Tell us about your case

Yes No
work injury
car accident
medical facility
other/not applicable

We Will Call You As Soon As Possible

Experienced, Dedicated, Trial Attorneys

When you have been injured and can't work because of your injuries, don't wait until you have been denied benefits or compensation before consulting with an attorney. If your right to benefits or compensation is being challenged, it's time to act. Call the Philadelphia disability and workers' compensation attorneys at Fenner & Boles, LLC. We can help.

1515 Market Street, #1510
Philadelphia, Pennsylvania

Two Bala Plaza, Suite 300
Bala Cynwyd, PA 19004

Toll-Free: (866) 586-9830
Phone: (215) 268-7816
Fax: (215) 827-5616

Contact Us

First Name:   
*Last Name:   
Address:   
City:   
State:   
Zip:   
Home Phone:   
Work Phone:   
*E-mail Address:   
 
What time of day would you like us to call?
  No Preference
Daytime
Evening
 

I. General Incident Information
Date you were injured.
 
City and state incident occurred.
 
Briefly explain events that caused your injuries.
 
Briefly describe your injuries.
 
Are any of those injuries permanent?
  Yes   No
Are any of the injuries substantiated by diagnostic tests, and if so, which tests?
 
Who do you believe was at fault in causing your injury, and what do you believe they did wrong? [Note: We may be able to help you even if you cannot answer this question at the present time; however, your input will help us.]
 
If you were involved in an automobile accident, were you covered by an insurance policy?
  Yes   No
If you were covered by an insurance policy, did you elect full tort or limited tort coverage?
 
 

II. Employment and Earnings
Were you employed at the time of the incident?
  Yes   No
What was your employment at the time of the incident?
 
Did the incident occur at work?
  Yes   No
Have you lost any earnings due to your injuries?
  Yes   No
Are you still out of work from your injuries?
  Yes   No
Before your injury, what was your monthly gross income?
 
 

III. Legal and Insurance Issues
Have you contacted any other lawyer about your potential claim?
  Yes   No
If you contacted another lawyer, did the lawyer agree to represent you?
  Yes   No
If you contacted another lawyer, is that lawyer currently representing you?
  Yes   No
If the lawyer is not currently representing you, please tell us the circumstances under which your relationship with that lawyer terminated.
 
Have you negotiated with any insurance company or any other person in connection with this claim?
  Yes   No
If you answered yes to the previous question, are negotiations still ongoing?
  Yes   No
 

IV. Legal Disclaimer
I agree that by submitting this information for evaluation, I will not be charged for the initial response. I further understand and agree that the above does not constitute a request for legal advice and that I am not forming an attorney-client relationship by submitting this information for evaluation. I understand that I may only retain an attorney by entering into a fee agreement, and that I am not hereby entering into a fee agreement. Since this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter.