Free Case Evaluation

Name*

Lastname*

Phone Number*
- -

Phone Type*
HomeMobile

Best time to be reached*

Email *

Employer's name *

Job Title*

Begining date (Month/Day/Year)*

Are you still working? *

Injury's short description *

Body parts injured *

Injury Reported? *
YesNo

Workers Compensation information *

Claim *
AcceptedDeclined

Medical Treatment received? *
YesNo

If the answer is Yes, Name and Specialty of the Doctor (1)

Situation
DischargedConsidered PermanentStationary

Name and Specialty of the Doctor (2)

Situation
DischargedConsidered PermanentStationary

Name and Specialty of the Doctor (3)

Situation
DischargedConsidered PermanentStationary

Name and Specialty of the Doctor (4)

Situation
TreatingReleased from doctorBack to work

Taking on Employers and Insurance Companies at Each Point in the Process

Our primary goal is to make you whole by obtaining compensation for your physical, emotional and financial setbacks. We achieve this goal by being extremely proactive and aggressive in handling your case. We review the pertinent facts and analyze your situation to determine the appropriate strategy moving forward. We make sure that you obtain the necessary medical treatment, coordinate your medical appointments and advise you in applying for any supplemental benefits for which you may be eligible, such as unemployment benefits, State Disability Insurance benefits, or Social Security benefits.

"I can honestly say that every attorney that works for our firm and goes up against Michael Burgis agrees that he fights for his clients and is very well respected."

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