Injury | LawLegal.co

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Calculate Slip Fall (on the job)
Compensation

Date of Accident:

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Have you lost wages or suffered medical bills due to the injury? NO YES

Please select YES or NO

Did the injury cause you to miss more than 5 days of full-time work? NO YES

Please select YES or NO

Did you notify your employer? NO YES

Please select YES or NO

Do you currently have an attorney helping you with your case? NO YES

Please select YES or NO

Please describe your claim

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First Name

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Last Name

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Phone Number (xxx) xxx-xxxx

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Street Address

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Zip code

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City

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State

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