Work Comp Chicago
Chicago Workers Compensation Attorneys
Contact Our Office for  assistance:   (312) 541-0049
Contact Information

Please supply any important information necessary to answer questions. 

We will reply as soon as possible by phone or email.

All information is strictly confidential.  Our Privacy Policy is in effect.  No information provided in this form is shared outside of our office in any manner.

Contact information provided will not form an attorney-client relationship.  We do not undertake legal representation without a specific signed written representation agreement or acknowledgment letter.

We will respond as promptly as possible if available but usually no more than 24 hours.


First Name:
Last Name:

Accident City location:
Employer:

Date of Accident:
Part of body injured ?
Was surgery involved ?

Are you receiving benefits ?

Street Address:
City:
Zip code:

              
Daytime Phone:
Cell Phone:
How did your accident Occur ?
Email address:
Enter information and questions here::



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