fbpx
Pre-stage

Expertpays is ready for your request

This application is secure and any confidential information will remain confidential. We only use case information for underwriting purposes.

Please fill out this form completely. If you submit an incomplete form we will have to obtain the missing information from you before approving your funding request.

Attorney contact

Enter attorney contacts. This action will automatically save your data.

Attorney contact

Enter attorney contacts. This action will automatically save your data.

Attorney name James
email jamesgorn@gmail.com
phone number +1-541-754-3010

Attorney contact

Enter attorney contacts. This action will automatically save your data.

Attorney name James
email jamesgorn@gmail.com
phone number +1-541-754-3010

How did you hear about us?

Expert report type

Lorem ipsum dolor sit amet, consectetur adipiscing elit.

Please select the expert report you are looking for

Standard Medical Cost Projection
Complex Medical Cost Projection
Non-Catastrophic Life Care Plan
Catastrophic Life Care Plan
Vocational Assessment
Economist Report for either a life care plan or a vocational assessment (separate field) 4750
Economist report for both a vocational assessment and a life care plan (7500)
Records Retrieval Services
Nursing Home Case Services
Medical Chronology / Narrative Summary
Medical Standard of Care Report
Accident Reconstruction Report

Already have an Expert?

Tell us about your client

Enter client’s contacts. This action will automatically save your data.

Tell us about your client

Enter client’s contacts. This action will automatically save your data.

Client name James
DOB 03.15.1984
DOL 01.05.2010

Tell us about your client

Enter client’s contacts. This action will automatically save your data.

Client name James
DOB 03.15.1984
DOL 01.05.2010

Client language

Tell us about your client

Enter client’s contacts. This action will automatically save your data.

Client name James
DOB 03.15.1984
DOL 01.05.2010

Expert report is due

Has the adverse accepted liability?

Tell us about your client

Enter client’s contacts. This action will automatically save your data.

Client name James
DOB 03.15.1984
DOL 01.05.2010

Case status

Tell us about your client

Enter client’s contacts. This action will automatically save your data.

Client name James
DOB 03.15.1984
DOL 01.05.2010

Select all that apply

Tell us about your client

Enter client’s contacts. This action will automatically save your data.

Client name James
DOB 03.15.1984
DOL 01.05.2010

Is the plaintiff still receiving treatment?

Is future surgery recommended for the plaintiff?

Tell us about your client

Enter client’s contacts. This action will automatically save your data.

Client name James
DOB 03.15.1984
DOL 01.05.2010

Provide the Adverse insurance carrier’s information:

Tell us about your client

Enter client’s contacts. This action will automatically save your data.

Client name James
DOB 03.15.1984
DOL 01.05.2010

Is there any Additional coverage?

Case type

Enter client’s contacts. This action will automatically save your data.

Choose one:

Motor vehicle accident (MVA)
Medical Malpractice
Work related injury
Premises liability
Nursing Home
Product defect
Other

MVA prompt

Enter client’s contacts. This action will automatically save your data.

Select all that apply

Additional info about MVA prompt case type

Enter client’s contacts. This action will automatically save your data.

Plaintiff was not the driver:

Plaintiff was not rear-ended:

Plaintiff’s vehicle was not severely damaged:

Repair estimate of the property damage:

OR

Photos of the crash:

Premises Liability

Enter client’s contacts. This action will automatically save your data.

Select all that apply

Additional info about Premises Liability case type

Enter client’s contacts. This action will automatically save your data.

This is not a slip and fall, choose one:

Attach incident or police report:

Attach photos or video of the accident:

Complaint:

Product defect

Enter client’s contacts. This action will automatically save your data.

Select all that apply

Nursing Home Care

Enter client’s contacts. This action will automatically save your data.

Select all that apply

Additional info about Nursing Home Care case type

Enter client’s contacts. This action will automatically save your data.

Date of death

Drop the file of expert report(s) in those cases:

Med Mal

Enter client’s contacts. This action will automatically save your data.

Select all that apply

Additional info about Med Mal case type

Enter client’s contacts. This action will automatically save your data.

Attach Expert written opinion on standard of care