What’s My Claim Worth?

We’ve designed this special Insider Claim Worksheet to what attorneys and insurance companies need to know when evaluating your potential case.

By filling out and submitting the Insider Claim Worksheet, you’ll take your first step to getting pre-approved for a FREE telephone call scheduled with either Attorney Carlin Phillips or Attorney Andrew Garcia.

Just fill out the information in the worksheet below and you’ll be called within 1 business day to schedule your FREE telephone call convenient with your schedule.

ACT NOW because time slots fill up really fast.

Auto Accident Claim Work Sheet

Added Bonus - Free Auto Accident Claim Work Sheet
  • Your telephone number is required so that we can call you to schedule your free consult with an attorney
  • What is the date of your accident? The date is important because there are certain time limits that may prohibit you bringing a claim.
  • Just Check All That Apply to Your Accident Claim
  • Enter amount of any ambulance bill (if none enter "0")
  • Enter estimated amount of hospital bills to date (if none, enter "0")
  • Enter amount(s) of diagnostic tests - MRI, CT Scan, X-Rays, etc. (if none enter "0")
  • Enter amount(s) of Doctor or Chiropractor Bills (if none enter "0")
  • Enter amount(s) of Physical Therapist Bills (if none enter "0")
  • Enter amount(s) of Any Other Accident Related Bills such as Massage Therapy, Acupuncture, Medical Braces, etc. (if none enter "0")
  • Even if you reach the "tort threshold" above, it does not always mean you have a personal injury case. In Massachusetts, the other driver(s) must be at least 51% at fault before they can be held responsible. If the other driver violated the legal "Rules of the Road," then they may be held responsible for the accident (but there is no guaranty). The below list does not cover all of the ways in which the other driver could be held legally responsible, but they are some of the more common violations of the "Rules of the Road." Check all that apply to your situation. DID THE OTHER DRIVER DO ANY OF THE FOLLOWING?
  • Use this field to tell us any other information that you think is relevant to analyzing your accident case.