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Online Accident Review Form


There are over 3 million injuries a year from transportation accidents and around 40,000 fatalities. Over 35% of fatalities are alcohol related. An even higher percentage of injuries are the result of driver error and negligence.

Sometimes injuries may be directly or indirectly the result of mechanical or other defects affecting automobiles or component parts. Defective tires, brakes, steering, and seatbelts can have devastating consequences and victims and their families need aggressive representation to protect their rights. Our lawyers are available to represent those injured in auto, motorcycle, trucking and pedestrian accidents and in all cases including wrongful death and aim to maximize the recovery for their clients.




Please fill out the form below for a *free Evaluation

Name

Enter Your Email Address. (It will only be used regarding this matter).  

Phone Number with area code:  

Do you have an attorney working on this case?  

How do you prefer to be contacted?  

Where you a passenger or the driver?  

Where was your automobile hit?  

Please provide a brief description of the accident:  

If you were the driver, are you the owner of the vehicle?   

If you are the owner of the vehicle, does your automobile insurance limit liability?   

If you are the owner of the vehicle, does your automobile insurance limit uninsured motorist coverage?   

If you are the owner of the vehicle, does your automobile insurance limit medical payment benefits?   

Did you file a claim?   

Was a police report filed?   

Were there any witnesses?   

If yes, do you know how to contact these witnesses?   

Were you injured?   

If yes, were you taken to the hospital by ambulance?   

Were you treated in an emergency room?   

Were you employed at the time of the accident?  

If yes, has a worker's compensation claim been opened?  

Have you been involved in an accident before?