Claims Initial Enquiry Form – get answers within 24 hours Claims Initial Enquiry We’ll get answers within 24 hours. Client Details Full Name (required) DOI (Date of Incident) DOB Address Phone Email Employer at time Employed as Injuries Previous injuries Medical Doctors Physiotherapists Specialists TPD if applicable Super fund TPD amount Policy number MVA Police report number Collision type Vehicle vs Vehicle/Motorcyclevs Bicyclevs Pedestrian Rego 1 Rego 2 WorkCover claim number Ombudsman reports for med neg Evidence Doctors reports available? YesNo Photos of incident/injuries If file upload is not available, please note whether photos are available below. Photos available (yes/no) and note Additional Currently with a lawyer? YesNo Current issues with law firm/lawyer How previous injuries affected you prior to this incident Liability How injury occurred Liability type Medical negligenceAt WorkMotor VehiclePublic LiabilityRental Property Injury Further answer Δ
