Schedule Your Mediation or Arbitration Session

Intake Form

Full Name*

Email Address*

Phone Number*

Attorney Information - Please list all the attorneys involved, including the party they represent, email address and phone number*

Party Names - Please list all parties, including insurance adjusters and insurance companies involved*

Have any of the parties been insured by Nationwide Insurance Co or Travelers Insurance Co, or their affiliates? If so, please complete the next section. If no, you can skip the next section. *

Yes

Former Nationwide or Travelers insureds info.If you answered Yes above, please let me know whether they have been defended by Nationwide Trial Division or Travelers Staff Counsel (in any state in the United States). Since I've defended insureds as an employee of both of those carriers, we may have to discuss potential conflicts.

Case Caption/ Cause Number/Court*

Identify the type of session your are interested in*

1/2 day Mediation

Full day Mediation

1/2 day Arbitration

Full day Arbitration

Fill out the form to request your session. You will be able to select your preferred date separately

Contact

Reach out for scheduling mediation sessions

Email

Phone

Betsy@Betsysmithadr.com

206-965-0631