Wrongful Death Claim

We are willing to evaluate your potential wrongful death case and discuss its merits and value with you. There is no charge for our preliminary evaluation and discussion, but we do need certain information from you to perform our evaluation. Once we receive the information requested below, we will contact you to discuss our evaluation. Again, there is no cost to you whatsoever for this case evaluation.

If you are interested in receiving help on your potential wrongful death claim, please provide us with the information requested below. Please be sure to provide us with as much information as is reasonably available. The quality of our evaluation is dependent upon the accuracy of the information you provide to us.

Your full name:

E-mail Address:
(Required)

Mailing Address:

Home Number:

Work Number:

Best time to reach you if you prefer a response by telephone:

How would you like for us to respond to you (e.g., telephone, e-mail, regular mail, doesn't matter)?

What is the name of the person killed:

What was his or her age at death?

How are you related to this person?

Has probate begun or an estate been opened and, if so, who is the personal representative of the estate?

What are the names, ages, and relationships of the deceased's nearest relatives (spouse, children, parent, etc.)?

Describe the accident which caused the death as fully as possible:

Who do you believe was at fault in causing the death and what do you believe they did wrong that would make them responsible?

Was the deceased person working before the accident which caused his or her death and, if so, how was the person employed and approximately how much did they earn per year.

Was the deceased person contributing to the support of, or providing any special services to any other person during the year before he or she died and, if so, what is the name and relationship to the decedent?

Are there any other ways in which you or any other family members or persons close to the decedent have been damaged or harmed by the death?

Have you contacted any other lawyer about your potential claim and, if so:

Did the lawyer agree to represent you?
Are you still being represented by the lawyer?
Are you now seeking a lawyer to represent you, or are you just looking for a second opinion?
Do you owe any other lawyer a fee in this matter?
If we are willing to represent you, do you wish to employ us?

Have you negotiated with any insurance company or any other person in connection with this claim and, if so:

Are negotiations still ongoing?
What was the lowest settlement amount that you asked for?
What was the highest amount that you have been offered to settle?
Have the medical or funeral bills or lost wages been paid for by:
Workers Compensation?
Medicare, medicaid, or some other government program?
Employer's health plan?
Private insurance?
Are there any other questions you wish answered?
Is there any other information that you want to provide us?
Would you like to arrange a personal interview?
Are there any other instructions you wish to give us?

If you are finished, agree with the above, and want to send this information by e-mail:

If you want to start over to correct or change information:

Final Instructions

INTERNET SECURITY: Sending information over the internet is not always a secure way to send information. While we will keep the information you send us over the internet CONFIDENTIAL once it is received in our office, we cannot be assured that it will be secure while being transmitted to our office.

THE SERVICE WE PROVIDE: When we receive the information you have provided, we will evaluate the information and then contact you by telephone or by mail at the address and phone number you have given us to tell you:

a. Our preliminary evaluation of the merits of your case
b. Whether we would be willing to represent you.

Obviously, the information you have sent us may not be sufficient to provide full answers to the above matters. If more information is needed, we will contact you to obtain the necessary additional information before we give you our evaluation of your potential claim.

We will try to be in touch with you by mail, telephone, or e-mail within a short time. We are an active law firm with many trials, however, and on occasion the requirements of providing service to our clients may cause us to delay answering you inquiry. If you do not hear from us in a reasonable time, don't hesitate to call. Under most circumstances, you should expect to hear from us within two days of our receipt of your inquiry.

LIMITATIONS ON OUR SERVICE:

1. The advice we provide is obviously limited by the information you provide to us. Final advice would be based upon a complete evaluation of your entire case. This cannot be accomplished with the limited information you have given us above. Often a full evaluation of a claim cannot be given without collecting considerable information, records, and other investigation. Often a decision about a claim can only be made after a personal interview.

2. Your claim may be barred by the Statutes of Limitations. These statutes provide that if a suit is not brought within a certain amount of time, the claim can never be thereafter brought. Likewise, the information you furnish may be furnished at a time so close to expiration of the statute of limitations that we do not have time to provide any help to you before the time expires. By asking for our help, you agree that we are not liable for failing to file suit on your behalf or failing to take any other action on your behalf.

3. You are not obligated to employ this firm by sending this information. Likewise, we are not obligated to accept you as a client by providing this help to you. We reserve the right to decline to represent you for any reason whatsoever. Once we have provided the limited service mentioned above, we reserve the right to refuse to become involved in further evaluation of your claim or in providing further advice. If we decline to represent you, or to provide additional advice, we will so advice you in writing at the address you have given us.

ADDITIONAL SERVICES: We are available to provide additional advice and services upon written or telephoned request unless we advice you of our decision not to do so as outlined above.

