Friday, March 19, 2010

Massachusetts Attorneys >> Workers Compensation

Massachusetts Attorneys.com provides a directory of Massachusetts lawyers who offer free case evaluations. To contact an attorney reviewing workers compensation cases, please fill out the free workers compensation evaluation form below.

Once you submit your form, your contact information will be sent to the sponsored Massachusetts attorney or law firm listed below. That lawyer will review your form in accordance with the site terms and conditions and may contact you to discuss your case. There is no cost or obligation for this service. This form will be sent to:

Attorney Adam Becker, Esquire
Ten Tremont Street
Boston, MA 02108
(617) 227-7000 X24

Free Workers Compensation Consultation

Title:
First Name:	*
Middle Name:
Last Name:	*
Home Phone:	*
Cell Phone:
Work Phone:
Email Address:
Address:	*
City:	*
State, Zip:	* *
What is the best way to reach you? Please provide the best place, time and method for contacting you.

Injured Person Information:

Date of Birth / Age: (ex. mm/dd/yyyy or 54)
Were you injured?	Yes No
If not, who are you inquiring on behalf of?

If you are NOT inquiring on your own behalf,
what is your relationship to the injured person?

Is the person deceased?

Yes No

If deceased, what is the cause of death
as stated on the death certificate:

Date of Death: (ex. mm/dd/yyyy)
Was an autopsy performed?	Yes No
If not deceased, does the injury prevent you or the victim from working?	Yes No

If yes, when did you/victim stop working?
What is the approximate lost wages due to the injury?

Accident / Injury Information:

Date of Accident:	*
City where accident occured:	*
State where accident occured:	*

Please briefly explain the incident that caused the injury:
Who do you believe was at fault in causing the injury, and what do you believe they did wrong?
Describe the injuries in detail:

Do you believe the injuries are permanent?

Yes No

Case Description*
Please explain exactly what happened, trying to state
as thoroughly as possible who you believe was responsible
and why you believe that person was negligent:

Please explain the full extent of the victims injuries:

Comments / Additional Information
Is there anything else that would assist us in
understanding the facts of your case?

To Better Serve You:

Please tell us how you found us? If "other" please specify.

Please specify how you found us (if other than above):

If you found us using a search engine,
please tell us which search engine?

Please tell us exactly what terms you typed into the
search engine to find us? (i.e. Personal Injury Lawyers)

I understand that by filling out this free consultation form I am not forming an attorney client relationship. I understand that I may only retain an attorney by entering into a fee agreement and that by submitting this form I am not entering into a fee agreement. I understand that not all submissions may receive a response.
Yes No

I agree that the above does not constitute a request for legal advice. I agree that any information that I will receive in response to the above question is general information and I will not be charged for the response to this e-mail question. I further understand that the law for each state may vary, and therefore, I will not rely upon this information as legal advice. I agree that if this matter requires advice regarding my home state, local counsel may be contacted for referral of this matter. I understand that email is not secure and thus I am not forming a confidential relationship.
Yes No

I have read and agree with the TERMS AND CONDITIONS
Yes No

By Clicking the box below, I agree to submit my case for a free case evaluation:

* = Required Fields

FREE ONLINE CONSULTATION

Massachusetts Law: Click Here to brows a database of Massachusetts General Laws.

MassachusettsAttorneys.com is powered by C-4 Analytics.

HOME | SITE MAP

Amtrak & Acela Accidents Asbestos Auto Accidents Aviation Accidents Birth Injury Brain Injury Business Litigation Cerebral Palsy Chantix Suicide Construction Site Accidents Criminal Law Criminal Law - Murder Defective Drugs Digitek Toxicity Dog Bite DUI / DWI Explosion Cases Factory Explosions Immigration Industrial Explosions Insurance Bad Faith Denial IT Overtime Investigation Legal Malpractice Lineman Electrocutions Medical Malpractice Mesothelioma Motorcycle Accidents Nursing Home Abuse Personal Injury Railroad Accident Real Estate Scaffolding Collapse Shoulder Pain Pump Social Security Disability Spine & Spinal Cord Injury Stock & Broker Fraud Tractor Trailer Accidents Train & Railroad Death Traumatic Brain Injury Truck Accident Welding Fumes Workers Compensation Wrongful Death