Were you severely injured by a commercial or semi-truck?Step 1 of 7

Yes

No

What is the date of the accident?

Did you receive medical treatment? Step 2 of 7

Yes

No

What kind of injuries were sustained?Step 3 of 7

Please SelectWhiplashLost limbBrain injuryBroken bonesSpinal cord injury or paralysisLoss of lifeOther

Was a police report filed? Step 5 of 7

Yes

No

Was the accident your fault or were you issued a ticket for the accident?

No

Yes

Is an attorney helping you with your claim or has an attorney already rejected your claim?Step 7 of 7

No

Yes

Zip Code where the injury occurred

State where the injury occurred

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StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
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