Sibley Lawyers

Personal Injury Form

Date of birth
Residential address
Have you sustained any work-related injury, injury on the road or an injury in a public place ('the event')?
Did the event occur in Queensland?
Was the event within the last three (3) years?
If you answer no to this question we cannot assist by referring your work injury claim.
If work related, do you have an approved workers' compensation claim?
Has any injury been medically diagnosed?
If you answer no to this question we cannot assist by referring your work injury claim.
Was another person or party at fault for the event?
Have you suffered any financial loss (i.e. loss of wages or medical expenses)?
How much time off work have you had?
Are you currently working?
Do you consent to us providing details of your injury and your contact details to our trusted colleagues, who are experts in compensation law, Rogalski Lawyers?
If you answer no to this question we cannot assist by referring your work injury claim.

By Ticking Yes, I hereby authorise and consent to Sibley Lawyers providing my personal details and this application to Rogalski Lawyers to assist with any investigation into a claim for personal injury claim and/or capital benefits. I understand that Sibley Lawyers is not responsible for any legal advice provided to me by Rogalski Lawyers, and is not acting for me in relation to any claim. Sibley Lawyers is not giving me any advice, and is referring me to a specialist for that purpose. I authorise Sibley Lawyers to communicate with Rogalski Lawyers regarding the above-mentioned matters and vice versa, and authorise both Firms to carbon copy the other into correspondence with me.

Sibley Lawyers are not personal injury lawyers so we cannot provide any advice in that area of law. Having said that strict time limits may apply to personal injury claims. You may wish to engage with our trusted partner, Rogalski Lawyers, to discuss and protect your entitlements. We strongly recommend that you act without delay. Any delay may be prejudicial to your interests. We do not act for you in relation to any personal injury matter. We will not be protecting any of your entitlements regarding any potential personal injury claim.