Start your claim - Work accident

Please complete the claim form below.

When we receive your information, we will phone you to ask about any further details we may need to support your claim for compensation.

1. Your work accident

Basic description of your accident and injury:

Don't worry if you miss something out. When we contact you, we will ask for any further details we need to start examining your claim.

Name:

E-mail address:

Daytime phone number:
Alternative daytime phone number:

When would you prefer to be called?

Call back times are for Mon-Fri only and do not include public holidays

Amelans helped Tim Seaman of Cornwall to claim after he was knocked off his motorbike by a car.

Mark Maddocks from Stockport was involved in a road traffic accident and received £1,600 compensation.