Step 1 of 2 Injury Details

What was the injury cause? - select injury cause Auto Accident Work Injury Slip & Fall Medical Malpractice Mass Transit Accident Wrongful Death Defective Drug Birth Defect Motorcycle Accident Truck Accident Dog Bite/Animal Attack Pedestrian/Bike Hit By Car Nursing Home Abuse Brain Injuries Construction Amusement Park Assault/Battery/Sex Abuse

Approximate date of injury: month January February March April May June July August September October November December year 2018 2017 2016 2015 2014 or earlier

Did the injury require hospitalization,

medical treatment, surgery or cause you to miss work? - select yes/no Yes No

Were you at fault for the accident? - select yes/no Yes No