Crew member and seaman injuries claim information

Crew member and seaman injuries questionnaire

Tell us what happened and share the records you have. It is fine if you do not know every date. Sending this form does not extend a deadline or make us your attorney.

Name *

Phone *

Email *

Employer

Vessel

Position and duties

Nationality (optional)

Country of residence (optional)

Injury date and place

Medical care received

Is maintenance and cure being paid?

Employment contract and arbitration clause available?

Best time to call

Medical treatment and reporting

Employment, wage and vessel records

Tell us what happened (optional)

Ticket, contract, reports, medical records, photos or video (optional)

Up to 10 PDF, image or MP4 files, 10 MB each. For larger videos, call to arrange private transfer. Do not submit Social Security numbers.

305-748-3789

By submitting, you authorize contact by phone or email about this request. A submission does not create representation, guarantee acceptance or stop any deadline. Do not rely on this form for emergencies.

Frequently asked questions

What should I preserve for crew member and seaman injuries?

Address immediate safety or medical needs first. Preserve original records concerning crew member and seaman injuries. Collect employer and vessel and job duties and employment agreement. Keep complete communications, including unfavorable or uncertain details. Request prompt individual review; do not calculate a deadline from general guidance.

Which details help review crew member and seaman injuries?

Employer; Vessel; Position and duties; Country of residence (optional). Identify missing records or uncertain facts.

Does submitting create representation?

No. Representation requires a signed written engagement agreement. No outcome is guaranteed.

How can I arrange a meeting?

Meetings by appointment only.

South Florida and statewide service

Serving Miami-Dade, Broward and Palm Beach and clients throughout Florida, including Tampa, Orlando and Jacksonville. Based in Hollywood, Florida. Serving clients throughout Florida. Meetings by appointment only.

Complete the crew member and seaman injuries questionnaire