Dampier (L) (R) - Winter Gray - Executed Packet
Dampier (L) (R) - Winter Gray - Executed Packet
Dampier (L) (R) - Winter Gray - Executed Packet
1. CONTINGENT FEE
For legal services performed, Clients agree to pay Law Firm fees and costs. The fees shall be paid as
listed below out of the total amount recovered, whether by settlement or suit, which fee is determined on
the total gross Client recovery before reduction of costs:
(i) If recovery occurs before the defendants file an answer to the complaint or demand
appointment of arbitrators, the attorneys’ fee will be: 33 1/3% of any recovery up to $1 million; 30% of
any portion of the recovery between $1 million and $2 million; and 20% of any portion of the recovery
exceeding $2 million.
or
(ii) If recovery occurs after the defendants file an answer to the complaint or demand appointment
of arbitrators, or after the time period for this action expires, the attorneys’ fee will be: 40% of any
recovery up to $1 million; 30% of any portion of the recovery between $1 million and $2 million; and
20% of any portion of the recovery exceeding $2 million.
or
(iii) If all defendants admit liability at the time of filing their answers and request a trial only on
damages, the attorneys’ fee will be: 33 1/3% of any recovery up to $1 million; 20% of any portion of
the recovery between $1 million and $2 million; and 15% of any portion of the recovery exceeding $2
million.
In addition to the fees noted above, an additional 5% of any gross recovery will be charged as fees if an
appellate proceeding is filed or post-judgment relief or action is required for recovery on the judgment,
and the proceeding or action is handled by Law Firm. If the proceeding or action is handled by outside
counsel, then the fees and costs owed outside counsel will be subject to a separate agreement between
outside counsel and Clients.
In the event a court awards attorneys’ fees against the opposing side, the fees paid by the opposing side
are included as part of the total amount recovered by Clients for purpose of calculating the contingency
fee to be paid by Clients.
This employment of Law Firm is on a contingent fee basis and unless a recovery is made there
will be no obligation by Clients to pay attorneys’ fees or costs.
2. COSTS
If a recovery is made, Clients are responsible to pay all expenses incurred by Law Firm in handling
Clients’ case, in addition to the attorneys’ fees noted above, but in no event will Clients’ responsibility for
paying costs and fees exceed Clients’ recovery.
Costs include but are not limited to: cash and non-cash expenditures for filing fees; subpoenas;
depositions; witness fees; in-house and outside investigation services; expert witness fees; state court
and multi-district litigation assessments; medical records and reports; computer research; photographs;
in-house and outside photocopies; facsimiles; long-distance calls; postage and overnight delivery
All costs advanced on behalf of clients shall bear interest at the prime rate as published by the Wall Street
Journal at the time the cost is incurred until such time as the costs are paid.
In the event Clients make a recovery on a claim after representation has been discontinued (whether by
withdrawal or discharge), Clients are responsible to pay costs incurred by Law Firm during representation,
but only if the Clients ultimately recover.
3. ASSOCIATE COUNSEL
Clients approve the association of Levin, Papantonio, Rafferty (LPR) or other co-counsel as necessary to
pursue this case and agree that the attorneys' fees discussed above will include fees paid associate
counsel, which fees will be divided between Dampier (50%) and LPR (50%) based upon the
contributions, work performed, referral relationship, and value added by each firm. Clients will pay no
more in fees with the hiring of associate counsel than if Law Firms alone represented Clients; however,
Clients agree to pay costs incurred by associate counsel on Clients’ behalf in the same manner as
paying Law Firms’ costs. Law Firms and associate counsel each will be jointly responsible to represent
Clients’ interests, and each will be available to Clients for consultation. Associate counsel joining in the
representation of Clients can do so by signing an addendum that is incorporated as part of this
Agreement.