Wrongful Death Claim

Wrongful Death Claim : Henry & McCord Tullahoma, Tennessee

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	300 North Jackson Street Tullahoma, Tennessee 37388 Service, Tradition and Experience^SM 1-888-461-4LAW
Henry, McCord, Bean, Miller, Gabriel & LaBar, P.L.L.C
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Wrongful Death Claim We are willing to evaluate your potential wrongful death case and discuss its merits and value with you. There is no charge for our preliminary evaluation and discussion, but we do need certain information from you to perform our evaluation. Once we receive the information requested below, we will contact you to discuss our evaluation. Again, there is no cost to you whatsoever for this case evaluation. If you are interested in receiving help on your potential wrongful death claim, please provide us with the information requested below. Please be sure to provide us with as much information as is reasonably available. The quality of our evaluation is dependent upon the accuracy of the information you provide to us. Your full name: E-mail Address: (Required) Mailing Address: Home Number: Work Number: Best time to reach you if you prefer a response by telephone: How would you like for us to respond to you (e.g., telephone, e-mail, regular mail, doesn't matter)? What is the name of the person killed: What was his or her age at death? How are you related to this person? Has probate begun or an estate been opened and, if so, who is the personal representative of the estate? What are the names, ages, and relationships of the deceased's nearest relatives (spouse, children, parent, etc.)? Describe the accident which caused the death as fully as possible: Who do you believe was at fault in causing the death and what do you believe they did wrong that would make them responsible? Was the deceased person working before the accident which caused his or her death and, if so, how was the person employed and approximately how much did they earn per year. Was the deceased person contributing to the support of, or providing any special services to any other person during the year before he or she died and, if so, what is the name and relationship to the decedent? Are there any other ways in which you or any other family members or persons close to the decedent have been damaged or harmed by the death? Have you contacted any other lawyer about your potential claim and, if so: Did the lawyer agree to represent you? Are you still being represented by the lawyer? Are you now seeking a lawyer to represent you, or are you just looking for a second opinion? Do you owe any other lawyer a fee in this matter? If we are willing to represent you, do you wish to employ us? Have you negotiated with any insurance company or any other person in connection with this claim and, if so: Are negotiations still ongoing? What was the lowest settlement amount that you asked for? What was the highest amount that you have been offered to settle? Have the medical or funeral bills or lost wages been paid for by: Workers Compensation? Medicare, medicaid, or some other government program? Employer's health plan? Private insurance? Are there any other questions you wish answered? Is there any other information that you want to provide us? Would you like to arrange a personal interview? Are there any other instructions you wish to give us? If you are finished, agree with the above, and want to send this information by e-mail: If you want to start over to correct or change information: Final Instructions INTERNET SECURITY: Sending information over the internet is not always a secure way to send information. While we will keep the information you send us over the internet CONFIDENTIAL once it is received in our office, we cannot be assured that it will be secure while being transmitted to our office. THE SERVICE WE PROVIDE: When we receive the information you have provided, we will evaluate the information and then contact you by telephone or by mail at the address and phone number you have given us to tell you: a. Our preliminary evaluation of the merits of your case b. Whether we would be willing to represent you. Obviously, the information you have sent us may not be sufficient to provide full answers to the above matters. If more information is needed, we will contact you to obtain the necessary additional information before we give you our evaluation of your potential claim. We will try to be in touch with you by mail, telephone, or e-mail within a short time. We are an active law firm with many trials, however, and on occasion the requirements of providing service to our clients may cause us to delay answering you inquiry. If you do not hear from us in a reasonable time, don't hesitate to call. Under most circumstances, you should expect to hear from us within two days of our receipt of your inquiry. LIMITATIONS ON OUR SERVICE: 1. The advice we provide is obviously limited by the information you provide to us. Final advice would be based upon a complete evaluation of your entire case. This cannot be accomplished with the limited information you have given us above. Often a full evaluation of a claim cannot be given without collecting considerable information, records, and other investigation. Often a decision about a claim can only be made after a personal interview. 2. Your claim may be barred by the Statutes of Limitations. These statutes provide that if a suit is not brought within a certain amount of time, the claim can never be thereafter brought. Likewise, the information you furnish may be furnished at a time so close to expiration of the statute of limitations that we do not have time to provide any help to you before the time expires. By asking for our help, you agree that we are not liable for failing to file suit on your behalf or failing to take any other action on your behalf. 3. You are not obligated to employ this firm by sending this information. Likewise, we are not obligated to accept you as a client by providing this help to you. We reserve the right to decline to represent you for any reason whatsoever. Once we have provided the limited service mentioned above, we reserve the right to refuse to become involved in further evaluation of your claim or in providing further advice. If we decline to represent you, or to provide additional advice, we will so advice you in writing at the address you have given us. ADDITIONAL SERVICES: We are available to provide additional advice and services upon written or telephoned request unless we advice you of our decision not to do so as outlined above.