You may be entitled to compensation!

If you do not already have an attorney, choose "yes" for a free consultation.

Have you been injured in an auto accident that was not your fault in the last two years?

Were you told you were at fault for the incident?

No Yes

What are your estimated medical bills?

Was the other driver driving a commercial vehicle?

No Yes

Date of the incident

Month

Day

Year

Have you been in a work related accident in the last 12 months where you have suffered an injury and incurred medical expenses or loss of work as a result?

Did the injury require hospitalization, medical treatment, surgery or cause you to miss work?

No Yes

Month of Injury?

Year of Injury?

Briefly describe your case

Did you or a loved one use a hair relaxer or chemical straightener and later develop uterine or ovarian cancer?

No Yes

Were you or a Family Member Stationed, Worked, or Lived at Camp Lejeune between 1953 and 1987 and Developed Cancer or a Serious illness?

No Yes

Are you employed?

No Yes