Crash Evaluator

Did the accident occur within the last six months?

 Yes    No   

How much damage was done to your car?

 Less than $1,000    Greater than $1,000   

Did the police file a report?

 Yes    No   

Were you on the job at the time of the accident?

 Yes    No   

Was a government vehicle involved (e.g., bus, police, military)?

 Yes    No   

Are you receiving any public benefits (e.g., SSI, SSD, Medicaid, Medicare)?

 Yes    No   

Did the person at fault have insurance?

 Yes    No   

When did you first see a medical professional for treatment (e.g., doctor, chiropractor, therapist, etc.)?

 Never    Within 2 weeks    After more than 2 weeks   

Were you treated by a professional for longer than 4 months?

 Yes    No   

While receiving treatment, did you ever go longer than 30 days between appointments?

 Yes    No   

Did you suffer any injuries other than neck or back whiplash as a result of your accident (e.g., surgery, broken bones, scaring, disc complications, numbness, etc.)?

 Yes    No