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Where Did your Accident Occur? QueenslandAnother State
What is the nature of your accident? Car/Road AccidentWorkplace AccidentOther Accidents
Have you received an offer of lump sum compensation in a Notice of Assessment? YesNo
Did you accept the offer of lump sum compensation? YesNo
Did your accident occur in the last 3 years? YesNo
Please enter the date of your accident
Was there someone else to blame for your accident?For example, another vehicle hitting you from behind, instructed by an employer to undertake an unsafe task, slipping on milk in a supermarket. YesNo
Please select the box which best describes the nature of your injuries? MinorMediumMajor
Were you employed at the time of the accident? YesNo
Are you still Employed? YesNo
Will you lose income in the future due to your injuries?For example, do you anticipate reducing your work hours, looking for alternative employment or ceasing work for a period of time? YesNo
Have you required care and assistance for your injuries? YesNo
Are you incurring medical expenses? YesNo
$0-2000$2500-$5000more than $5000
Do you suffer from any pre-accident injuries/illnesses or disabilities? YesNo
MinorMediumMajor
What age group to you fit into?
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