Intake – User's blog

01

Document Upload

AWS Textract OCR — upload supporting documents

🪪 Driver's Licence JPG · PNG · PDF

🏥 Health Card JPG · PNG · PDF

📋 Insurance Card JPG · PNG · PDF

🚔 Police Report JPG · PNG · PDF

+ Add More Files

02

Administrative

File details, retainer, and classification

Matter ID

Date of Interview

Interviewer

Referred By

Claim Classification

AB Claim Tort Claim Both 6-Month Tort Review Retainer Signed Conflict Check Done

Client Role in Accident

Driver Passenger Pedestrian Cyclist

03

Client Personal Information

Contact details and identification

Full Name *

Date of Birth

Cell Phone

Home Phone

Work Phone

Email Address

Preferred Language

Home Address

Marital Status

Number of Children

Driver's Licence #

Licence Class

Health Card #

OHIP / SIN

Emergency Contact

Social Media

City / Municipality Entity

Interpreter Required?

No Yes

04

Insurance Coverage

AB and tort insurance details

Coverage Type

Standard Enhanced Optional Non-Resident OCF-1 Submitted AB File Requested Optional Benefits

AB Insurance (Client's Policy)

Policy Holder

Insurance Company

Policy #

Claim #

Effective Date

Expiry Date

Vehicle Make

Vehicle Model

Plate / Owner

05

Accident Details

Date, location, circumstances

Date of Loss *

Time of Accident

Location / Intersection

City

Police Report #

Officer Name

Badge #

Conditions at Time of Accident

Narrative — How did the accident happen?

Other Occupants in Vehicle

06

Defendants & Property Damage

At-fault parties and vehicle damage

Defendant 1

Name

Address

Insurance Co.

Policy #

Vehicle Make/Model

Plate #

Defendant 2

Name

Address

Insurance Co.

Policy #

Vehicle Make/Model

Plate #

Property Damage

Damage Description

Witnesses

Total Loss Secondary Impact Scene Photos Vehicle Photos Injury Photos

07

Medical History & Injuries

Prior claims, injuries, and pre-existing conditions

Prior Claims / History

Prior MVA Prior AB Claim Prior Tort Claim WSIB Claim Criminal Record Substance Use

Prior Claim Details

Current Injuries *

Pre-Existing Conditions

08

Treatment

Hospital, imaging, ongoing care

Ambulance to Hospital X-Ray MRI CT Scan Ultrasound

Hospital Name AI

Visit Expenses

Current Family Doctor

GP Since (Date)

Previous GP

Walk-In Clinic

Pharmacy

Physio / Rehab Clinic

Activities Affected

09

Employment & Income

Work status and loss of income details

Employment Status

Full-Time Part-Time Self-Employed Unemployed Retired Student On Disability

Employer Name

Job Title

Annual Salary / Rate

Union Member?

Missed Work From

Return to Work Date

Modified Duties?

Accountant

Extended Health Benefits

LTD / STD Coverage

Caregiver Responsibilities

Accommodations Required