Why This Matters (Please Read First)
Insurance adjusters do not experience what you are going through—they only see medical records and bills. Those records often do NOT show how your injuries affect your daily life.
That is why this report is so important.
Your answers help us show:
What your life looks like today, not just on paper
The real-world impact of your injuries
The things you’ve lost that don’t show up in medical records
Adjusters place value on claims based largely on how injuries affect:
Your daily routine
Your ability to function
Your independence
Your enjoyment of life
The more specific and real your answers are, the stronger your case becomes.
Think in terms of:
What can’t you do anymore?
What is harder than it should be?
What do you push through in pain?
Part 1: Your Story – How Your Life Has Changed
1. What You Can No Longer Do (or Can Only Do with Pain)
What activities could you do before the accident that you now avoid?
What can you only do now with pain, help, or breaks?
Examples:
Gym, workouts, running, lifting weights
Sports like basketball, golf, or softball
Yard work or home projects
Long walks or standing
2. A Typical Day for You Now
Walk us through your day:
How do you feel when you wake up?
How long does it take to get moving?
When does pain show up during the day?
What do you have to limit, stop, or avoid?
3. Sleep Issues
Trouble falling asleep or staying asleep?
Pain waking you up?
Need pillows, medication, or naps?
How does poor sleep affect your day?
4. Getting Dressed & Personal Care
Difficulty bending, lifting arms, or putting on shoes?
Pain when showering?
Need help with basic tasks?
5. Cooking & Household Tasks
Can you cook like before?
Trouble standing, lifting, reaching?
What chores do you no longer do?
Who does them now?
6. Kids & Family Life
Difficulty lifting or playing with children?
Missed games, practices, or events?
Changes in your role at home?
7. Work & Driving
Is driving painful or stressful?
Does work increase your pain?
Are you working through pain?
8. Hobbies & Social Life
What have you stopped doing?
What do you still do but no longer enjoy?
9. Travel & Missed Experiences
Trips canceled or avoided?
Difficulty with long car rides or flights?
10. Before vs. Now
Who were you before the accident?
Who are you today?
What do you miss most?
Part 2: Quick Checklist (Complete This Too)
Check all that apply and add notes where helpful:
Daily Life
☐ I have trouble sleeping
☐ I wake up in pain or stiffness
☐ I need extra time to get ready
☐ I avoid certain movements (bending, lifting, reaching)
Personal Care
☐ Getting dressed is difficult
☐ Showering/bathing is painful
☐ I need help with personal tasks
Home & Chores
☐ I cannot do certain household chores
☐ I need help with cooking or cleaning
☐ I take breaks to complete simple tasks
Physical Activity
☐ I no longer go to the gym
☐ I stopped playing sports (list): __________
☐ Walking or standing is limited
Work & Driving
☐ Driving causes pain or stress
☐ I avoid driving when possible
☐ Work increases my pain
☐ I have missed work or reduced duties
Family & Kids
☐ I cannot play with my children like before
☐ I miss activities or events
☐ I feel limited in my role at home
Social & Enjoyment
☐ I go out less often
☐ I avoid social events
☐ I no longer enjoy hobbies
Travel
☐ I have canceled trips
☐ Long travel is difficult or painful