Automobile Accident
Motorcycle Accident

Workers Compensation

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Medical Malpractice
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Head Injuries
Other Injuries
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The Legal Offices of David Grey

6100 Wilshire Blvd., Suite 1104

Los Angeles, CA 90048

(323) 857-9500

or

1-800-GREY-LAW

Worker's Compensation

Name:
Home Phone:
Work Phone:
Cell/Pager:
E-Mail Address:
Date of Accident (mm/dd/yyyy):
Name of your employer?
Are you still employed there?
Did you report your injury to your employer?
When?
Were you injured?
Please explain your accident and injuries?


Disclaimer and Notice: Making a false or fraudulent worker's compensation claim is a felony subject of up to 5 years or a fine of up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine. The materials on this website have been prepared for general information purposes only and do not constitute legal advice. Neither communication by you using this e-mail nor any response to you will establish an attorney-client relationship. In addition, it is important to note that you should not transmit confidential or sensitive information via e-mail.

                     

© 2003 Law Offices of David Grey
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