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Accidents at work

Your employer has a legal requirement to protect you from injuries in the workplace. Of course, accidents do sometimes happen and that is why your employer must, by law, have an insurance policy to cover compensation for injuries and loss of earnings when disaster strikes.

By filling in this form you can find out if you are entitled to compensation. Simply fill out each section and click on SUBMIT. Our online assessment system will analyse your details and tell you whether or not you have a claim. One of our advisors will then contact you (without obligation) to discuss the matter further within 24 hours (48 hours at weekends).

Your Details

Name:
Email address:
Home Tel No:
Mobile Tel No:
Best time to call:

Details of your accident

1.	What was the date of your accident? (DD/MM/YYYY)
2.	Were there any witnesses?	Yes / No
3.	Did you report the accident to any specific person?	Yes / No
4.	Was the accident entered in any accident book?	Yes / No
5.	Had you been properly trained to do whatever you were doing at the time of the accident?	Yes / No
6.	Had there previously been similar accidents involving other employees?	Yes / No
7.	Had there previously been any complaint about the working practices that caused your accident?	Yes / No
8.	When did you go to your GP/Hospital?
	(a) Within 24 hours
	(b) Within 1 week
	(c) Not at all