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Pre-stage 1 of 10 in this 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.

Firm contact

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How did you hear about us?

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Death case?

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Client name James
DOB 03.15.1984
DOL 01.05.2010

Client language

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Client name James
DOB 03.15.1984
DOL 01.05.2010

Tell us about your client & case

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Client name James
DOB 03.15.1984
DOL 01.05.2010

Case status

Attach complaint

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Has the adverse party accepted liability?

Provide the at fault party's insurance carrier’s information:

Plaintiff still treating

Future Surgery Recommended?

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Client name James
DOB 03.15.1984
DOL 01.05.2010

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Settlement Offers

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Client name James
DOB 03.15.1984
DOL 01.05.2010

Is there any additional coverage?

Case type

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Choose one:

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

MVA prompt

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Additional info about MVA prompt case type

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Plaintiff was not the driver:

Plaintiff was not rear-ended:

Plaintiff’s vehicle was not severely damaged:

Repair estimate of the property damage:

OR

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Photos of the crash:

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Premises Liability

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Additional info about Premises Liability case type

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This is not a slip and fall, choose one:

After injury went to

Attach incident or police report:

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Attach photos or video of the accident:

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Complaint:

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Product defect

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Product defect expert report:

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Nursing Home Care

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Additional info about Nursing Home Care case type

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

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Med Mal

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Additional info about Med Mal case type

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Attach Expert written opinion on standard of care

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Vocational Assessment

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Vocational Assessment

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Expert report type

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
Economist report for both a vocational assessment and a life care plan
Records Retrieval Services
Nursing Home Case Services
Medical Chronology / Narrative Summary
Medical Standard of Care Report
Accident Reconstruction Report
DTI brain imaging
Medical causation report
Already have an Expert?

Expert report is due

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Optional fields

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