Farmers Insurance PIP Class-Action Lawsuit Registration

In any class-action suit, the court approves who will be eligible for participation. If you feel you may qualify to be part of this class or would like to receive additional information, we request you fill out the form below.

All information is confidential. However, if you would like to join the class and do not wish to submit information via the Internet, please contact us by phone at (206) 623-7520.

Name:
Street:
City, State, Zip
Email Address:
Phone Number:
Date of Injury (MM/DD/YYYY):
Name of PIP insurance company:
Are you currently represented?:
If so, name of attorney:
Briefly explain your situation and any relevant correspondence you've received from your PIP insurance company:



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