Attorney Questionnaire - Lawsuit Financial, Inc

Client Name*
Attorney*
Email*
Phone Number*
Type of Case
Date of Loss
Is the case in suit?
Has there been any attempted alternative case resolution?
Has a date been set for trial?
Have there been any offers on the case? If so, how much?
What is the demand amount?
What is the estimated opinion of case value? (Range is Acceptable, ie. $50K-100K)*
What is the likelihood of settlement?
When do you expect the case to settle?
Has liability been contested?
What are the client's injuries and diagnosis?
Is the client still treating?
Does the client have any preexisting injuries?
Third-party Insurance Carrier
Claim Number
Policy Limits
Adjuster's Name
Adjuster's Phone
First-party Insurance Carrier
Claim Number
Policy Limits
Adjuster's Name
Adjuster's Phone
Please provide the plaintiffs insurance coverage information:
PIP
UM
UIM
Please provide the amount accrued for the following benefits:
Medical
Wage Loss
Replacement Services
Attendant Care
Are there any current liens against this case?
Medical (Amount)
Child Support (Amount)
Other (Amount)
Has your client received any prior litigation funding advances?
Additional Comments
Email
This field is for validation purposes and should be left unchanged.

Please provide the plaintiffs insurance coverage information: