Register a Motor Accident Case
Use this form to register a motor accident case with HCCC Legal Services. We will contact you within 48 hours to discuss your matter further. Your information will be encrypted.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
What state did the accident happen?
Please Select
New South Wales
Victoria
Australian Capital Territory
Northern Territory
What date did the accident happen?
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Were you the driver, passenger or pedestrian / cyclist in the accident
Driver
Passenger
Pedestrian / Cyclist / other
Did the police attend the accident?
Yes
No
No, but I have reported the accident to police since the accident
What is the license plate / registration of the vehicle that you state caused the accident (write 'unknown' if you don't know)?
Please give a short description of how the accident occurred
Please list the injuries you have suffered because of the work accident
Have you made a claim upon the motor vehicle insurer at fault because of your accident?
Yes
No
What is the name of the motor vehicle insurer you have made a claim upon?
Has the motor vehicle insurer accepted liability for your claim?
No, they have said I was at fault
Yes, they have accepted liability
Yes, they have accepted liability, but they have refused to pay me all my entitlements, or they have told me my payments will be stopping.
Have you previously been given legal advice about your claim?
No I have not had advice from another lawyer
Yes I have a current lawyer but I am thinking of changing
Yes, I have a previous lawyer regarding this case but they are no longer representing me.
Have you have been to a court or a tribunal about your motor accident claim already?
Yes
No
My case is schedule for a hearing in the future
Please attach any files you would like HCCC Legal to review in relation to your case. We will securely store these files and destroy them if we are unable to assist you in your case.
Browse Files
Drag and drop files here
Choose a file
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How you would you like HCCC Legal Services to contact you for further discussion about your case?
By telephone during business hours
By telephone after hours
By video conference during business hours
By video conference after hours
By email
I will log on to the HCCC Legal Services contact page and arrange an appointment that suits me.
Submit
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