North Carolina Workers Compensation Intake Form

Edelstein & Payne has a long history of providing high quality legal services to injured workers. If you have suffered a job-related injury, finding a reliable source of information regarding workers' comp can make a big difference for case outcome as well as peace of mind. Fill our our North Carolina Workers' Compensation Intake Form to take the first step toward a free consultation.

If you are a human, ignore this field

Name *
Phone *
Email *
Employer *
Date of Injury *
Injured Body Part *
Do you currently have an attorney for a Workers' Compensation claim?
Briefly describe how your injury happened:
How did you find our firm? (Referral, Google, etc)
Did you report the injury to a supervisor? *
Have you filed a claim with the Industrial Commission?
If you filed a claim with the I.C. what was the date of the claim?
If you filed a claim was it accepted or denied?

Contact Our Firm

Thank you for visiting! Please fill out this form if you want an attorney or staff member to contact you regarding a legal issue. If you are seeking a consultation regarding an employment law issue, please go to our employment law page (under "practice areas") and fill out the more detailed form there!

North Carolina Workers Compensation Intake Form

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