Clients agree that Law Firm is not being retained to pursue any action against Clients’ healthcare
providers. If Clients wish to sue their healthcare providers, Clients must retain other counsel. Clients
understand they may have a claim against healthcare providers, and the defendants may attempt to
blame Clients’ healthcare providers for the damages. If a judge or jury determines the healthcare
providers were partially at fault, then Client’s recovery may be reduced by that portion of fault. Clients
understand there are time limitations for how long an injured person has to sue healthcare providers
(known as statutes of limitation), and if a lawsuit is not filed before the statute of limitations expires, then
Clients will be prevented from ever suing the healthcare providers. Therefore, Clients should retain other
counsel immediately if they want to sue their healthcare providers.
Clients agree to cooperate in the pursuit of their litigation by attending any court proceeding where their
presence is needed, by providing information about their case, and by attending meetings with Law Firm
personnel as necessary. Clients agree to maintain and preserve all documents and electronic information
relevant to their claims. Clients further understand the need to respond quickly and accurately to
discovery requests, and to keep the Law Firm informed of any changes in circumstances or facts that
might affect their claims and recovery. Clients also will promptly notify Law Firm of any changes
regarding their contact information, such as mailing address, telephone numbers, and email address.
6. TIMELINESS OF CLAIMS
Client agrees that the Law Firm must have certain documentation before any lawsuit can be filed for the
Client, including medical records establishing the injury and proof that Client was injured by the fault of
another party. 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. Client agrees that it will take the Law Firm a
minimum of sixty (60) days after the receipt of such documentation to evaluate Client’s case to
determine whether to file any lawsuit, and in the event that any deadline expires prior to or during
Clients agree that Law Firms’ representation, and that of associate counsel, begins only after
Clients sign and return this Agreement, and Law Firms and associate counsel have both accepted
the case and also signed this Agreement. Law Firms and associate counsel will take no action on
Clients’ case until after representation begins.
8. ARBITRATION
Disputes that might arise out of the services performed or failed to be performed under this Agreement
(including fees, costs, duty, negligence, or other forms of action), whether involving Law Firms, associate
counsel, or any of their attorneys or staff, shall be resolved solely by arbitration pursuant to the Florida
Arbitration Code (Fla. Stat. Ch. 682). The arbitration will be conducted by a panel of three arbitrators and
each arbitrator shall be an actively practicing attorney in the state of Florida. Clients will select one
arbitrator and Law Firms will select one arbitrator, and the two arbitrators will select the third arbitrator.
The powers and rulings of the arbitrators shall be determined by a majority of their number. As part of
this arbitration agreement, Clients and Law Firms waive any right to bring or participate in a class action
lawsuit or class action claim in arbitration.
Florida law requires the following language as part of arbitration agreements. NOTICE: This Agreement
contains provisions requiring arbitration of disputes. Before you sign this Agreement, you should
consider consulting with another lawyer about the advisability of making an agreement with
mandatory arbitration requirements. Arbitration proceedings are ways to resolve disputes without
use of the court system. By entering into agreements that require arbitration as the way to resolve
disputes, you give up (waive) your right to go to court to resolve those disputes by a judge or jury.
These are important rights that should not be given up without careful consideration.
Law Firm and Associate Counsel will retain Clients’ file for six years after the case is completed. After six
years, the entire file will be destroyed, and no portion will be available. Thus, it is Clients’ responsibility to
seek the return of any portion of the file desired immediately when the case is completed.
10. DEFINITIONS
Common Benefit Charges are expenses incurred by Law Firm and Associate Counsel for the benefit of
a group of its clients. These charges are shared among the group whether a client retained Law Firm
early or late in the litigation and whether the charges were incurred before or after the client retained Law
Firm. For example, if an expert witness is hired in one client’s case that can benefit a group of clients,
this is a common benefit charge. Rather than have the first client pay this expert bill, Law Firm spreads
the cost among all clients who will benefit from the expert. Common benefit charges are determined at
the time a client receives his/her recovery, and is calculated by dividing the outstanding common benefit
charges by the number of clients being represented by Law Firm at the time of distribution. Common
benefit charges may include but are not limited to postage, telephone, copies, faxes, experts,
investigation, computer research, travel, depositions and many of the costs incurred in trying one client’s
case before a jury or arbitration panel where the outcome can benefit a group of clients.
