1
Basic Injury Details

2
What Body Parts Were Injured?

Shoulder
Back
Hip
Brain
Arm
Leg
Heart
Mandible
Nasal Passage
Hearing
Sternum
Stomach
Hand
Thumb
1st/Index Finger
2nd/Middle Finger
3rd/Ring Finger
4th/Little Finger
Big Toe
Other Toes
Foot
Rib
Eye
Other

3
Your Personal Information



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*CALCULATION IS FOR ESTIMATION PURPOSES ONLY

YOUR FINAL AWARD IS SUBJECT TO YOUR IMPAIRMENT RATING TO EACH SCHEDULED BODY PART FROM YOUR AUTHORIZED TREATING PHYSICIAN & POTENTIAL SECOND OPINIONS and/or INDEPENDENT MEDICAL EVALUATIONS, LOSS OF USE OF BODY PARTS, SPECIFIC JOB DUTIES, EMPLOYMENT HISTORY, FINAL DISABILITY DETERMINATION & OTHER FACTORS. WE UNDERSTAND THE FACTORS THAT CAN INCREASE and/or DECREASE THE VALUE OF YOUR WORKERS’ COMPENSATION CLAIM.

Information on this website is not legal advice. Reviewing the information on this website does not create an attorney-client relationship with the law firm. Please understand that no attorney can ethically guarantee a result in any case. The content of this webpage, including any settlement chart or payout chart, should not create any expectation that our firm will obtain similar results in your case. Your case has its own unique set of facts and circumstances.

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