Accidental Injury Claims Questionnaire 2026

1. Click ‘Get Form’ to open the Accidental Injury Claims Questionnaire in the editor.
2. Begin by entering your name and ID number at the top of the form. Ensure that all information is accurate for processing.
3. In Section 1, indicate whether you are seeking payment from another party involved in your injury. If yes, provide details about your attorney if applicable.
4. If you are still under medical care, fill in the treating physician's information as requested. Include their name, address, and phone number.
5. For motor vehicle accidents, complete Section 2 by providing a police report and answering questions about the accident's time and location.
6. List all vehicles involved along with their insurance details. Attach any necessary documentation such as insurance coverage limitations.
7. In Section 3, confirm if you were working during the accident and provide additional details if not related to a vehicle accident in Section 4.
8. Finally, review all sections for completeness before submitting your questionnaire along with any supporting documents to the specified address.

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