Settlement: In mass torts cases like this one, the opposing side sometimes attempts to settle Law Firm’s
clients in groups. The settlement process can take many different forms. For example, Law Firm may
obtain each client’s authorization for a minimum amount for which each client authorizes Law Firm to
attempt to settle the client’s case. These minimum amounts differ for each client depending on the
circumstances of each case. Law Firm adds up the total of all clients’ minimum authorized demands and
If any provision, or portion thereof, contained in this Agreement is held invalid, illegal or unenforceable,
such will not affect the validity or enforceability of any other provision or portion, which shall be construed
as if such invalid, illegal or unenforceable provision was not contained. Similarly, if any provision or
portion of this Agreement does not comply with the laws or rules of a state determined to control this
Agreement, then this Agreement shall be modified to comply with the laws and rules of the controlling
state in a manner best capable of maintaining the intent of this Agreement. Each party may sign a
separate counterpart of this Agreement. All such counterparts, taken together, shall constitute one and
the same instrument.
Clients may cancel this Agreement by written notice to either Law Firm or Associate Counsel within
seven (7) days of the date this Agreement is signed, and if canceled Clients will not be required to pay
any attorneys’ fees.
14. RECOVERY
Clients agree that Law Firm or Associate Counsel may endorse and deposit into Law Firm’s or Associate
Counsel’s Trust Account, for Clients’ benefit, checks received in Clients’ name.
Clients acknowledge they have read the attached Client Statement of Rights before signing this Agreement,
understand their rights, and have received a signed copy for their records.
By:
By:
Date: Date: 12 / 19 / 2023
By: _____________________________
Date: ____________________________
Attorney – Client Employment Agreement 9.25.23 Page 4
CLIENT STATEMENT OF RIGHTS
Before you, the prospective client, arrange a contingent fee agreement with a lawyer, you should
understand this statement of your rights as a client. This statement is not a part of the actual contract
between you and your lawyer, but, as a prospective client, you should be aware of these rights:
1. There is no legal requirement that a lawyer charge a client a set fee or a percentage of money
recovered in a case. You, the client, have the right to talk with your lawyer about the proposed fee and to
bargain about the rate or percentage as in any other contract. If you do not reach an agreement with one
lawyer you may talk with other lawyers.
2. Any contingent fee contract must be in writing and you have three business days by law and
seven business days under this contract to reconsider the contract. You may cancel the contract without
any reason if you notify your lawyer in writing within seven business days of signing the contract. If you
withdraw from the contract within the first seven business days, you do not owe the lawyer a fee although
you may be responsible for the lawyer’s actual costs during that time. If your lawyer begins to represent
you, your lawyer may not withdraw from the case without giving you notice, delivering necessary papers
to you, and allowing you time to employ another lawyer. Often, your lawyer must obtain court approval
before withdrawing from a case. If you discharge your lawyer without good cause after the seven-day
period, you may have to pay a fee for work the lawyer has done.
3. Before hiring a lawyer, you, the client, have the right to know about the lawyer’s education,
training, and experience. If you ask, the lawyer should tell you specifically about the lawyer’s actual
experience dealing with cases similar to yours. If you ask, the lawyer should provide information about
special training or knowledge and give you this information in writing if you request it.
4. Before signing a contingent fee contract with you, a lawyer must advise you whether the lawyer
intends to handle your case alone or whether other lawyers will be helping with the case. If your lawyer
intends to refer the case to other lawyers, the lawyer should tell you what kind of fee sharing arrangement
will be made with the other lawyers. If lawyers from different law firms will represent you, at least one
lawyer from each law firm must sign the contingent fee contract.
