Workers' compensation & social security lawyers

Workers' Compensation Case Evaluation

Because we practice solely in Colorado, we can only evaluate your claim if you have been injured in Colorado, or the company you work for is based in Colorado.

You can send this information over the Internet by clicking submit at the bottom of the form. If you are concerned about the privacy of this information, you can fill out the form, print it out and fax it to us at (719) 632-4807. Please note that no attorney-client relationship is established by submitting this form.

Fields in red are required.  Wherever you see the help icon you can get help answering the question.

First Name
 
 
Last Name
 
Address
 
City
 
 
State / Zip
 
You will need to enter either a phone number or e-mail address so that we can contact you.
 
E-mail
 
 
  
How did you get to us? (check all that apply)
Spencer & Spencer Newsletter
Link from another site
  

  

  
 
 
 
 
Has the Insurance Carrier sent you an Admission of Liability? (Requires Acrobat Reader to view)
yes   no
 
    If yes, please select:
     General Admission of Liability was filed
     Final Admission of Liability was filed
Date of Admission:
 
Injury(s)
 
Have you missed any work because of your injury?
    
   
 
Did you report your injury(s) to your supervisor?
    
 
Was a claim filed with Division of Workers' Compensation? (Requires Acrobat Reader to view)
        
 
Are you receiving worker's compensation benefits checks?
        
 
Are your medical bills getting paid?
        
 
Doctors seen for workers' compensation injury
 
What medical treatment are you currently receiving?
 
Why did you decide to contact an attorney?
 

 
After you have filled out the form, a lawyer will review your case, and someone from our office will contact you.
 
You can send this information over the Internet by clicking submit at the bottom of the form. If you are concerned about the privacy of this information, you can fill out the form, print it and fax it to us at: (719) 632-4807.

 


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© 1998-2008 Spencer & Spencer, P.C., Attorneys at Law
830 Tenderfoot Hill Road, Suite 320, Colorado Springs, Colorado 80906

Practice limited to workers' compensation and social security disability law.