Your Contact
Information
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* Incident Date:
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* First Name:
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* Last Name:
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* Enter Your Email
Address.
It will only be used regarding this matter.
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* Enter Your Area Code, Then
Phone Number:
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* Enter your Zipcode so a
Local Lawyer can contact you:
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Do you currently have an Attorney
working on this case?
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How do you prefer to be contacted?
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Online Automobile Accident Case Review
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Were you a passenger or the driver?
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Where was your vehicle hit?
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Please provide a brief description of the
accident:
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If you were the driver, are you the owner
of the vehicle?
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If you are the owner of the vehicle, does
your automobile insurance limit liability?
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If you are the owner of the vehicle, does
your automobile insurance limit uninsured motorist
coverage?
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If you are the owner of the vehicle, does
your automobile insurance limit medical payment
benefits?
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Did you file a claim?
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Was a police report filed?
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Were there any witnesses?
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If yes, do you know how to contact these
witnesses?
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Were you injured?
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If yes, were you taken to the hospital by
ambulance?
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Were you treated in an emergency
room?
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Were you employed at the time of the
accident?
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If yes, has a worker's compensation claim
been opened?
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Have you been involved in an accident
before?
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Please Note: Statutes of limitation exist which limit
the time period in which a case can be brought to
trial. As such, it is important to know exactly when
and where the incident occured.
(*) This is a required field
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www.automobileinjuries.com is not intended to be
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related to legal issues commonly encountered. Your
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