Simple Assessment AXIDENTLAWYERS VALUE ASSESSMENT TOOL ARE YOU MALE OR FEMALE? MALE FEMALE None AGE: SEX & AGE WILL HAVE VARIOUS MULTIPLYERS FOR CERTAIN THINGS. LIKE FOR HIP FRACTURES AND OTHER BONE FRACTURES, HIGH AGE INCREASES RISK SO HIGHER MULTIPLYER. FOR COSMETIC INJURIES, FEMALE AND LOW AGE HIGHER MULTIPLYER. FOR ANY FUNCTIONAL DEFICIT, LOWER THE AGE, THE HIGHER THE MULTIPLYER AS THE LONGER THE PERSON HAS TO SUFFER THE LOSS. None WHAT STATE DID THE ACCIDENT OCCUR IN? SEX & AGE WILL HAVE VARIOUS MULTIPLYERS FOR CERTAIN THINGS. LIKE FOR HIP FRACTURES AND OTHER BONE FRACTURES, HIGH AGE INCREASES RISK SO HIGHER MULTIPLYER. FOR COSMETIC INJURIES, FEMALE AND LOW AGE HIGHER MULTIPLYER. FOR ANY FUNCTIONAL DEFICIT, LOWER THE AGE, THE HIGHER THE MULTIPLYER AS THE LONGER THE PERSON HAS TO SUFFER THE LOSS. Please select your answer Alaska Texas California Montana New Mexico Arizona Nevada Colorado Oregon Wyoming Michigan Minnesota Utah Idaho Kansas Nebraska South Dakota Washington North Dakota Oklahoma Missouri Florida Wisconsin Georgia Illinois Iowa New York North Carolina Arkansas Alabama Louisiana Mississippi Pennsylvania Ohio Virginia Tennessee Kentucky Indiana Maine South Carolina West Virginia Maryland Hawaii Massachusetts Vermont New Hampshire New Jersey Connecticut Delaware Rhode Island ARE YOU ENQUIRING ON YOUR OWN BEHALF OR SOMEONE ELSE’S BEHALF? MY OWN SOME ONE ELSE None IF SOMEONE ELSE, IS THAT PERSON RELATED TO YOU? YES NO None IF SOMEONE ELSE, DID THAT PERSON DIE AS A RESULT OF THE ACCIDENT? YES NO None IF YOUR OWN, WERE YOU INJURED IN THE ACCIDENT? YES NO None WERE THERE ANY WITNESSES? YES NO None WERE PARAMEDICS CALLED? YES NO None WAS THE POLICE CALLED? YES NO None WAS A POLICE REPORT MADE? YES NO None WERE YOU TRANSPORTERD TO A HOSPITAL? YES NO None DID YOU GO TO AN URGENT CARE THE SAME DAY? YES NO None DID YOU GO TO SEE A PHYSICIAN THE SAME DAY? YES NO None DID YOU SEE A PHYSICIAN SHORTLY AFTER? YES NO None ARE THERE INSURANCE COVERAGES IN FORECE TO COVER THE DAMAGES? YES NO None DOES THE PARTY AT FAULT HAVE INSURANCE TO COVER YOUR DAMAGES? YES NO None DO YOU HAVE INSURANCE TO COVER YOUR DAMAGES? YES NO None WERE YOU SO SEVERELY INJURED THAT YOU COULD NOT WALK AFTER THE ACCIDENT? YES NO None DID YOU SUFFER LOSS OF CONSCIOUSNESS AFTER THE ACCIDENT? YES NO None DID YOU HAVE ANY OF THE FOLLOWING IMMEDIATELY AFTER THE ACCIDENT? PANIC ATTACK $200 SEVERE ANXIETY $200 DIFFICULTY SPEAKING $200 NAUZEA $200 VOMITING $200 HEADACHE $200 DIZZINESS $200 BLURRED VISION$200 VISUAL PROBLEMS $200 NECK PAIN $3500 BACK ACHE $3500 CHESTWALL PAIN $500 CHESTPAIN $500 SHORTNESS OF BREATH $500 PARALYSIS $25000 BIFFICULTY WALKING $2000 DIFFICULTY USING HANDS $20,000 ABDOMINAL PAIN $10,000 NOSEBLEED $25000 BLOOD IN URINE $25000 BLOOD FROM RECTUM OR IN FECES $75000 ANY