Do you believe your incident involves a significantly large group of people?
*
Yes
No
What type of incident do you believe you fall under?
*
Data Breach/Privacy
Consumer Products
Automotive Class Actions
Medical (Drug & Medical Device and/or Medical Malpractice)
Environmental – Toxic Tort
Employment
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Data Breach/Privacy
Did you receive a data breach letter or email?
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Yes
No
Are you able to provide us with proof of the data breach letter?
*
Yes
No
Please provide a brief description of what happened.
*
What company experienced a breach?
*
What month and year did you receive the data breach notice?
*
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Consumer Products
Are you currently, or were you ever, represented by an attorney for this matter?
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Yes
No
What is the name of the company/product name/service/entity involved in your incident?
*
Give us a brief description of what happened.
*
Have you contacted the manufacturer or store regarding these concerns?
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Yes
No
Did the manufacturer or store provide you with a refund or a replacement product?
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Yes
No
When did you purchase the product?
*
Do you still own the product?
*
Yes
No
Do you still have proof of purchase?
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Yes
No
Was the product still under warranty at the time the issue arose?
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Yes
No
Did this issue arise within the past 5 years?
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Yes
No
Were you injured by this product?
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Yes
No
Please explain your injuries.
*
Please list the month and year you were injured.
*
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Automotive Class Actions
What is the make and model of the vehicle involved in your incident?
*
What is the year of your vehicle?
*
On approximately what date did you purchase the vehicle?
*
When did the issue first start (month/year)?
*
Please provide a brief description of what happened.
*
In what state did the incident occur?
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Have you contacted the manufacturer or dealer regarding these concerns?
*
Yes
No
Did they repair the damages/fix the issue free of charge?
*
Yes
No
Did you self-pay to have the issue(s) fixed?
*
Yes
No
Approximately how many miles were on the vehicle when the accident happened?
*
Do you still own the vehicle?
*
Yes
No
Was the vehicle under warranty at the time of the accident?
*
Yes
No
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Medical (Drug & Medical Device and/or Medical Malpractice)
Were you injured by:
*
A medication
A medical device
Medical malpractice
If you were injured by a medication, list the name and manufacturer of the medication involved in your incident?
*
When did you first start taking the medication (month/year):
When did you first start to experience adverse effects/onset of symptoms (month/year):
*
If you were injured by a medical device, list the name and manufacturer of the medical device involved in your incident?
*
If injured by a medical device, when was the device implanted (month/year)?
*
If injured by a medical device, when did you first start to experience adverse effects/onset of your symptoms?
If injured by a medical device, did you require a revision surgery/repeat surgery to correct the problem?
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Yes
No
If you were injured by a health professional, list the hospital or healthcare facility where the incident occurred.
*
What month and year did this incident occur?
*
Give us a brief description of what happened.
*
Have you contacted the manufacturer/medical staff regarding these concerns?
*
Yes
No
What was the month and year you notified them?
*
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Environmental - Toxic Tort
Give us a brief description of exactly what happened.
*
If the incident involved a toxic product, please list the brand name of the product (i.e. Roundup).
*
If the incident involved an environmental toxin (i.e. chemical spill, wildfire, water contamination), please list the city and state where the exposure occurred.
*
List the month and year of first exposure to the toxic product or environment.
*
Have you been suffering from medical problems due to exposure to the product of environmental toxin?
*
Yes
No
please check any and all that apply:
*
Cancer
Respiratory problems
Parkinson's
Other neurological disorder
Gastric problems
Confusion
Nausea and/or vomiting
Dizziness
Seizures
Skin issues
Non-medical problems (I.e. property damage/loss)
medical bills
Other
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Employment
We handle cases including any kind of worker rights violations, whether that be discrimination, unpaid wages, or misclassification. If your employer hasn’t paid you fairly or has retaliated against you, you may be owed backpay, overtime, or other compensation. We’re here to help you figure out if you may be entitled to compensation.
Are you currently (or have you ever been) represented by an attorney for this matter?
*
Yes
No
Were you denied overtime, forced to work off-the-clock or otherwise refused your rightful pay?
*
Yes
No
What problems are you having with your pay?
*
Unpaid overtime
Workplace mistreatment
Unpaid minimum wages or tips
Unpaid wages like commissions
Missing paycheck
Unpaid vacation or PTO
Other (not listed here)
Do you have an employment contract in place with your employer?
*
Yes
No
What is the name of the company/facility that did not pay you properly?
*
Do you still work for this employer?
*
Yes
No
On approximately what date did you start working for this employer?
*
Can you describe what happened?
*
How much money do you think you are owed?
*
Are you an employee or an independent contractor?
*
Yes
No
In what city did you work for the Employer in?
*
In what state did you work for the Employer in?
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
In what city is the employer headquartered in?
*
In what state is the employer headquartered in?
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
What state do you currently live in?
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
How are you paid?
*
hourly
salary
commission
piecemeal/production
How much do you earn per hour/per day/biweekly/etc.?
*
How many hours per week do you work typically?
*
Are you paid time and a half (or double time) for working over 40 hours in a week?
*
Yes
No
If you are not paid time and a half, what type of payments do you get for over 40 hours?
*
nothing for overtime
straight hourly pay
salary only
other
What was your job title/ position when you weren’t paid correctly?
*
Are you 18 years of age or older?
*
Yes
No
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You do not qualify.
We appreciate you reaching out to us, however, without proof of a data breach letter, we are unable to move forward with your case. If you receive a breach letter at a later time, please contact us at 772-SUE-THEM.
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You do not qualify.
We appreciate your interest in working with Join Class Actions, however, we do not take cases from other attorneys. Please consider us for any future cases!
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