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CALCULATE AUTO INJURY COMPENSATION
Date of Incident
Was the accident your fault, or were you issued a ticket for the accident?
Yes
No
Was a police report filed?
Yes
No
Were you physically injured or in pain?
Yes
No
Does anyone involved have vehicle insurance coverage?
Yes
No
What types of injuries were sustained?
(Please check all that apply)
Whiplash
Lost Limb
Brain injury
Broken Bones
Loss of life
Spinal cord injury or paralysis
Did the accident cause hospitalization, medical treatment, surgery, or missed work?
Yes
No
Is an attorney helping you with your claim or has an attorney already rejected your claim?
Yes
No
State where the injury occurred:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Estimated medical bills:
No Medical Bills
Less than $1,000
$1,000 - $5,000
$5,000 - $25,000
$25,000 - $100,000
More than $100,000
Please describe your injuries:
ALMOST DONE... A REAL INJURY ATTORNEY COULD ESTIMATE YOUR POTENTIAL COMPENSATION IN 2 MINUTES
My claim is unique. The law firm may ask me for additional case details so the lawyer can appraise my claim value.
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