Medical report - low value personal injury claims in employers' liability and public liability (£1,000 - £25,000)
| Published date | 21 March 2018 |
1
Medical report form (EPL3)
Low value personal injury claims in employers’
liability and public liability (£1,000 to £25,000)
Section A— Claimant’s details
Claimant’s full name
Address
Date of birth
/ /
Occupation
Postcode
1.1 Were medical records provided?Yes No
If Yes, which records were seen?
1.2 Has photo ID been conrmed?Yes No
If Yes, what type of photo ID was checked
If No, what other ID was provided
1.3 Age of the claimant at time of accident/period(s)
of exposure?
1.4 Date of examination/ /
1.5 Date of report/ /
1.6 Name of instructing solicitors/agency
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