Tell us what happened.

A few questions so we understand your situation before we call. It takes about two minutes, and the consultation is free.

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Step 1

What kind of matter is this?

Pick the one that fits best. You can go back at any point.

Which best describes your personal injury matter?

Which best describes your workers' compensation matter?

Tell us a little more

What was the nature of the truck accident? Please select all that apply.

Select all that apply.

Collision with another vehicle Collision with a stationary object Truck rollover Lost load from the truck Other

Please specify the details of the other nature of the accident.

At what time of day did the accident occur?

Morning (5 AM - 12 PM) Afternoon (12 PM - 5 PM) Evening (5 PM - 9 PM) Night (9 PM - 5 AM)

Did you suffer any injuries from the accident?

Yes No

Is there an existing claim or lawsuit regarding this truck accident?

Yes No

Was the truck driver deemed at fault by any party?

Yes No

Did the Uber/Lyft accident occur within the last two years?

Yes No

Did you seek medical attention for your injuries following the Uber/Lyft accident?

Yes No

Have you been in contact with Uber/Lyft, insurance companies, or other parties involved in the accident?

Yes No

Are you interested in seeking compensation for medical expenses, pain and suffering, or other damages resulting from the Uber/Lyft accident?

Yes No

Where did the accident happen?

When did this happen?

Did the accident result in any significant injuries?

Yes No

Were there any witnesses to the accident?

Yes No

Did you seek medical attention after the accident?

Yes No

Was the accident caused by a vehicle?

Yes No

Did the accident result in any injuries?

Yes No

Were you injured while on someone else s property?

Yes No

In what city and state did the injury take place

Have you reported the injury to the property owner, manager, or relevant authorities?

Yes No

When Did This Happen?

Where Did This Happen?

What is your relationship to the deceased person?

Spouse Parent Child Other

Please specify

How did the deceased person die?

Car Accident Trucking Accident Medical Malpractice Workplace Accident Other

What was the approximate date of the death?

Where did the accident occur?

Please provide the city in which you re located

Have you or your loved one been involved in an accident that resulted in catastrophic injuries?

Yes No

Please select the type of accident:

Automobile accident Slip and fall Medical malpractice Workplace accident Other

If Other , please describe the type of accident:

Did the injury result in hospitalization?

Yes No

Are you working with another lawyer on this case?

Yes No

What is the current medical status of the injured party?

Receiving ongoing treatment Permanent disability Recovered Other

If Other , please specify the current medical status:

Are you aware of any party responsible for the accident?

Yes No

Please provide the city in which you re located

Did your injury occur on someone else s property?

Yes No

What type of location did the injury occur at?

Retail store Private residence Public space Commercial building Other

Please specify the location type.

Was the injury caused by a slip, trip, or fall?

Yes No

Were there any witnesses to the incident?

Yes No

Have you reported the incident to the property owner or manager?

Yes No

Have you previously sought legal advice or representation for this incident?

Yes No

Are you currently undergoing medical treatment as a result of the injury?

Yes No

Please provide the date of accident

Please provide the city in which you re located

Have you reported the injury to your employer?

Yes No

When did the injury occur?

Within the last week Within the last month More than a month ago Over a year ago

What was the nature of the injury?

Injury due to machinery Slip or fall Exposure to harmful substances Overexertion or repetitive motion Other

Please describe the injury.

Are you currently receiving any medical treatment for your injury?

Yes No

Has your injury impacted your ability to work?

Yes No

Please provide the city in which you re located

Has your claim for workers compensation been officially denied?

Yes No

Please select the reason provided for denial of your claim.

Not reported in time No medical evidence of injury Dispute on whether injury is job-related Other

Please specify the other reason for denial.

Are you currently receiving any medical treatment for the injury claimed?

Yes No

Was the injury sustained during your employment?

Yes No

Have you previously filed for workers compensation?

Yes No

Select any of the following that apply to your situation.

Select all that apply.

I was injured at work I am unable to work due to the injury I have dependents relying on my income I have disputed the denial formally

Have you hired an attorney for this matter before?

Yes No

Please provide the city in which you re located

Did you suffer a work-related injury or illness?

Yes No

Have you been unable to work due to your work-related injury or illness?

Yes No

Have you reached Maximum Medical Improvement (MMI) for your condition?

Yes No

Has a doctor or medical professional stated that your injury or illness is permanent?

Yes No

Has any prior service connected disability claims been filed, allowed, and or denied for any condition before the VA?

Yes No

Did you receive your work injury while working for the Department of Defense (DoD), Coast Guard, U.S. Army Corps of Engineers (USACE), or the National Interagency Fire Center (NIFC)?

Yes No

Please provide the city in which you re located

Have you or your employee been injured at work?

Yes No

Is the claim related to an illness or injury?

Illness Injury Both

Was the injury or illness reported to the employer?

Yes No

Has any compensation been offered or paid by your employer?

Yes No

Which of the following best describes the status of your workers’ compensation claim?

Pending decision Denied Partially accepted Resolved Other

Please describe your situation.

Are there any other parties involved in the claim besides the employer?

Yes No

Are you currently represented by an attorney for this matter?

Yes No

Please provide the city in which you re located

Have you been injured at your workplace while performing your duties?

Yes No

Did you already file a workers compensation claim for this incident?

Yes No

Are you currently receiving any form of workers compensation benefits?

Yes No

What type of employment were you engaged in at the time of the injury?

Full-time Part-time Temporary Contractual Other

Please specify your employment type:

What are the primary issues you are facing with your workers compensation claim? (Select all that apply)

Select all that apply.

Denied claim Delay in benefits Dispute over benefit amount Issue with treatment or medical coverage Other

Please elaborate on your issue:

Please share 1-2 sentences about your matter

What was the date of the incident?

What was the location of the incident?

What was the Name of the Hospital / Clinic?

Please provide the Name(s) of the Healthcare Provider(s) involved

What was the medical condition or symptoms being treated?

Describe the treatment or procedure performed

What do you believe the healthcare provider did wrong?

Was there a diagnosis made?

Yes No

Was the diagnosis accurate?

Yes No

Were there any unexpected complications?

Yes No

Describe the complications or injuries that occurred:

Describe the outcome of the treatment or procedure:

Have you sought additional medical treatment after the incident?

Yes No

Describe the subsequent treatment and outcomes:

How has the injury affected your daily life?

Have you consulted with or retained another attorney regarding this matter?

Yes No

Do you have copies of medical records, bills, or any correspondence related to this incident?

Yes No

Please provide a brief description

Is there anything else you believe is important for us to know about your case? Optional

What is your date or birth?

What is your address?

How can we reach you?

We will follow up about your consultation. Your details stay with the firm.

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Last Name *

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815-730-1977

Offices

Joliet 3260 Executive Drive Joliet, IL 60431
Naperville Naperville, IL

We represent clients throughout the Chicagoland area.

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