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Request for Prorated Exemption

Coverage
Request for Prorated Exemption

Only use this form if you have previously purchased PLF coverage and are now claiming an exemption, and, if applicable, requesting a refund. Depending on the timing of your exemption, you may owe funds to the PLF. Please contact Accounting at 503.924.1771 or 1.800.452.1639 (toll-free in Oregon) if you are in default or have activated coverage midyear.

UPDATE YOUR CONTACT INFORMATION ON WWW.OSBAR.ORG.

This form can only be used for 2023 and 2024 midyear exemptions.

Submitting this form does not guarantee that this request will be approved. If monies are owed with this form the PLF will contact you. All fees must be received to process this request.

I have reviewed the PLF proration terms.

Year:

Name:

Bar No:

Contact Telephone:

Contact Email:

Last Date Of Private Practice In Oregon: / /

PLEASE NOTE: The cost of PLF coverage is prorated to the month only, not the day. If you practice one day in a month you need coverage for the entire month.

I hereby apply for a prorated refund (if applicable) of my current or prior year's PLF assessment. The refund should be made payable and sent to the address listed below:

Payee Name:

Payee Address1:

Payee Address2:

Payee City:

Payee State:

Payee Zip:

I certify that following the date shown above I am exempt from maintaining malpractice coverage from the Professional Liability Fund under the terms of PLF Policy 3.400 and the PLF exemption rules for the following reason:

My principal office is outside of Oregon. If you were admitted under comity or reciprocity, OSB Admission Rule 15.05 applies.

Do you have malpractice coverage?

Yes

I am employed exclusively as a government attorney or licensed practitioner, or as a judge.

I am employed exclusively by a corporation or business entity (including nonprofit organizations).

I work exclusively as an employee or independent contractor for a legal aid or public defender office that provides me with professional liability coverage as required by the PLF.

I am presently employed in a non-law related field.

I am retired from the private practice of law.

I work as a law clerk/supervised attorney/supervised practitioner not engaged in the private practice of law.

I am presently unemployed

Other

If Other, please explain:

By submitting this exemption I hereby certify the following.

(1) I will not engage in the private practice of law in Oregon with my principal office in Oregon after my last day of private practice in Oregon as stated on this form. This means, among other things, that I will not consult with a current, former, or prospective client, partner, fellow shareholder, associate, employee, or associated lawyer concerning the ongoing progress or handling of an existing matter or new matter unless permitted to do so within the scope of my exemption. (Note: You are permitted to inform a former client, or the new attorney handling a matter for the former client, about the status of the matter and explain your past actions in representing the client, but you should not provide any ongoing advice or professional services to the client or new attorney.)
(2) I understand that I will be required to pay my full annual assessment if I return to PLF coverage during the Plan Year with a gap in continuous coverage of less than two full calendar months as provided in PLF Policy 3.400(C).
(3) I agree to notify the PLF immediately if my status changes from exempt to non‐exempt at any future time in the Plan Year.
(4) If leaving private practice, I have made arrangements to safely store my client files. To obtain a closed client file, a client should contact:

Contact Name:

Contact Osb No:

Contact Phone:

OREGON STATE BAR
PROFESSIONAL LIABILITY FUND
16037 SW Upper Boones Ferry Road, Suite 300
PO Box 231600
Tigard, OR 97281-1600
phone: 503.639.6911
toll free: 800.452.1639

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