Get Personal Injury Application - Connecticut Judicial Branch

This guide provides a clear and comprehensive overview of how to complete the Personal Injury Application online for the Connecticut Judicial Branch. Users can navigate the form efficiently, ensuring all necessary information is accurately submitted.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the Personal Injury Application. This will allow you to open the form in the online editor.
2. Begin by completing Section 1, which requires information about the victim. Enter the title, full name, birth date, age, address, phone numbers, email, and primary language spoken.
3. If the victim and claimant are different, fill out Section 2 with the claimant's information, including their relationship to the victim, title, name, birth date, contact details, and primary language spoken.
4. Proceed to Section 3 if you are completing this on behalf of a minor or incapacitated adult. Enter the parent, legal guardian, or conservator's details, including name, address, phone number, and relationship to the victim.
5. In Section 4, indicate whether you have legal representation. If yes, provide the attorney's name, firm, and contact details.
6. Complete Section 5 if you authorize contact with someone else for communication regarding the claim. Include their details and how you know them.
7. Section 6 is optional, where you can provide statistical information about the victim, such as demographics and how you learned about the Victim Compensation Program.
8. Move on to Section 7 or Section 7a to describe the crime, focusing on its details, reporting, and police involvement. Choose the relevant section based on the crime type.
9. In Section 8, if applicable, provide details about any offenders, including whether anyone was arrested and known docket numbers.
10. Fill out Section 9 to report any crime-related expenses and financial resources available. It’s important to list all applicable expenses even if you currently have none.
11. Finally, complete Section 10, signing to certify that the information is truthful and accurate. Review all sections for completeness before submission.

Complete your Personal Injury Application online to ensure prompt assistance and access to benefits.