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FREE Claim Check v3

Did you suffer financial loss as a result of this injury?

Yes

Did the accident happen BEFORE December 2017?

Yes

When did the accident occur?

Less than 6 months ago

More than 6 months ago

More than 3 years ago

How did your injury happen?

One off Accident

Work Conditions

Multiple Incidents

Aggravation of a Previous Injury

Did an ambulance take you to hospital?

No there was no ambulance at the scene

Yes I was taken to hospital

Yes but I wasn't taken to hospital

Did Police Attend the Scene?

No but there is an Event number

Yes there is a Police Report

I am not sure

Who do you believe is responsible for the accident?

It was the other side's fault

It was my fault

It was a bit of both

The road was unsafe (tree falls, damaged, unrestrained animal)

Do you require surgery for any of these injuries?

Yes

Full Name

Phone

Would you like to provide further details?

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