Injured While Employed as a Civilian Contractor?

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Were or are you employed by an American civilian contracting company to work in a war-zone?
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What company(ies) were or are you employed by to work as a civilian contractor in a war-zone?

Please provide your dates of employment.

(mm/dd/yy) - (mm/dd/yy)

Did or does your employer provide you with insurance coverage? If so, which insurance company serviced the policy?

Were you ever injured while working for the company listed above?
Yes No

Please describe the circumstances surrounding your injuries and the injuries themselves?

Did you have any problems receiving insurance payments after your injury? If so, please describe those problems.

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