**Please note for the following questions** A personal injury is a bodily injury sustained by the claimant as a result of negligence. A wrongful death is where the claimant who sustained the personal injury has died. If you select "Other", you will need to provide an additional basis for your claim.
STATE NATURE AND EXTEND OF EACH INJURY OR CAUSE OF DEATH, WHICH FORMS THE BASIS OF THE CLAIM. (Check all that apply)
