BACKGROUND Provide any information we can include in your settlement letter which would help in describing your preaccident lifestyle, the type of person you are and your accomplishments (#of years married, # of children, education including any honors, sports, arts, interests, talents, clubs, community service, recognition for accomplishments, awards, titles, etc):
Mechanics: Describe what happened (1) to your vehicle, and (2) to your body at the time of impact:
Injuries - List all symptoms and/or medical problems you experienced within first few days after the accident:
All prior accidents, injuries or problems you have had of a similar nature before or after this accident (include dates of accidents and treatment)
List any CURRENT problems you continue to experience as a result of the accident in our case
Name of Care Provider who saw you last
Future Appts with
List ALL Medical Providers You Saw for your Injuries:
List any home treatments used - - ice packs, heating pad, hot baths or showers , massage, exercises,
Identify any visible signs of injury that you believe will be permanent, such as scarring, limping, etc
Identify any equipment or appliances prescribed and inclusive dates of use (crutches, braces, collars)
INCOME LOSS If you lost any time from work or school as a result of your accident injuries, please provide your rate of pay, and approximate dates or periods of time missed from work.
MISCELLANEOUS If you found it necessary to hire professional or outside help to provide services you otherwise would have performed yourself prior to the accident, please list the names and addresses of the individual or company hired, nature of work and cost of service. Send copies of any supporting paperwork. (Note: If relatives or friends helped at no charge, please let us know so we can mention this in our demand, despite the fact we cannot claim the expense) (examples - housecleaning, yard maintenance, babysitter, etc - - - make certain we have all prescription receipts.)
RESTRICTIONS & LIMITATIONS Provide a brief statement concerning the impact of your injuries on your social and recreational activities, family life, career or any other aspect of daily living that was affected. Include sports, hobbies, social events and weekend activities you were forced to forgo, physical problems encountered in caring for and playing with your children or grandchildren, impact on your intimate relationships with partner and routine daily tasks which produce discomfort or which you are completely unable to perform due to pain or the likelihood it will aggravate your condition.