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SB 899 Fact Sheet
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Horror Stories
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Permanent Disability
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Block Hoch
 
 
 
 
 

 
TELL US YOUR STORY
  
We want to hear about your horror story. Please feel free to fill out the form below.
 
INJURED WORKER'S INFO:
 
Full Name:
Age & Condition:
Telephone Number: ex. 916-555-1212
Address:
City:
State: ex. CA
Zip:
Email Address:
 
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INJURY INFORMATION:
    
Occupation When Injured:
 
Date of Injury:
ex. 01/05/04
 
Employer When Injured:
 
What Is The Injury? How Did It Happen?
 
How Has The New Workers' Compensation law (SB 899) Affected Your Case?
 
Ready To Talk With Media About Case?
Ready To Contact A Lawyer?
 
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ATTORNEY INFORMATION:
    
Attorney Name:
Telephone:
Facsimile:
Email Address:
 
Additional Notes:
 

 
 
 

 

 

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