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If you have been injured or a loved one has been killed by a fire or explosion, or if your insurance company refuses to pay for your covered homeowners or business owners claim, contact for a free consultation with one of our experienced trial attorneys.

33450 W 12 Mile Rd
Farmington Hills, MI 48331

LOCATION

33450 W 12 Mile Rd
Farmington Hills, MI 48331

248.553.2000

248.553.2020

[email protected]

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Contact Info
Name*
First Last
Email*
Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of Birth
MM slash DD slash YYYY
Case Info
Why do you need an attorney?*
Name of injured person
Location of the fire/explosion
Date of the fire/explosion
MM slash DD slash YYYY
Type of injuries suffered
Did the person pass away as a result of the fire/explosion?
- Yes
- No
Date of death
MM slash DD slash YYYY
Is the injured person currently hospitalized?
- Yes
- No
Name of Hospital
Room number
Describe injuries
Describe in your own words how the fire/explosion occurred
What caused the property damage (check all that apply)
- Fire
- Smoke
- Water
- Wind
- Hail
- Mold
- Vehicle struck building
- Theft
- Other
IF other, explain
Date of the event/incident causing the damage
MM slash DD slash YYYY
Address of loss
Same as previous

Street Address Address Line 2 City State ZIP Code
Was the property insured?*
- Yes
- No
Name of Insurance Company
Policy Number
Claim Number
Has anybody from the insurance company communicated with you regarding the claim?*
- Yes
- No
Name
Position
Phone Number
Address
Same as previous

Street Address Address Line 2 City State ZIP Code
Has the insurance claim been denied?*
- Yes
- No
What were the reasons given for the denial?*
Has the insurance company requested you to participate in an Examination Under Oath (EUO)?*
- Yes
- No
Name of attorney that is conducting the Examination Under Oath
Date, if any, that the EUO is scheduled for
MM slash DD slash YYYY
Do you believe a person or a company caused the damage?*
- Yes
- No
Who caused the damage?

33450 W. Twelve Mile Rd.
Farmington Hills, MI 48331

p. 248.553.2000
f. 248.553.2020

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