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Uninsured Motorist Coverage Case Form

 

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Uninsured Mororist Coverage


Did my insurance carrier handle my claim properly?


How much is my case worth?


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Were you told by your insurance company that "you should not contact an attorney?" Are you unhappy with the settlement amount that your insurance company gave you? Even if you already settled your case, you may be entitled to bring a claim against your insurance carrier if they gave you bad advice. In fact, if you settled with your own insurance company, without consulting an attorney we want to know why?


PERSONAL INFORMATION


First Name:
Last Name:
E-mail Address:
Address:
City:
State:
Zipcode:
Phone: () - ext.

INSURANCE CARRIER INFORMATION


State Farm
Nationwide
Allstate
GEICO
Other Insurance Carrier
Name of Carrier:
  • Were you told by the insurance company not to contact an attorney?
  • If the insurance company told you not to contact us, let us know, as your rights may have been violated.
  • Even if you already settled your case, you may be entitled to bring a claim.
  • In fact, if you settled with your own insurance company, without consulting an attorney we want to know why?
Please describe what the adjuster said to you about using an attorney:

CASE INFORMATION


Date of Accident:
City Incident Occurred:
State Incident Occurred:
Roadway or Intersection:
Describe What happened:
Doctors or Physicians Involved:
Hospital Involved:
Who was the driver of your vehicle:
Who was/were the passenger(s) in your vehicle:
Name(s) Injured Party(ies):
Witness Names and Contact information:
Was a Ticket issued?
Yes
No
Please describe:

ADDITIONAL COMMENTS


Additional Comments:
Please Describe Your Current Situation:
Philadelphia Lawyers - Pennsylvania Lawsuits at Monheit Law

Law Offices of Michael Monheit 1368 Barrowdale Road  Rydal, PA  19046
Call Us Toll Free: 866-761-1385  P: 215-840-6573  E: Michael@Monheit.com