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Services request form

Please answer the following case information questions (5-10 minutes).
The form is quick, smart and inclusive, resulting in streamlined processing.
Our staff will get started right away!

Attorney Contact

How did you hear about ExpertPays (required)

Step 1

Client Contact

Employed
Case Type? (required)
Death Case
Date of Death
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Step 2

Expert Product Desired

Medical Cost Projection
Life Care Plan
Vocational Assessment/Economist Report
Records Retrieval
Functional Capacity Evaluation
Medical Chronology
Nursing Home Cases
Expert Type
Case experts
Specialty(s)
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Expert focus
Other

Step 3

Case Information

Report Due Date (required)
Liability Accepted? (required)
Settlement offers
Case Status (required)
Estimated Case Value (required)
Claim Summary (can be brief)
Insurance Coverage information

Step 4

General Medical

Injures?
Plaintiff Still treating
Total Medical Bills to Date:
Future Surgery Recommended?

Step 5

MVA Questions

Ambulance
After Injury went to:
Hospitalized?
Traffic Accident Report
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Air bag deployed
Number of claimants
Position
Type of MVA
Towed from scene
Damage to vehicle
Repair estimate for Property Damage
Photos of Crash
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Medical Malpractice Questions

Summary of breach of standard of care and resulting injury
Have you retained standard of care expert:
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State med mal cap?

Product Defect

Has this product had a successful claim against it for the same issue before?
Expert Report
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Is this part of a class action case?

Nursing Home Case

Have you filed a claim against this home in the past?
Successful
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State cap on nursing home case

Premises Liability Questions

Ambulance
After Injury went to:
Hospitalized?
Please choose type which best describes
Incident or police Report
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Photos or video of Incident
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If liability is being disputed please explain why you believe liability is solid.

Step 6

Vocational Questions

Can plaintiff perform pre-injury occupation
Annual salary before Injury
Wage loss claim?