To Claimant: If you received treatment for a previous injury to the same body part or for an illness similar to the one described in your current. (vease abajo.) El no.Claim, fill out this form. Llame al 646-960-8195 o complete este formulario en línea para obtener una consulta gratuita con un abogado de lesiones personales con experiencia. Please fill out the card based on the instructions below. If you are uninsured when your Nassau County car accident occurs, you might be unable to recover compensation for your injuries. Fill out this form to submit your request or call us at.