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Medical report - low value personal injury claims in employers' liability and public liability (£1,000 - £25,000)

Document Cited in Related
Vincent
Published date21 March 2018
Subject MatterRoad Traffic Act personal injury forms
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 conrmed? 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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