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Unfortunately based on your answers, more information is needed at this time.
Please call (866) 812-8846 to see if one of our Disability Advocates can help you.
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You may also qualify for help in the following areas.
GET WORKERS COMPENSATION HELP
Injured on the Job? Get the Compensation You Deserve
GET YOUR FREE EVALUATION
Worker's Compensation Injury Claim Details:
Complete this section if you would like help with your injury claim.
Approximate date of Injury?
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Please fill out this field.
You cannot enter an injury date that is in the future. Please correct the month or year
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
Before 2014
Please fill out this field.
Did the injury occur while you were working?
Yes
No
Please select one of these options.
Were you still employed when you reported the injury?
Yes
No
Please select one of these options.
Was the injured person hospitalized?
Yes
No
Please select one of these options.
Has your workers compensation case already been rejected or accepted by another law firm?
Yes
No
Please select one of these options.
Please describe your injuries:
Please fill out this field.
No Thanks
You must fix the error in the question above.
GET AUTO ACCIDENT HELP
Have you been injured from a car accident caused by someone else?
GET YOUR FREE EVALUATION
Auto Injury Claim Details:
Complete this section if you would like help with your injury claim.
Approximate date of Injury?
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Please fill out this field.
You cannot enter an injury date that is in the future. Please correct the month or year
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
Before 2014
Please fill out this field.
Was the injury someones else's fault?
Yes
No
Please select one of these options.
Who was injured?
Select a Type
Self
Family
Other
Please fill out this field.
Did the injury require a hospital stay?
Yes
No
Please select one of these options.
Would you like to speak to an auto accident attorney about your auto accident case?
Yes
No
Please select one of these options.
Has your auto accident case already been rejected or accepted by another law firm?
Yes
No
Please select one of these options.
Please describe your injuries:
Please fill out this field.
No Thanks
You must fix the error in the question above.
GET PERSONAL INJURY HELP
Have you been injured due to someone else's Negligence resulting in a personal injury?
GET YOUR FREE EVALUATION
Personal Injury Claim Details:
Complete this section if you would like help with your injury claim.
Does the issue involve an auto injury?
Yes
No
Please select one of these options.
Approximate date of Injury?
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Please fill out this field.
You cannot enter an injury date that is in the future. Please correct the month or year
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
Before 2014
Please fill out this field.
Was the injury someones else's fault?
Yes
No
Please select one of these options.
Who was Injured?
Select a Type
Self
Family
Other
Please fill out this field.
Did the injury require a hospital stay?
Yes
No
Please select one of these options.
Has your personal injury case already been rejected or accepted by another law firm?
Yes
No
Please select one of these options.
Personal Injury Claim Type
Select a Type
Auto Accident Injury
Slip and Fall
Product Liability
Wrongful Death
Medical Malpractice
Gunshot or Stabbing
Other
Please fill out this field.
Please describe your injuries:
Please fill out this field.
No Thanks
You must fix the error in the question above.
GET LEGAL HELP
Do you have a legal issue or case that you need help with?
GET YOUR FREE EVALUATION
Legal Issues Details:
Complete this section if you would like help with your legal Issues.
Case Type
Select a Type
Motor Vehicle Collision
Medical Malpractice
Nursing Home Neglect
General Personal Injury
Veterans Benefits
Asbestos and Mesothelioma
Product Liability
Other
Please fill out this field.
Please describe your case
Please fill out this field.
Insured’s Date of Birth
Please fill out this field.
Date of Injury
Please fill out this field.
What is the insured’s present condition?
Please fill out this field.
No Thanks
You must fix the error in the question above.
