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Helpline: 0845 094 0863

Make a claim online by Registering Your Case

If you've had an accident in a car, as a driver or a passenger, slipped or tripped whilst out and about, suffered an injury at work, or been involved in any other accident that has caused injury, you may be entitled to compensation.
Finding out couldn't be easier. Simply fill in and submit the claim form below, or print out our Freepost Claim Form, give us a call on 0845 094 0863
or request a call back.

We will assess the information provided, and estimate the likelihood of your case being successful - completely free of charge and without obligation.
When completing the form below you need to complete the fields marked with an asterisk (*) whilst all the other additional information you can provide will help us to assess your case more quickly.

Personal Details
Title
First Name(s)*
Surname*
Date of Birth*
Full Address*
(inc. Postcode)
Email Address
Telephone* Home*   Work  
Incident Details
Type of Accident*
Date of Accident*
Please give a brief description of your accident, including the location:*
Extent of Injuries
Please give a description of the injuries you sustained due to the accident:*
Did you see your GP?
Did you attend hospital?
Other Relevant Information

Were there any witnesses to your accident?   

Please state below the best time to contact you, and by which method.

Please use this box for any other comments or questions you may have:

The information submitted on this form will be treated with strict confidentiality. It will not be used for any purpose other than assessing your claim for injury compensation.