Thank you for asking this firm for assistance in your workers’ compensation claim.In order to begin processing your claim, we need to develop the basic information of the events of your collision. All information that you provide is confidential and protected by attorney-client privilege. It is important to be accurate and complete – incorrect or missing information could seriously affect your case in a negative manner! Please fill this form ASAP, keeping a copy for yourself. Please refer to it from time to time. If more or different information is appropriate, please provide this to me.