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Car Accident Lawsuit Questionnaire

Would you like a free legal review of your potential car accident lawsuit? All you need to do is fill out the simple form below. There is no commitment, and we will let you know if we can help you.

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Please complete the following questionnaire:

First Name:
Last Name: *
Home Phone: *
Work Phone:
Best time to call:
City and State:
Email:
Were you a:
If other, please describe:
Did you get the other driver's information?	Yes No
Do you have collision insurance?	Yes No
Date of Accident (mm/dd/yyyy):
Approximate Time of Accident:
Weather Conditions:
Location of Accident:
What are your Injuries?
Please describe the accident and how it happened:
Were photos taken of:	Accident Scene Injuries
Was the accident reported to the police?	Yes
Were you hospitalized?	Yes No
Additional comments:

see also:

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Car Accidents

Car Accident Information From the Lawyers of Weitz & Luxenberg
Get a free legal review and car accident information from our firm

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MESOTHELIOMA
DEFECTIVE MEDICINES AND DEVICES
ENVIRONMENTAL POLLUTION
- Arsenic
- Benzene
- Chromium
- Dioxins
- Gulf Oil Spill
- Lead Poisoning
- Mercury Poisoning
- Gas Drilling/Fracking
- Pesticides
- Petroleum Spills
- PCB
- PCE
- Radium
- TCE
- Vapor Intrusion
- Water Contamination
ACCIDENTS
PERSONAL INJURY
MEDICAL MALPRACTICE

Name:

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Case Description:

$423 million settlement
MTBE suit involving the contamination of 153 public water systems nationally

$16.5 million verdict
Asbestos case involving exposure from dental tape

$1.4 million settlement
Accident involving woman struck down by ambulance

$1.5 million settlement
for 47-year-old construction worker who fell off elevated train tracks

$6 million settlement
Pediatric malpractice involving infant who suffered brain damage at birth

$53 million verdict
brake mechanic suffering from mesothelioma

$13.5 million verdict
one of the very first Vioxx trial cases

$15 million settlement
man wound up a paraplegic due to negligent hospital care

$37 million verdict
2 asbestos lung cancer plaintiffs

$47 million verdict
boilermaker who died from mesothelioma

$2.6 million settlement
ill-fitting prosthesis caused decubitus ulcers

$75 million verdict
historic consolidated trial involving men who had worked at the Brooklyn Navy Yard in the 1940s and 1950s

$8 million settlement
obstetrical malpractice resulted in neurological deficits

$64.65 million award
4 asbestos plaintiffs

$17.5 million
consolidated trial of 5 mesothelioma victims

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A nationally-recognized personal injury law firm, Weitz & Luxenberg is committed to helping clients win cases,

get the compensation to which they’re entitled and continue with their lives. In just over a quarter century, we’ve collected more than $7 billion for plaintiffs.

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