Step
1
of
33
- How were you injured?
0%
How were you injured?
(Required)
Car Accident
Slip & Fall
On the Job
Other
Sorry to hear about your car accident. Who was hurt?
(Required)
I was hurt
A loved one was hurt
We were both hurt
No one was hurt
Sorry to hear about your slip & fall accident. Who was hurt?
(Required)
I was hurt
A loved one was hurt
We were both hurt
No one was hurt
Sorry to hear about your work accident. Who was hurt?
(Required)
I was hurt
A loved one was hurt
We were both hurt
No one was hurt
Oh No!
Based on some of the specifics of your incident, we cannot move forward with your claim. You can email us if you think we’ve made a mistake.
Did the accident happen within 2 years?
(Required)
Yes
No
Were you treated for your injuries?
(Required)
I was treated at a hospital
I was treated at a doctors office
I was not treated
Other
Can you describe the injury?
(Required)
Head injury
Back or neck
Body injury
Anxiety or emotional injury
Death
Other injury
What was your role in the accident?
(Required)
Driver
Passenger
Pedestrian
Cyclist
Mass transit
What type of accident was it?
(Required)
Someone else rear ended me
I rear ended someone else
Single car
Other
Is the injured party unable to sign due to injury?
(Required)
Yes
No
Is the person that can sign next to kin?
(Required)
Yes
No
Will the injured party be able to sign documents with us?
(Required)
Yes
No
Is the injured party currently represented by an attorney for this matter?
(Required)
Yes
No
They were but not anymore
What type of accident was it?
(Required)
Someone else rear ended me
I rear ended someone else
Single car
Other
Were you hit by a vehicle?
(Required)
Yes
No
Are you represented by an attorney?
(Required)
Yes
No
I was but not anymore
Were you at fault?
(Required)
Yes
No
Did the accident happen within 2 years?
(Required)
Yes
No
Were you treated for your injuries?
(Required)
I was treated at a hospital
I was treated at a doctors office
I was not treated
Other
What kind of work do you do?
(Required)
Permanent military vessel worker
Federal non-military
Railroad worker
I’m a security guard
Casino
General/other employee
Oh No!
Based on some of the specifics of your incident, we cannot move forward with your claim. You can email us if you think we’ve made a mistake.
Can you describe the injury?
(Required)
Head injury
Back or neck
Body injury
Anxiety or emotional injury
Death
Other injury
Were you treated within 12 months of being injured?
(Required)
Yes
No
Did the accident happen within 2 years?
(Required)
Yes
No
Were you treated for your injuries?
(Required)
I was treated at a hospital
I was treated at a doctors office
I was not treated
Other
Can you describe the injury?
(Required)
Head injury
Back or neck
Body injury
Anxiety or emotional injury
Death
Other injury
Who is responsible for the fall?
(Required)
My fault
Fault of city/state
Fault of business
Fault of homeowner
Not sure
Was the incident job related?
(Required)
Yes
No
Were you treated within 12 months of being injured?
(Required)
Yes
No
Are you represented by an attorney?
(Required)
Yes
No
I was but not anymore
One More Thing...
Fill out the info below so we can start assembling your personal legal care team.
First Name
(Required)
First Name
Last Name
(Required)
Last Name
Phone Number
(Required)
Email Address
(Required)
We're ready to review your case!
We just need a little more information about your case before we move forward.
First Name
(Required)
First Name
Last Name
(Required)
Last Name
Phone Number
(Required)
Email Address
(Required)
Description of Incident
(Required)
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