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Quick Whiplash Claim Assessment

Where did your injury occur? *

We don't require the exact address/location at this point, we just need to learn which city/province you were injured in. (NOTE: Any injuries occurring outside of Canada are out of our jurisdiction and you will be required to seek legal advice in that country/state/jurisdiction.)

When did your injury occur? *

This is important because most injury claims must be filed by a certain date. This is known as a limitation date and it ranges from 1 month to 2 years, depending on the circumstances of your case.

Were you working at the time? *

If you were working at the time of your injury/accident it is quite likely that your matter will be handled by Workers' Compensation (WCB).

YesNo

Who was at fault? *

Please provide us with a short explanation of how your injury occurred and why you feel the other party was at fault.

Have you seen a doctor or sought help from any other health provider following your accident/injury?*
YesNo

If you answered "Yes" to the above question, please provide us with as much detail as possible about what the doctor/health provider told you.

Details of your medical assessment:

Were you employed at the time of the accident/injury? *
YesNo

If you answered "Yes" to the above question, please provide the details about how this injury has affected your income or ability to earn income.

Loss of income details:

Have you been injured in any other PREVIOUS accidents?*
YesNo

If you answered "Yes" to the above question, please provide the details of that early injury.

Details of ANY previous injuries:

Do you currently have a lawyer (for this injury or any other matter)?*
YesNo

Did you contribute to your injuries in any way?*

This information will help us prepare for any allegations of "contributory negligence". For example, failing to wear a seat belt may reduce your chance of receiving full compensation. It's important for us to know up front, and these facts will usually NOT invalidate your claim completely.

Are you prepared to follow the treatment plan provided by your health care provider and to attend ALL appointments on time *
YesNo (I don't have the time, I'm just looking for a quick settlement)

Additional Details/Concerns/Questions

Use this space to provide any additional information you feel may be relevant to your case. Feel free to ask questions here as well.

Upload Photos (optional)

If you have any photos of your injuries (or damage to your vehicle) you can upload them here to give us a better appreciation of your circumstance (Optional - Max 20 MB file).

Quick Whiplash Claim Assessment

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