OTHER BLEEDING $5000 OTHER SYMPTOMS (Please add here) None Comment HOW DID THE ACCIDENT HAPPEN? CAR ACCIDENT $5,000 TRUCK ACCIDENT $10,000 BICYCLE ACCIDENT $15,000 BUS ACCIDENT $15,000 CONSTRUCTION ACCIDENTAL INJURY $15,000 DOG BITE $10,000 E-SCOOTER RENTAL $10,000 UBER/LYFT PASSENGER $50,000 UBER/LYFT DRIVER $50,000 MOTORCYCLE $150,000 PEDESTRIAN ACCIDENT $150,000 SLIP & FALL $80,000 TRAIN & RAIL ACCIDENT $80,000 PREMISES ACCIDENT $80,000 BIG RIG ACCIDENT $250,000 ATV ACCIDENT $150,000 AVIATION ACCIDENT $500,000 BOATING ACCIDENT $500,000 ELEVATOR ACCIDENT $300,000 ESCALATOR ACCIDENT $250,000 ELECTRIC SCOOTER ACCIDENT $200,000 MOTORIZED SCOOTER ACCIDEDENT $150,000 TRAIN ACCIDENT $100,000 WHIPLASH INJURY ACCIDENT $30,000 OTHER ----SPECIFY: Type here please>…. None Comment AS A RESULT OF THE ACCIDENT, HOW MANY OF THE FOLLOWING DID YOU SUFFER? SKIN AND MUSCLE INJURY to HEAD $30,000 HEAD TRAUMATIC BRAIN INJURIES WITH BRAIN FUNCTION ISSUES $500,000 MEMORY LOSS $500,000 MENTAL FUNCTION CHANGES $500,000 NECK INJURY $100,000 BACK INJURY $100,000 BODY INJURY $50,000 AMPUTATION $1000,000 BROKEN BONES/FRACTURES $100,000 KNEE MENISCUS INJURIES $75000 HIP INJURY $100,000 ROTATOR CUFF INJURY $100,000 SPINAL COLUMN INJURY WITH NEUROLOGICAL PROBLEMS $250,000 EYE INJURY WITH VISUAL PROBLEMS $250,000 FACE INJURIES AND FACIAL DISFIGUREMENT $750,000 Men $1000,000 Women SKIN AND TISSUE TEARS $100,000 BODY DISFIGUREMENTS $100,000 NOSE INJURIY $100,000 NOSE BREATHING PROBLEMS $100,000 SPLEEN INJURY $500,000 LIVER INJURY $500,000 BOWEL INJURY $500,000 BLADDER INJURY $500,000 LUNGS INJURY $750,000 KIDNEY INJURY $750,000 RIB FRACTURE $300,000 OTHER ORGAN INJURY $300,000 ORTHOPEDIC INJURIES $200,000 SPINAL CORD INJURIES $300,000 TRAUMATIC BRAIN INJURY (TBI) $750,000 BURN INJURY $500,000 DISFIGURMENT OF ANY KIND $500,000 LOSS OF A PART OF YOUR BODY (DISMEMBERMENT) $750,000 EYE INJURY OF ANY KIND $500,000 HAND INJURY $250,000 FOOT INJURY $300,000 HIP INJURY $400,000 KNEE INJURY OF ANY KIND $300,000 HIP FRACTURE $350,000 KNEE FRACTURE $300,000 ANKLE FRACTURE $100,000 ARM FRACTURE $100,000 NECK FRACTURE $250,000 SPINAL COLUMN FRACTURE $300,000 BONE FRACTURES CUTTING THROUGH THE SKIN $300,000 BONE FRACTURES WITH BONE PIECES MOVED APART FROM EACH OTHER BUT NOT THROUGH SKIN $75,000 BONE FRCTURES WITH FINE LINE FRACTURES $75,000 MULTIPLE BONE FRACTURES $150,000 EYE INJURIES WITH VISUAL CHANGES $500,000 INJURY LEADING TO INABILITY TO WALK NEEDING WHEELCHAIR PERMANENTLY $2,000,000 INJURY LEADING TO INABILITY TO WALK FOR A FEW WEEKS $100,000 INJURY LEADING TO INABILITY TO WORK FOR A FEW WEEKS $100,000 INJURY LEADING TO INABILITY TO USE ONE ARM FOR A FEW WEEKS $100,000 INJURY LEADING TO INABILITY TO USE BOTH ARMS FOR A FEW WEEKS $500,000 INJURY LEADING TO INABILITY TO USE BOTH ARMS PERMANENTLY $20,000,000 INJURY LEADING TO INABILITY TO CARE FOR YOURSELF NEEDING ASSISTANCE$10,000,000. SPINAL CORD INJURY WITH PERMANENT NEUROLOGICAL DEFICIT TO ARMS AND LEGS $50,000,000 None Comment ARE ENQUIRING ON BEHALF OF SOMEONE WHO PASSED-AWAY IN THE ACCIDENT: Wrongful Death None ARE YOU THE SPOUSE OF THE DECEASED? YES NO None IF YOUR INJURY WAS NOT AS A RESULT OF AN ACCIDENT INVOLVING A MOTORCYCLE, A CAR, OR A FAMILY TYPE VEHICLE SUCH AS A SUV OR A SMALL TRUCK, THEN YOU ARE DONE WITH THIS ASSESSMENT AND YOU CAN NOW CONTACT OUR SERVICE CENTER FOR YOUR EVALUATION RESULT AT 213…… YOU WILL RECEIVE A $ FIGURE FROM THEM AS AN ESTIMATE FOR THE VALUE OF YOUR CLAIM FOR YOUR DAMAGES ONCE THEY CONFIRM THE RESPONSES TO A FEW OF THE QUESTIONS ABOVE, IF NEEDED! None IF YOUR INJURY WAS CAUSED AS A RESULT OF A MOTORCYCLE, CAR, FAMILY TRUCK, SUV ACCIDENT, PLEASE CONTINUE TO ANSWER THE FOLLOWING QUESTIONS: WHAT KIND OF VEHICLE? MOTORCYCLE CAR SUV SMALL-MEDIUM PASSENGER TRUCK 4X4/LARGE PASSENGER TRUCK None WERE YOU THE DRIVER? YES NO $5,000 None HOW WAS YOUR VEHICLE INVOLVED IN THE ACCIDENT? OUR VEHICLE HIT THE OTHER VEHICLE (CASE MAY NOT BE GOOD) THE OTHER VEHICLE HIT OUR VEHICLE None HOW MUCH DO YOU ESTIMATE THE DAMAGE TO YOUR VEHICLE WAS? LESS THAN $1500.00 (CASE MAY NOT BE GOOD) 1500 TO $10,000.00 $10,000.00 TO $20,000.00 $20,000.00 TO $30,000.00 MORE THAN $30,000.00 THE VEHICLE WAS TOTALLED AND NOT DRIVABLE. None HOW DID THE ACCIDENT HAPPEN? THE OTHER VEHICLE BROKE THE LAW AND CAUSED THE ACCIDENT THE OTHER VEHICLE PASSED THE RED LIGHT AND CAUSED THE ACCIDENT THE OTHER VEHICLE PULLED IN FRONT OF US INTENTIONALLY THE OTHER VEHICLE SUDDENLY HIT THE BREAKS TO CAUSE THE ACCIDENT THE OTHER VEHICLE SIDE SWIPED OUR CAR THE OTHER VEHICLE HIT OUR CAR FROM THE BACK THE OTHER VEHICLE HIT OUR CAR FROM THE BACK AND DROVE US INTO THE CAR IN FRONT OTHER (Describe briefly please:) None Comment THE ACCIDENT HAPPENNED IN THE FREEWAY WHILE OUR CAR WAS AT: FULL STOP MOVING AT 10 -25 MILES PER HOUR MOVING AT 25-45 MILES PER HOUR MOVING AT 45-65 MILES PER HOUR MOVING AT 65 MILES PER HOUR OR MORE None THE ACCIDENT HAPPENNED IN THE FREEWAY WHILE THE OTHER CAR WAS MOVING: MOVING AT 10 -25 MILES PER HOUR MOVING AT 25-45 MILES PER HOUR MOVING AT 45-65 MILES PER HOUR MOVING ABOVE 65 MOLE PER HOUR None Comment THE ACCIDENT HAPPENNED IN THE STREET WHILE OUR CAR WAS AT: FULL STOP MOVING AT 10 -25 MILES PER HOUR MOVING AT 25-45 MILES PER HOUR MOVING AT 45-65 MILES PER HOUR MOVING AT 65 MILES PER HOUR OR MORE None Comment THE ACCIDENT HAPPENNED IN THE STREET WHILE THE OTHER CAR WAS MOVING: MOVING AT 10 -25 MILES PER HOUR MOVING AT 25-45 MILES PER HOUR MOVING AT 45-65 MILES PER HOUR MOVING ABOVE 65 MOLE PER HOUR None Comment 1 out of 1 Name Email Time's up March 9, 2023 by drdavidsonmdmba.esqp@gmail.com 0