Law Offices of Sandra H. Castro, Inc.

AGGRESSIVE ATTORNEY COMMITTED TO SERVICING YOUR LEGAL NEEDS.

Home

Employment Law

Personal Injury

Workers' Compensation

Driving Directions

Contact Us
Workers' Compensation
What are your rights?
  • Death Cases
  • Hearing Loss
  • Burns
  • Slip & Fall
  • Medical Treatment
  • Disability Pay
  • Toxic Exposure
  • All work-related injuries
If you have been injured in the job and your questions are not being answered, or you are not receiving benefits, it is time to seek legal representation. We will fight to make sure you are adequately compensated. NO RECOVERY-NO FEE. Call the Law Offices of Sandra H. Castro today.
Workers' Compensation Questionnaire
PLEASE READ:

By completing and submitting this form you acknowledge and agree that there is NO attorney/client relationship between you and the Law Offices of Sandra H. Castro, Inc. The Law Offices of Sandra H. Castro will NOT take any action in your behalf until you sign a written retainer agreement. No analysis is made by the Law Offices of Sandra H. Castro as to any applicable statute of limitation. Attorney is only licensed to practice law in the state of California.
First Name
Last Name
Address Line 1
City
State
Zip Code
Daytime Phone() -
Evening Phone() -
E-mail Address
Name of your employer at the time of your injury?
Address of your employer?
Telephone number?() -
When did you sustain an injury, or disease as a result of your occupation?
Describe how it occurred.
Describe the parts of your body injured.
Have you received medical treatement?
Who referred you to the provider?
Provide the name and address of the provider.
Are you currently represented by an attorney?
If yes, provide the name and address.
Do you wish to change attorneys?
Have you ever filed a claim for Workers' Compensation?
If so, list all claims filed and the outcome.
Have you ever injured the body parts you are claiming here prior to your work injury?
If yes, describe in detail when, what treatment you received and the names and addresses of where you were treated.
Who is your employer's carrier for Workers' Compensation benefits/insurance company? Please provide name, address, telephone number, and adjusters name.
Have you ever filed a claim with any Workers' Compensation Appeals Board for this claim?
if so, where did you file the claim and what case number were you assigned?
Has your deposition (a question and answer process) taken place regarding this claim?
Have you ever been convicted of a felony?
Making a false or fraudulent Workers' Compensation claims is a felony subject to up to 5 years in prison or a fine of up to $50,000 or double the value of that fraud whichever is greater, or both inprisonment & fine.