[Name and Address of Insured]
[Date]
Page 1

[Date]

[Name and Address of Insured]

RE:[Caption of Case]

Dear :

XXX has recently been asked to defend [Name of Insured] in the above-captioned matter (the “Lawsuit”). We understand that [name of insurer] will be paying our fees and expenses. [In addition, pursuant to XXX’s worker’s compensation statutes, [name of insurer] also is a party defendant in the matter and we will be entering an appearance on its behalf as well as on behalf of[Name of Insured]].

Under the [stateinwhichmatterispending] Rules of Professional Conduct (the “Rules”), we are prohibited from accepting compensation for representing a client from anyone other than the client unless certain requirements are met. The first requirement is that the client consent after consultation. [Name of Insured] will be our sole client in this matter. Because the payment of our fees by [name of insurer] will be made pursuant to its obligations under [Name of Insured]’s insurance policy (the “Policy”), we assume that [Name of Insured]consents to such payment.

The second requirement is that there be no interference with the lawyer’s independence of professional judgment or with the client-lawyer relationship. We will not allow any such interference.

The third requirement is that information relating to our representation of [Name of Insured] must be protected as required by the Rules. We will ensure that such information is so protected, as we do in connection with all clients’ matters, but we understand that [Name of Insured] consents to our disclosure to [name of insurer] of information to which it may be entitled under the Policy or otherwise by virtue of its position as insurer, subject to the further understanding that it will maintain the confidentiality of all such information.

[Use this paragraph only if we regularly are retained to represent the insurer’s insureds.] Our firm has an ongoing business relationship with [Name of Insurer], which frequently retains us to represent its insureds. To avoid the potential of a conflict of interest, we will not represent [Name of Insured] in any insurance coverage dispute, and we will not advise [Name of Insured] with respect to any coverage issues that become apparent in the course of our representation. Thus, you should seek the advice of an independent attorney with respect to any such issue.

Under the applicable Rules of Civil Procedure, if [Name of Insured] has any potential claim or cause of action arising out of the same transaction or occurrence which is the subject matter of the Lawsuit, that claim must be presented in the Lawsuit or it will be forever barred. This is known as the compulsory counterclaim/crossclaim rule. If you are aware of any potential counterclaim or crossclaim against any party in the Lawsuit, please let us know. If we agree to handle that claim for you, we will send written confirmation to you defining our scope of work and the terms of that engagement. If you do not advise us of a potential counterclaim or crossclaim, we will assume that [Name of Insured] does not have a claim against any other party in the Lawsuit.

Please contact us if we misunderstand your wishes or intent or if you have any questions.

Very truly yours,

XXX

By:

[Name of Lawyer]

cc:[Name of insurer]