ABOUT THIS LIMITED POWER OF ATTORNEY FORM
This is a sample Limited Power of Attorney form between a personal injury client and their attorney. This POA form is typically required when an accident case settles. Usually the insurance company cuts a settlement check that is either made out to the client or to the client and the attorney jointly. This POA gives the attorney express authorization to endorse the settlement check on behalf of the client, deposit the funds into escrow and then dispurse them.
IN THE CIRCUIT COURT FOR BALTIMORE CITY
JANE DOE, Plaintiff
v. Case No.:
JOHN TORTFEASOR, Defendant
LIMITED POWER OF ATTORNEY
The undersigned, [CLIENT NAME] , hereby appoint(s) [ATTORNEY NAME] , of [FIRM NAME] , as my true and lawful Attorney In Fact for the limited purpose of endorsing a settlement check from GEICO in the amount of Two Hundred Thousand Dollars ($200,000) arising out of an automobile accident that occurred on February 11, 2020. I/We further direct our Attorney In Fact to disburse the settlement as follows:
TOTAL SETTLEMENT PROCEEDS = 200,000
Attorneys’ Fees = $?
Attorneys’ Expenses = $?
Outstanding Medical Bills = $?
Medical Liens = $?
Total Deductions = $?
DISBURSEMENT TO CLIENT = $?