5. If your lawyer intends to refer your case to another lawyer or counsel with other lawyers, your
lawyer should tell you about that at the beginning. If your lawyer takes the case and later decides to refer
it to another lawyer or to associate with other lawyers, you should sign a new contract that includes the
new lawyers. You, the client, also have the right to consult with each lawyer working on your case and
each lawyer is legally responsible to represent your interests and is legally responsible for the acts of the
other lawyers involved in the case.
6. You, the client, have the right to know in advance how you will need to pay the expenses and the
legal fees at the end of the case. If you pay a deposit in advance for costs, you may ask reasonable
questions about how the money will be or has been spent and how much of it remains unspent. Your
lawyer should give a reasonable estimate about future necessary costs. If your lawyer agrees to lend or
advance you money to prepare or research the case, you have the right to know periodically how much
money your lawyer has spent on your behalf. You also have the right to decide, after consulting with your
lawyer, how much money is to be spent to prepare a case. If you pay the expenses, you have the right to
decide how much to spend. Your lawyer should also inform you whether the fee will be based on the
gross amount recovered or on the amount recovered minus the costs.
7. You, the client, have the right to be told by your lawyer about possible adverse consequences if
you lose the case. Those adverse consequences might include money that you might have to pay to your
lawyer for costs and liability you might have for attorney’s fees, costs, and expenses to the other side.
8. You, the client, have the right to receive and approve a closing statement at the end of the case
9. You, the client, have the right to ask your lawyer at reasonable intervals how the case is
progressing and to have these questions answered to the best of your lawyer’s ability.
10. You, the client, have the right to make the final decision regarding settlement of a case. Your
lawyer must notify you of all offers of settlement before and after the trial. Offers during the trial must be
immediately communicated and you should consult with your lawyer regarding whether to accept a
settlement. However, you must make the final decision to accept or reject a settlement.
11. If at any time you, the client, believe that your lawyer has charged an excessive or illegal fee, you
have the right to report the matter to The Florida Bar, the agency that oversees the practice and behavior
of all lawyers in Florida. For information on how to reach The Florida Bar, call 850-561-5600, or contact
the local bar association. Any disagreement between you and your lawyer about a fee can be taken to
court and you may wish to hire another lawyer to help you resolve this disagreement. Usually fee disputes
must be handled in a separate lawsuit, unless your fee contract provides for arbitration. You can request,
but may not require, that a provision for arbitration (under Chapter 682, Florida Statutes, or under the fee
arbitration rule of the Rules Regulating the Florida Bar) be included in your fee contract.
By:
By:
Date: Date: 12 / 19 / 2023
By: _____________________________
Date: ____________________________
I authorize and direct Covered Entity/Medical Provider to disclose and to supply copies of my protected
health information (medical records) described below to any member of Levin, Papantonio, et al, 316
S. Baylen St., Suite 600, Pensacola, Florida 32502 / The Dampier Law Firm, P.C, PO Box 161 Fairhope, AL
36533, and/or their agents, for the purpose of litigation.
Information to be disclosed:
Copy of the complete medical record Surgical Report
Discharge Summary Radiology Report
Face Sheet Physical Therapy Notes
History & Physical Report Laboratory Reports
Other (specify)
Reproductions of this signed authorization are to be complied with and given the same consideration
as the original.
I understand that I may inspect or copy the protected health information described in this authorization.
I understand that information used or disclosed pursuant to this authorization could be subject to
redisclosure by the recipient and, if so, may not be subject to federal or state law protecting its
confidentiality.
I understand that I may refuse to sign this authorization and that my refusal to sign will not affect my
ability to obtain treatment, payment or eligibility for benefits.
Right to Revoke:
I understand that this authorization may be revoked in writing and delivered to the Covered
Entity/Medical Provider at the above address at any time, and that Covered Entity/Medical Provider
must cease using this authorization, except that Covered Entity/Medical Provider may complete any
actions it initiated in reliance on this authorization and prior to my revocation.
Expiration
This authorization will expire two years from the date of patient=s signature.
