{"id":1686,"date":"2026-09-15T21:39:24","date_gmt":"2026-09-15T21:39:24","guid":{"rendered":"https:\/\/www.injurycheck.info\/?page_id=1686"},"modified":"2026-09-30T19:18:11","modified_gmt":"2026-09-30T09:18:11","slug":"claims-enquiry-form","status":"publish","type":"page","link":"https:\/\/www.injurycheck.info\/de\/claims-enquiry-form\/","title":{"rendered":"Claims Initial Enquiry Form \u2013 get answers within 24 hours"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"1686\" class=\"elementor elementor-1686\">\n\t\t\t\t<div class=\"has_eae_slider elementor-element elementor-element-93d8828 e-flex e-con-boxed e-con e-parent\" data-eae-slider=\"46067\" data-id=\"93d8828\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-eb9b704 elementor-widget elementor-widget-elementskit-contact-form7\" data-id=\"eb9b704\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"elementskit-contact-form7.default\">\n\t\t\t\t\t<div class=\"ekit-wid-con\" ><div class=\"ekit-form\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1687-p1686-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1687\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/de\/claims-enquiry-form\/?tpretry=1791073872#wpcf7-f1687-p1686-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\" data-no-translation-aria-label=\"\" data-trp-original-action=\"\/de\/claims-enquiry-form\/?tpretry=1791073872#wpcf7-f1687-p1686-o1\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1687\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.7\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1687-p1686-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"1686\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p><strong>Erster Anruf<\/strong>\n<\/p>\n<p>Wir erhalten die Antworten innerhalb von 24 Stunden.\n<\/p>\n<p>F\u00fcllen Sie alle mit Ihnen vertr\u00e4glichen Details aus. Nur Ihr Name, Telefonnummer und E-Mail-Adresse sind erforderlich. Je mehr Informationen Sie angeben, desto schneller k\u00f6nnen wir beurteilen, ob Sie Anspruch auf Entsch\u00e4digung haben.\n<\/p>\n<h3>Details des Kunden\n<\/h3>\n<p><label><em>Voller Name<\/em> (erforderlich) <span class=\"wpcf7-form-control-wrap\" data-name=\"full-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"full-name\" \/><\/span><\/label><label><em>DOI (Datum des Vorfalls)<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-incident\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-of-incident\" \/><\/span><\/label><label><em>Datum der Geburt<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-birth\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-of-birth\" \/><\/span><\/label><label><em>Adresse<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address\" \/><\/span><\/label><label><em>Telefon<\/em> (erforderlich) <span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"phone\" \/><\/span><\/label><label><em>E-Mail<\/em> (erforderlich) <span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span><\/label><label><em>Arbeitgeber zum Zeitpunkt<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"employer-at-time\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"employer-at-time\" \/><\/span><\/label><label><em>Als Angestellter<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"employed-as\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"employed-as\" \/><\/span><\/label><label><em>Verletzungen<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"injuries\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"injuries\"><\/textarea><\/span><\/label><label><em>Vorherige Verletzungen<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"previous-injuries\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"previous-injuries\"><\/textarea><\/span><\/label>\n<\/p>\n<h3>Medizinische\n<\/h3>\n<p><label><em>\u00c4rzte<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"doctors\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"doctors\"><\/textarea><\/span><\/label><label><em>Physiotherapeuten<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"physiotherapists\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"physiotherapists\"><\/textarea><\/span><\/label><label><em>Experten<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"specialists\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"specialists\"><\/textarea><\/span><\/label>\n<\/p>\n<h3>TPD falls zutreffend\n<\/h3>\n<p><label><em>Superfonds<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"super-fund\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"super-fund\" \/><\/span><\/label><label><em>TPD-Betrag<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"tpd-amount\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"tpd-amount\" \/><\/span><\/label><label><em>Polizeienummer<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"policy-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"policy-number\" \/><\/span><\/label>\n<\/p>\n<h3>MVA\n<\/h3>\n<p><label><em>Polizeiberichtnummer<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"police-report-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"police-report-number\" \/><\/span><\/label>\n<\/p>\n<p><em>Verkehrsart<\/em>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"mva-type\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"mva-type[]\" value=\"Vehicle vs Vehicle\/Motorcycle\" \/><span class=\"wpcf7-list-item-label\">Fahrzeug gegen Fahrzeug\/Motorrad<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"mva-type[]\" value=\"vs Bicycle\" \/><span class=\"wpcf7-list-item-label\">gegen Fahrrad<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"mva-type[]\" value=\"vs Pedestrian\" \/><span class=\"wpcf7-list-item-label\">gegen Fu\u00dfg\u00e4nger<\/span><\/label><\/span><\/span><\/span><label><em>Rego 1<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"rego-1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"rego-1\" \/><\/span><\/label><label><em>Rego 2<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"rego-2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"rego-2\" \/><\/span><\/label><label><em>WorkCover Anmelde-Nummer<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"workcover-claim-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"workcover-claim-number\" \/><\/span><\/label><label><em>Berichte des Ombudschafters f\u00fcr med neg<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"ombudsman-reports\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"ombudsman-reports\"><\/textarea><\/span><\/label>\n<\/p>\n<h3>Beweise\n<\/h3>\n<p><em>Sind Arztberichte verf\u00fcgbar?