{"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\/es\/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=\"\/es\/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>Reclamaciones: Investigaci\u00f3n inicial<\/strong>\n<\/p>\n<p>Recibiremos respuestas dentro de las 24 horas.\n<\/p>\n<p>Complete todos los datos que considere adecuados. Solo se requieren su nombre, tel\u00e9fono y correo electr\u00f3nico. Cuanto m\u00e1s informaci\u00f3n proporcione, m\u00e1s r\u00e1pido podremos evaluar si tiene derecho a una indemnizaci\u00f3n.\n<\/p>\n<h3>Datos del cliente\n<\/h3>\n<p><label><em>Nombre completo<\/em> (obligatorio) <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 (Fecha del incidente)<\/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>Fecha de nacimiento<\/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>Direcci\u00f3n<\/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>Tel\u00e9fono<\/em> (obligatorio) <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>Correo electr\u00f3nico<\/em> (obligatorio) <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>Empleador en el momento<\/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>Empleado como<\/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>Lesiones<\/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>Lesiones anteriores<\/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>M\u00e9dico\n<\/h3>\n<p><label><em>M\u00e9dicos<\/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>Fisioterapeutas<\/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>Especialistas<\/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 si corresponde\n<\/h3>\n<p><label><em>Fondo de inversi\u00f3n<\/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>Importo de TPD<\/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>N\u00famero de la pol\u00edtica<\/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>N\u00famero de informe policial<\/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>Tipo de colisi\u00f3n<\/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\">Veh\u00edculo contra veh\u00edculo\/Motocicleta<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"mva-type[]\" value=\"vs Bicycle\" \/><span class=\"wpcf7-list-item-label\">Contra la bicicleta<\/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\">Contra un peat\u00f3n<\/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 N\u00famero de la reclamaci\u00f3n<\/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>Informes del Ombudsman sobre 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>Evidencias\n<\/h3>\n<p><em>\u00bfHay informes m\u00e9dicos disponibles?<\/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\">S\u00ed<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"doctors-reports\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span><label><em>Fotos del incidente y de las lesiones<\/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>Si la opci\u00f3n de subir archivos no est\u00e1 disponible, por favor, indique si las fotos est\u00e1n disponibles debajo.\n<\/p>\n<p><label><em>Se proporcionan fotos (s\u00ed\/no) y nota<\/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>Adicional\n<\/h3>\n<p><em>\u00bfEst\u00e1 actualmente con un abogado?<\/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\">S\u00ed<\/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\">No<\/span><\/label><\/span><\/span><\/span><label><em>Problemas actuales con el bufete de abogados\/el abogado<\/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>C\u00f3mo te afectaron los traumatismos anteriores antes de este incidente<\/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>Responsabilidad\n<\/h3>\n<p><label><em>C\u00f3mo se produjo la lesi\u00f3n<\/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>Tipo de responsabilidad<\/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\">Negligencia m\u00e9dica<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"liability-type[]\" value=\"At Work\" \/><span class=\"wpcf7-list-item-label\">En el trabajo<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"liability-type[]\" value=\"Motor Vehicle\" \/><span class=\"wpcf7-list-item-label\">Veh\u00edculos de motor<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"liability-type[]\" value=\"Public Liability\" \/><span class=\"wpcf7-list-item-label\">Responsabilidad civil<\/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\">Da\u00f1os en propiedades de alquiler<\/span><\/label><\/span><\/span><\/span><label><em>M\u00e1s respuesta<\/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>Antes de enviar<\/strong>\n\t<\/p>\n\t<p>Injury Check No somos un bufete de abogados. Utilizamos sus datos para comprobar si tiene derecho a una indemnizaci\u00f3n y, si est\u00e1 de acuerdo, para envi\u00e1rsela al bufete de abogados que elija para que pueda contactarlo. Algunos de nuestros proveedores de servicios almacenan datos en el extranjero, incluido Estados Unidos. Puede acceder a sus datos, corregirlos o eliminarlos en cualquier momento: <a href=\"mailto:info@injurycheck.info\">info@injurycheck.info<\/a>. <a href=\"https:\/\/www.injurycheck.info\/es\/privacy-policy\/\" target=\"_blank\" rel=\"noopener\">Lea nuestra Pol\u00edtica de privacidad<\/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\">Estoy de acuerdo con que Injury Check recopilen mi informaci\u00f3n sobre lesiones y salud, as\u00ed como cualquier fotograf\u00eda o documento que proporcione, para verificar mi reclamo, seg\u00fan lo descrito en el apartado <a href=\"https:\/\/www.injurycheck.info\/es\/privacy-policy\/\" target=\"_blank\" rel=\"noopener\">Pol\u00edtica de privacidad<\/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\">Estoy de acuerdo en Injury Check enviar mis datos, incluyendo informaci\u00f3n m\u00e9dica y fotograf\u00edas, a la firma de abogados elegida por la persona lesionada para que pueda contactarme.<\/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=\"Presentar consulta\" \/>\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=\"es\"\/><\/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\/es\/wp-json\/wp\/v2\/pages\/1686","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.injurycheck.info\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.injurycheck.info\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.injurycheck.info\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.injurycheck.info\/es\/wp-json\/wp\/v2\/comments?post=1686"}],"version-history":[{"count":10,"href":"https:\/\/www.injurycheck.info\/es\/wp-json\/wp\/v2\/pages\/1686\/revisions"}],"predecessor-version":[{"id":1837,"href":"https:\/\/www.injurycheck.info\/es\/wp-json\/wp\/v2\/pages\/1686\/revisions\/1837"}],"wp:attachment":[{"href":"https:\/\/www.injurycheck.info\/es\/wp-json\/wp\/v2\/media?parent=1686"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}