Were You Hurt in a Car Accident? Tell Us About It

If you were injured in a motor vehicle accident, fill out the form below in your own words. It takes about five minutes. A case reviewer will go over your answers and contact you to talk about your options. Fields marked with * are required.

Before you start — please read

This form is meant to be filled out by you, the person who was injured, in your own words. Please answer honestly and only from what you actually know. If you are not sure about an answer, say so when we speak with you rather than guessing here.

Submitting this form does not create an attorney-client relationship and does not mean a law firm has agreed to take your case. MVAResolve is not a law firm and does not give legal advice. We review what you send and, if your case looks like a fit, we share it with one of our partner law firms so an attorney can contact you about representing you.

Your information is used to review your potential claim and to contact you about it. You choose whether to give us permission to call, text, or email you — see the permission section at the bottom of this form, and our Privacy Policy.

Who is filling out this form?

Are you the person who was injured in the accident, filling this out yourself right now?

Please answer "Yes, this is me" only if you are the injured person and you are entering your own information. The consent you give at the bottom of this form only counts if you give it yourself, for your own phone number.

Anyone completing this form on the injured person's behalf — including a referral partner — must provide an independent TrustedForm or Jornaya certificate URL below, from a separate form that the injured person personally filled out and consented on. Without it, this submission will be disqualified and the partner account flagged for quality review. Never enter another person's phone number for contact consent they did not give themselves.

Your information

We need this so a case reviewer can reach you. Please use a phone number and email address you check yourself.

Your first name *

Your last name *

Your email address *

Your phone number *

This is the number we will use to reach you about your case.

Your street address

Your city

Your state

Your ZIP code

County you live in *

Date of birth *

Social Security number (optional)

Optional. Stored encrypted and only used to prepare your attorney paperwork.

About your accident

Tell us what happened in your own words. A rough description is fine — you do not need documents or legal terms to fill this out.

Date of your accident *

Most states limit how long you have to bring a claim. We are generally only able to review accidents from the last 12 months.

State where the accident happened *

Injuries you suffered

What happened?

A few questions about your case

Please answer these as honestly and accurately as you can, based only on what you actually know. There are no right or wrong answers — they simply help a reviewer understand your situation and whether one of our partner law firms is likely to be able to help you. If you are unsure about something, give your best honest answer and tell us when we speak.

Were you physically injured in the accident? *

Was the other driver at fault for the accident? *

Did the police come to the scene and take a report? *

Do you have a police report or a case number for the accident?

Do you have the at-fault driver's insurance information, or do you have uninsured/underinsured motorist (UM/UIM) coverage on your own policy? *

Did you see a doctor, go to an ER, or get any medical treatment within 7 days of the accident? *

Are you still being treated for your injuries at least once a month?

Have you been back for at least one follow-up visit since your first treatment?

Was your most recent medical treatment within the last 30 days?

Are you currently without a lawyer for this accident? (Answer Yes if no attorney represents you right now.) *

Has your case never been dropped by a law firm? (Answer Yes if no firm has dropped you.) *

Is your claim still unsettled? (Answer Yes if you have not already accepted a settlement.) *

Your permission to contact you

Please read this carefully before you check the box. You are giving us permission to contact you — you can withdraw it at any time.

Free to submit. No obligation. You decide whether to hire any attorney who contacts you.

Advertising disclosure

This is a paid advertisement for legal services. MVAResolve is not a law firm, does not practice law, and does not provide legal advice, legal opinions, or representation. Submitting this form does not create an attorney-client relationship with MVAResolve or with any attorney or law firm, and no such relationship is formed until you and an attorney sign a written representation agreement.

MVAResolve operates as a legal advertising and case-referral service. If the information you provide appears to match the intake criteria of one of our participating law firms, we share it with that firm so an attorney can contact you about possible representation. We receive compensation from participating law firms for advertising and referral services. That compensation does not increase what you pay, and you are never charged a fee by MVAResolve. You are under no obligation to speak with, hire, or retain any attorney who contacts you, and you are always free to choose your own attorney.

Participating attorneys and law firms are solely responsible for their own advertising, their own intake decisions, and the legal services they provide. Not all cases are accepted, and not everyone who submits this form will be contacted by an attorney. Case results depend on the specific facts and law of each matter; prior results do not guarantee or predict a similar outcome in your case. No representation is made that the quality of legal services to be performed is greater than the quality of legal services performed by other lawyers.

Legal claims are subject to strict filing deadlines (statutes of limitation) that vary by state and by claim type. Delay may permanently bar your claim. If you are concerned about a deadline, speak with a licensed attorney in your state promptly.

This service is intended for residents of the United States who are 18 or older. Services may not be available in all states, and this advertisement is not directed to residents of any jurisdiction where it would not comply with that jurisdiction's rules of professional conduct or advertising rules.