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Workers' Compensation Contact Form

Back injuries and repetitive motion injuries such as carpel tunnel syndrome are among the most common work-related injuries for which workers' compensation benefits are paid. Contact an attorney to determine whether you have a valid claim.

Indiana Workers' Compensation Attorneys

If you have been injured on the job, your first inclination may be to report the injury to your employer's HR department, complete claims forms and trust the "powers that be" to see to it that your workers' comp benefits are paid.

What you may not realize is that both your employer and the workers' compensation insurer have different priorities than you do. Your goal is to get better and to have your financial needs met: getting doctors' bills paid and replacing lost wages. Their goals include paying out as little as possible and closing your case as soon as possible.

Golitko & Daly, P.C. has valuable information to share with you as you begin to confront the system after a workplace injury. Talk to us if your workers' comp benefits have been denied.

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or use the form below.

Workers' Compensation Contact Form

Name

E-mail Address

Phone Number

When were you injured or did you become sick?

Were you working at the time of the accident or harmful circumstance?
Yes  No 

For whom?

What work-related activity were you engaged in at the time you were injured?

How did the accident or harmful circumstance happen?

Were your injuries caused by tool or equipment failure or use?
Yes  No 

If your injuries were caused by tool or equipment failure or use, who manufactured, distributed and/or sold the equipment with which you were working?

When and where did you first seek medical care for your injury?

What was your diagnosis? Prognosis?

Who is your physician(s)?

Had you ever experienced similar symptoms in the past?
Yes  No 

Did the accident or harmful circumstance exacerbate a pre-existing injury?
Yes  No 

Did the injury cause you to miss work?
Yes  No 

Has your doctor authorized you to return to work?
Yes  No 

DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.

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Office Locations

Carmel Office
716 Adams Street
Suite A
Carmel, IN 46032
Phone: 317-566-9600
Fax: 317-566-9606

Kokomo Office
317 West Alto Road
Kokomo, IN 46902
Phone: 765-865-9300
Fax: 765-865-9305

Indianapolis Office
201 North Illinois Street
16th Floor - South Tower
Indianapolis, IN 46204
Phone: 317-566-9600
Fax: 765-865-9305