<\/em>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"doctors-reports\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"doctors-reports\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"doctors-reports\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span><label><em>Fotos des Vorfalls\/der Verletzungen<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"incident-photos\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.pdf\" aria-invalid=\"false\" type=\"file\" name=\"incident-photos\" \/><\/span><\/label>\n<\/p>\n<p>Wenn die Dateiauswahl nicht verf\u00fcgbar ist, beachten Sie bitte, ob unten Fotos verf\u00fcgbar sind.\n<\/p>\n<p><label><em>Verf\u00fcgbare Fotos (ja\/nein) und Hinweis<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"photos-note\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"photos-note\"><\/textarea><\/span><\/label>\n<\/p>\n<h3>Zusatz\n<\/h3>\n<p><em>Sind Sie derzeit mit einem Anwalt zusammen?<\/em>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"currently-with-lawyer\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"currently-with-lawyer\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"currently-with-lawyer\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span><label><em>Aktuelle Probleme mit Anwaltskanzlei\/Anwalt<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"current-lawyer-issues\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"current-lawyer-issues\"><\/textarea><\/span><\/label><label><em>Wie fr\u00fchere Verletzungen Sie vor diesem Vorfall beeinflusst haben<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"previous-injuries-impact\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"previous-injuries-impact\"><\/textarea><\/span><\/label>\n<\/p>\n<h3>Verantwortung\n<\/h3>\n<p><label><em>Wie die Verletzung entstand<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"how-injury-occurred\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"how-injury-occurred\"><\/textarea><\/span><\/label>\n<\/p>\n<p><em>Typ der Haftung<\/em>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"liability-type\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"liability-type[]\" value=\"Medical negligence\" \/><span class=\"wpcf7-list-item-label\">Medizinisches Fehlverhalten<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"liability-type[]\" value=\"At Work\" \/><span class=\"wpcf7-list-item-label\">Auf dem Arbeitsplatz<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"liability-type[]\" value=\"Motor Vehicle\" \/><span class=\"wpcf7-list-item-label\">Kraftfahrzeug<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"liability-type[]\" value=\"Public Liability\" \/><span class=\"wpcf7-list-item-label\">Schadensersatzhaftung<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"liability-type[]\" value=\"Rental Property Injury\" \/><span class=\"wpcf7-list-item-label\">Sch\u00e4den an Mietobjekten<\/span><\/label><\/span><\/span><\/span><label><em>Weitere Antwort<\/em> <span class=\"wpcf7-form-control-wrap\" data-name=\"liability-further-answer\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"liability-further-answer\"><\/textarea><\/span><\/label>\n<\/p>\n<div class=\"ic-consent\" style=\"color:#222;\">\n\t<p class=\"ic-consent-notice\"><strong>Bevor Sie senden<\/strong>\n\t<\/p>\n\t<p>Injury Check Wir sind keine Anwaltskanzlei. Wir verwenden Ihre Daten, um zu pr\u00fcfen, ob Sie Anspruch auf eine Entsch\u00e4digung haben k\u00f6nnten, und, sofern Sie zustimmen, um diese an die von Ihnen gew\u00e4hlte Anwaltskanzlei zu \u00fcbermitteln, damit diese Sie kontaktieren kann. Einige unserer Dienstleister speichern Daten im Ausland, darunter in den Vereinigten Staaten. Sie k\u00f6nnen Ihre Daten jederzeit einsehen, korrigieren oder l\u00f6schen: <a href=\"mailto:info@injurycheck.info\">info@injurycheck.info<\/a>. <a href=\"https:\/\/www.injurycheck.info\/de\/privacy-policy\/\" target=\"_blank\" rel=\"noopener\">Lesen Sie unsere Datenschutzerkl\u00e4rung<\/a>\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"consent-health\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"consent-health\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">Ich stimme der Injury Check Erhebung meiner Verletzungs- und Gesundheitsinformationen sowie aller von mir bereitgestellten Fotos oder Dokumente zu, um meine Forderung gem\u00e4\u00df den in der Datenschutzerkl\u00e4rung beschriebenen Verfahren zu pr\u00fcfen. <a href=\"https:\/\/www.injurycheck.info\/de\/privacy-policy\/\" target=\"_blank\" rel=\"noopener\">Datenschutzrichtlinie<\/a>.<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"consent-referral\"><span class=\"wpcf7-form-control wpcf7-acceptance optional\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"consent-referral\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">Ich stimme der Injury Check \u00dcbermittlung meiner Daten, einschlie\u00dflich meiner Gesundheitsinformationen und Fotos, an die von der Verletzten ausgew\u00e4hlte Anwaltskanzlei, damit diese mich kontaktieren kann.<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"referral_code\" \/>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Anfrage einreichen\" \/>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>\u0394<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"71\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<input type=\"hidden\" name=\"trp-form-language\" value=\"de\"\/><\/form>\n<\/div>\n<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Claims Initial Enquiry We\u2019ll get answers within 24 hours. Fill in all the details you are comfortable with. Only your name, phone and email are required. The more information you provide, the quicker we can assess whether you have a claim for compensation. Client Details Full Name (required) DOI (Date of Incident) DOB Address Phone [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_acf_changed":false,"content-type":"","footnotes":""},"class_list":["post-1686","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.injurycheck.info\/de\/wp-json\/wp\/v2\/pages\/1686","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.injurycheck.info\/de\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.injurycheck.info\/de\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.injurycheck.info\/de\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.injurycheck.info\/de\/wp-json\/wp\/v2\/comments?post=1686"}],"version-history":[{"count":10,"href":"https:\/\/www.injurycheck.info\/de\/wp-json\/wp\/v2\/pages\/1686\/revisions"}],"predecessor-version":[{"id":1837,"href":"https:\/\/www.injurycheck.info\/de\/wp-json\/wp\/v2\/pages\/1686\/revisions\/1837"}],"wp:attachment":[{"href":"https:\/\/www.injurycheck.info\/de\/wp-json\/wp\/v2\/media?parent=1686"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}