I acknowledge, and hereby consent to such, that the released information may contain alcohol, drug
abuse, psychiatric, HIV testing, HIV results or AIDS information. (initial)
DATE
Signature of Patient or Representative
Authority of Patient (parent of minor,
guardian, etc); Copies of documentation such as a
Healthcare Power of Attorney may be attached.
Winter Gray
Print Name of Patient or Authority of Patient
Request Letter under HITECH Act of 2009 for Electronic Copy of my Medical Records
Pursuant to 45 CFR § 164.524, I am requesting that you send an electronic copy, in PDF format, of all of my protected
health information ("PHI") from to to my third-party designee, Levin Law Firm and/or
The Dampier Law Firm, P.C. I do not want a PHI summary but the full set of records.
Please scan paper records and/or convert electronic records to PDF format and email them to
. If you are unable to email my PHI, you may save in PDF format to a thumb drive and mail
the same to:
This copy is as valid as the original. Thank you for your prompt response.
Signature Date
Winter Gray
Printed Name
For more information on the Federal HITECH Act and its regulations:
Request # https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/
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c/o Consumer Attorney Record Services, 5041 Bayou Blvd, #301, Pensacola, FL 32503
Phone: 800-476-0489 | Fax: 850-912-8945 | Email: [email protected]
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Authoriza�on to Capture
and Use Digital Signature
The Dampier Law Firm P.C.
__________________________, for the purpose of securing records in support of your claim, employs the services of
Consumer Atorney Record Services, LLC. The use of these services includes the reques�ng, digi�za�on (as needed),
management, and limited storage of records obtained for your claim. The signing of this authoriza�on, for the purpose of
obtaining records, declares that you understand and agree to the following:
1. I agree to the use of my personally iden�fiable informa�on (PII) to be used to obtain my records.
2. I agree to the digi�za�on of my signature and ini�als for the purpose of obtaining my records.
3. I agree to allow Consumer Atorney Record Services, LLC to affix my signature and/or ini�als to documents used to
obtain my records with the same authority as if I signed the document myself.
4. I understand that this authoriza�on may remain effec�ve for two years following the date of this agreement or the
date of receipt of agreement revoca�on as received in wri�ng, whichever comes first.
5. I understand that the records being obtained may contain personal informa�on regarding my health, school history,
or criminal history. I understand that my records may include informa�on rela�ng to mental or behavioral health,
substance use disorder (drug or alcohol abuse), gene�c diseases or tes�ng, sexually transmited diseases (STDs),
human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and reproduc�ve health care
services, including, but not limited to, pregnancy, contracep�on, and termina�on or loss of pregnancy. I give my
permission to release records related to these categories. My grant of the release of this informa�on does not permit
re-disclosure to any party or en�ty (including third-party insurance companies) unless I specifically authorize such
release in wri�ng, or its re-disclosure is permited by federal or state law.
6. I understand that I may revoke my agreement to this authoriza�on at any �me by sta�ng such in wri�ng to: Consumer
Atorney Record Services, LLC, 5401 Bayou Blvd, Suite 301, Pensacola, FL 32533 or by contac�ng Wagstaff Law Firm.
7. I understand that revoca�on of this agreement shall take effect upon receipt of writen no�ce by you or by digital
communica�on by Wagstaff Law Firm. I understand that this revoca�on can only be to the extent of any ac�on that
has not yet been taken to obtain records.
8. I understand that revoca�on of this agreement prior to the obtaining of records may affect my claim and do hold
harmless Consumer Atorney Records Services, LLC of any consequences due to the revoca�on.
9. I agree and understand that I consent to the terms of this authoriza�on freely and voluntarily; and that I have the
right to refuse to sign this authoriza�on if I so choose.
Signature
CARS Form 20
Dampier (L)(R) - Hair Relaxer - Full Packet
2. Hair Relaxer Retainer.pdf and 4 others
2f9594945a00953a157f591c9e506b3b5ccd6911
MM / DD / YYYY
Signed