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Claim For Additional Accidents

Claim For Additional Accidents

Hi

You can let us know if you've been involved in any further non-fault accidents by completing the following questions

Your Details

First name:

Last name:

Your file reference No.:

A few quick
questions...


Have you been injured as a result of a non-fault road traffic accident – whether as the driver or as a passenger – that occurred in the in the past three years and for which you have yet to instruct a solicitor?

YesNo

Do you currently suffer from an illness or injury that has resulted from carrying out your duties in the workplace in the past three years, and for which you have yet to instruct a solicitor? (E.g. RSI, Vibration White Finger, Noise induced Hearing Loss, Tinnitus, Asbestosis etc.)

YesNo

Have you suffered an injury as a result of an accident in the workplace in the past three years, and for which you have yet to instruct a solicitor?

YesNo

Have you been mistreated or misdiagnosed by a doctor, nurse, or dentist in the past three years, and for which you have yet to instruct a solicitor?

YesNo

Have you suffered an injury that was not your fault whilst on holiday in the past three years, and for which you have yet to instruct a solicitor?

YesNo

Have you been injured in an accident that was not your fault whilst travelling on a motor bike or bicycle in the past three years, and for which you have yet to instruct a solicitor?

YesNo

Have you been injured as a result of a slip, trip, or fall that was not your fault in the past three years, and for which you have yet to instruct a solicitor?

YesNo

Have you suffered a dog attack in the past three years for which you have yet to instruct a solicitor?

YesNo

Have you suffered any criminal injuries in the past three years for which you have yet to instruct a solicitor?

YesNo

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