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Workers' Compensation Contact Form

If you get a work-related injury or industrial disease, you should file a claim as soon as possible for workers' compensation. Depending on your situation, you may be eligible for lost wages, medical expenses and/or vocational rehabilitation. To find out more about your potential benefits, contact an experienced workers' compensation lawyer now.

Learn About Ohio Workers' Compensation Laws

The attorneys at Friedman, Domiano & Smith represent clients in Cleveland and throughout Ohio in workers' compensation litigation. For more details about the cases we handle, please see the information we have provided on workers' compensation.

Below we have provided some general information about how the law applies in workers' compensation lawsuits. While this general information answers many basic questions about workers' compensation, the best way to get answers that apply specifically to your case is to contact us for a free initial consultation.

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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 

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Friedman, Domiano & Smith Co., L.P.A.
55 Public Square, Suite 1055
Cleveland, OH 44113
Local: 216-586-5520
Phone: 866-636-8367
Fax: 216-621-4008
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The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

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