Claim Form

If your attorney distributed the proceeds of your personal injury case within the past 4 years, and:

1. computed the amount of his contingent fee based upon the gross amount of the award or;
2. subtracted anything from your portion of the gross award,

...we might be able to give you some cash.

Please tell us a little about your case.

Your First Name:
Your Last Name:
Your email address:
Your Telephone No.:
Full Name of your Attorney:
Name of your First Hospital:
Name of your Health Insurance Co.:
Name of your Auto Insurance Co.:
Gross Amount of Settlement:
Net Amount you received:
Date of Settlement:
Date of your Accident
City of your Accident:

For more information, contact: info@overcharge-recovery.com