims including, but not limited to, Releases.
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All business transacted hereunder for me or for my account shall be transacted in my name, and all endorsements or instruments executed by my Attorney-in-Fact, for the purpose of carrying out any of the foregoing powers, shall contain my name followed by that of my Attorney-in-Fact and the designation “Attorney-in-Fact.”
2. CAPACITY:
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I HEREBY CERTIFY that as of the date of execution of this instrument, I am of sound and disposing mind and capable of executing a valid release for settlement. I heerby further certify that I am not under any medical treatment for mental disability or disorder, or subject to any type of mental disability or disorder.
2. EXPIRATION DATE:
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This Limited Power of Attorney shall expire when the claims for the above accident have
been settled and satisfied and all monies have been disbursed.
IN WITNESS WHEREOF, I have hereunto set my hand and seal, this
Witness (Print)
Witness (Print)
Client (Print)
Client (Print)
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) COMPLIANT MEDICAL AUTHORIZATION AND RELEASE FORM
Name of Patient:
Address of Patient:
DOB:
Social Security Number:
To Medical Provider:
Date(s) of Medical Treatment:
The undersigned hereby authorizes and consents to the disclosure by the above named health care provider(s) to Randy Evan McDonald and The Law Office of Randy Evan McDonald, LLC, for the purposes of my legal representation, of any and all medical information including but not limited to:
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All medical bills and records, including, but not limited to, inpatient, outpatient and emergency room treatment, all clinical charts, reports, documents, correspondence, test results, monitoring strips, statements, questionnaires/histories, office and doctor’s handwritten notes and records received by other physicians.
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All Autopsy, laboratory, histology, cytology, pathology, radiology, CT scan, MRI, echocardiogram and cardiac
catheterization reports. -
All radiology films, mammograms, myelograms, CT scans, photographs, bone scans, pathology/cytology/histology/autopsy/immunohistochemistry specimens, cardiac catherization videos/CD’s/films/reels/tracings and echocardiogram videotapes, CD’s and images of any kind.
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All pharmacy/prescription records, including NDC numbers and drug information handouts/monographs.​
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All billing records, including all statements, itemized bills and insurance records.
I further consent to the inspection and copying of the above referenced materials and to the furnishing of photo static or other copies of these materials to, as well as oral communications regarding the disclosed medical information with, Randy Evan McDonald and The Law Office of Randy Evan McDonald, LLC.
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A photocopy of this authorization shall have the same force and effect as an original.
I agree that this HIPAA-Compliant Medical Authorization and Release Form satisfies the notice requirements
and all other requirements and requisites to the production of medical records and information to Randy Evan
McDonald and The Law Office of Randy Evan McDonald, LLC, and its agents, employees, consultants, and
experts in connection with the pending lawsuit claim that I am a party to. This authorization is directed at any
health care providers contained in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45
C.F.R. & 164.512. I have been notified of my rights to object to the release and production of released documents
and information under HIPAA and I do not object to such release and production. I understand and affirm that
the information used or disclosed under this HIPAA Complaint Medical Authorization and Release Form may be
subject to re-disclosure by the recipient or his/her/their agents and or employees and may no longer be protected
by 45 C.F.R parts 160 and 14. I further understand and affirm that I have the right to consult legal counsel prior
to signing this authorization and the right to refuse to sign this authorization. I understand that I may revoke the
authorizations set forth herein in writing to Randy Evan McDonald and The Law Office of Randy Evan
McDonald, LLC, at 6305 Ivy Lane, Suite 240, Greenbelt, MD 20770.
I hereby declare this HIPAA-Compliant Medical Authorization and Release Form shall become void and unenforceable after (2) years of the following dates, or at such earlier date upon receipt by Randy Evan McDonald and The Law Office of Randy Evan McDonald, LLC, of written revocation signed by my personal representative(s) or me.
Patient (Print Name)
Date
Patient (Signature)
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