Workmans Compensation Claims and Settlements

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	Death Benefits Partial Incapacity Benefits Permanent and Total Incapacity Benefits Permanent Loss of Function and Disfigurement Temporary Total Incapacity Benefits


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Stopped or Reduced Benefits
Your benefits might be stopped or reduced for several reasons. Some of the more common reasons, when liability has been established, are:

it is ordered by an arbitrator, administrative judge, reviewing board, or higher court.
you have returned to work (the insurer must resume benefits if within 28 days you leave work again due to the same injury).
the insurer has been given a medical report by your treating doctor or an impartial medical examiner stating that you are capable of returning to work, and your employer has reported that a suitable position is available for you.
you are requested to attend an evaluation by a DIA vocational rehabilitation review officer and you refuse to attend, or refuse to cooperate with the provision of vocationalrehabilitation services.
you are asked to go to the insurer’s doctor for evaluation, and you fail to attend.
you are imprisoned after conviction for either a misdemeanor or felony.

Filing a workers' compensation claim is a complicated and difficult task. If you would like your claim to be reviewed by an attorney, complete the form below for a free evaluation.

Free Stopped or Reduced Benefits 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:

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

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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)

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