Workers' Compensation Quiz

1

Were you injured while you were working? * This field is required.

Yes

No

2

Did your injury involve an auto accident? * This field is required.

Yes

No

3

Were you injured on a construction site? * This field is required.

Yes

No

4

Did you report your injury to your supervisor? * This field is required.

Yes

No

5

Did you seek medical attention? * This field is required.

Yes

No

6

Do you have an attorney? * This field is required.

Yes

No

7

Have you received any Workers' Compensation monetary benefits?* This field is required.

Yes

No

8

Name* This field is required.

First Name

Last Name

9

Email* This field is required.

example@example.com

10

Phone Number* This field is required.

Please enter a valid phone number.