Grossman Law

Home
Practice Areas
About Us
- Our Team
Sign Up

(407) 601-0024

Personal Injury Law Case Evaluation

Step 1 of 8

12%

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is/are the best day(s) to contact you?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

What is/are the best time(s) to contact you?

Morning (9am - 12pm)

Afternoon (12pm - 3pm)

Evening (3pm - 6pm)

Employer

Work Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Phone

Ext.

Fax

Work Days/Hours

How long have you worked there?

Immediate Supervisor

Spouse's Name

Spouse's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Spouse's Phone

Prior claims and/or settlements (types, dates, attorneys):

List any prior injury settlements:

Accident Information

Date of Accident(Required)

MM slash DD slash YYYY

Day of Week(Required)

Time of Accident(Required)

AM or PM?(Required)

Where did the accident occur? Be specific(Required)

Where were you coming from?

Where were you going?

Weather conditions (if happened outside):

Was there any construction in the area?

Description of accident:(Required)

Please give as much detail as possible.

Did this injury occur when you were driving a vehicle?(Required)

Yes

Were you driving a company vehicle?

Yes

What was the make, model, and year of the vehicle you were driving?

Your Insurance Information

Name of Carrier

Is this a worker's comp claim?

Are you covered through your employer's insurance?

Yes

If so, provide company and agent, if known:

Policy or Plan Number

Did you file a claim with your insurance company?

Yes

Has anyone from the insurance company contacted you about this claim?

Yes

If yes, name of person who contacted you:

When was contact made?

If a statement was given, was it tape recorded or written?

Did you receive a copy?

Yes

Have you signed any authorizations to release information to anyone?

Yes

If so, identify:

Have you received any insurance benefits?

Yes

Deductible Amount

Liability Coverage

Medical Payment Amount

Uninsured Motorist Coverage Amount

Frequently Asked Questions

What areas of law does Grossman Law, P.A. practice?

We specialize in residential insurance claims, hospitality law, wage and employment claims, landlord/tenant disputes, personal injury, criminal defense, and breach of contract cases.

What does "Take Back The Power!" mean?

It's our philosophy of fighting corporate greed and standing up for regular, working people against more powerful opponents.

Do you charge for initial consultations?

We offer free case evaluations for all our practice areas. After we receive and assess your case, we will contact you about next steps.

What types of clients does Grossman Law represent?

We exclusively represent individuals and small businesses taking on larger, more powerful entities like corporations, insurance companies, and government bodies.

How does Grossman Law approach cases?

We combine the resources and skill of large corporate firms with the personal attention and care of a boutique firm.

What can I expect if I choose Grossman Law to represent me?

You'll receive high-quality legal services, constant communication, and guidance through every step of your case.

Does Grossman Law handle cases outside of Florida?

We primarily serve clients in Florida. Contact us for more information about your specific case.

How can I get in touch with Grossman Law?

You can fill out our free case evaluation form on our website or call our office directly.

What sets Grossman Law apart from other firms?

Our commitment to fighting for the underdog, our wide range of practice areas, and our philosophy of helping clients "Take Back The Power!"

As Seen On

9 Investigates illegal wage practices in the hospitality industry

On the Town: “Orlando Tip Pool” Helping Struggling Service Workers Amid Pandemic

Moe’s employees say they haven’t been paid

Contact Us

(407) 601-0024

545 Delaney Ave., Bldg. 9
Orlando, FL 32801

Explore

Home
Practice Areas
About Us
- Our Team
Sign Up

About Us

For over 20 years, we've fought corporate greed and bullies, exclusively representing Florida's working people against powerful adversaries. Whether facing employers, insurance companies, or the state, we provide outstanding representation with big-firm resources and boutique-firm care, empowering the powerless.

Case Evaluation