If you have been injured
while on the job, you have a right to seek Workers
Compensation benefits. The workers' compensation system
can be complex and confusing when dealing with employers
and insurance companies. An experienced Workers'
Compensation attorney can help you get the benefits to
which you are entitled. To have your situation
evaluation free of charge, please complete the following
form:
*
required fields
INJURY INFORMATION
Please describe your injuries in detail:
Please briefly
explain the incident that caused your injury:
When
did your injury occur?
(day/month/year) Check if
your injury was sustained over time... such as a
repetitive stress or muscle disorder.
City
where injury occurred:
State
where injury occurred:
Have you
received medical treatment? Please describe:
Has your doctor ordered
a leave of absence from work? YES
NO
WORKERS COMPENSATION
INFORMATION
Have you alerted your employer of your injury?YES
NO
Have you filed
for Workers Compensation?YES
NO
If you have filed for Workers Compensation, what is the
status of your claim?
