In what kind of accident were you involved?

What kind of injuries did you suffer?

This will help us estimate the severity of your case, which affects your compensation.

Did you have insurance at the time of the accident?

Did you get medical treatment?

The total cost of the medical bills incurred in your treatment (including those that were covered by insurance).

Will you need to get further medical treatment in the future?

The total cost of the medical bills of any treatment you anticipate you might need in the future.

Were you left with scarring after the accident?

Did you develop fear or anxiety from your accident?

Did you have to miss work because of your injuries?

The total cost of wages you may have missed when you were recovering ($). If you used time-off benefits, such as PTO, enter their dollar value ($) as well.

Did you have any pain and suffering from the accident?

Were you left with chronic pain after the accident?

Are you married?