Open A Case

Please complete the Western Limited Case Intake Form below to the best of your knowledge.

Contact Us if you have any questions or need assistance.

Client Information

Step 1: Client Information

Client Information


Step 2: Case Information

Case Information

Subject Information

Step 3: Subject Information

Subject Information

Physical Description

Attorney Information

Step 4: Defense Attorney Information

Defense Attorney Information*

*If you wish for your attorney to receive updates and reports

Employer | Insured Info

Step 5: Employer | Insured Information

Employer | Insured Information

Special Instructions

Step 6: Special Instructions

Special Instructions