Tell us about your injuries. We are here to help.

Tell us about your injuries. Please move the cursor to the individual subject areas and complete the information required. Provide as much information as you can. The form will expand to accommodate your requirements. You will have a preliminary response from us in 24 hours or less.

Required Fields are indicated by an asterisk (*)
Mr. Mrs. Ms
Name *
Address
City *
Postal Code
Phone *
E-mail Address
Age
Referred by:
Names of Parties Involved:
When did your injury occur? (Notice of claim must be provided to the Defendant within 120 days of the incident; to own insurer within 7 days)
How was the injury caused? Provide as much detail as you can. Include your view with respect to who is at fault.
What is the nature of your injuries?
Be as detailed as possible. 
Have you returned to work? Yes No
If so, when?
What kind of work do you do?
What is your annual income?
What continuing problems are you experiencing?
Have you applied for accident benefits?
For other benefits?
What accident benefits have you received to date?
What other benefits have you received to date?
What is the shortfall there between your income and benefits paid?
What is your insurer's name?
What evidence do you have of your income from all sources for the year preceding the incident?
What medical reports do you have? In the event that we agree to represent you we will require every medical report obtained as a result of this incident.
Can you provide a list of the names, addresses and telephone numbers of all hospitals, doctors, etc., who have treated you as a result of this incident?
Do you have a police report? Yes No
If a death was involved and an autopsy performed, provide the date and place of the autopsy and the name, address and telephone number of the doctor who performed the autopsy.
Additional Comments

Thank you! 

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If you have faced a tragic injury or loss, you will have many questions. At first, it’s a matter of timely direction. Where do you begin? Do you have a claim? How fast must you act? Later, it may be help navigating through the complex maze of accident benefits to get interim benefits. Our clients speak of our unwavering commitment, our constant support. Someone
is always available to offer
advice, encouragement, and words of wisdom.

    

“From returning my calls, informing me at all times, and their compassion, I no longer feel that intimidation. I felt supported and important. I want to thank Jim and his team at Oatley, Vigmond, and recommend them without a doubt!”

Joanne Robitaille