Connecticut Work Accident Lawyers | Workers Compensation | Workmens Compensation | Workers Comp

Serrano & Serrano, LLC

Attorneys at Law

800 856-6400

English

Skill

Determination

Experience

690 Flatbush Avenue West Hartford, CT 06110-1308

860 236-9350 800 856-6400 toll free 860 523-9101 fax

10 Church St, Naugatuck 203 729-6100


Work Accident Inquiry Form
* Required
Your Name*
Your Phone Number(s)*
Your Address & Town
Your E-Mail*
Accident Date*
Accident Address or Place
Accident Town
Your Employer*
Your Employer's Address
Has the Case Been Filed With the Conn. Workers Compensation Commission*	No Yes Not Sure
Has the Case Been Accepted by Your Employer's Insurance Company*	No Yes Not Sure
Insurance Company (if known)
Ins. Co. Claim No. (if known)
Ins. Co. Adjustor (if known)
Ins. Co. Phone No. (if known)
Your Medical Treatment	Ambulance Emergency Room Occupational Clinic Family or Primary Care Doctor Orthopedist Chiropractor
Please Tell Us About Your Injuries*
Please Tell Us How Your Injury Happened*

Please include the area codes for your phone number(s).

Please note that with this form you are only sending us information.

To hire us as your attorney you must sign a contract with us to represent you in this matter.

Thank you for sending us this information.

Please note that our website is designed to provide only general legal information.

This information is not intended to apply to individual cases.

If you have a legal matter, you should speak with and hire an attorney to handle your specific situation.