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Pre-Settlement Funding
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About Our Pre

Medical Malpractice Application ©

As you no doubt already know, Medical Malpractice claims are very difficult cases that can take many years to conclude and even then, may be subject to many appeals.

The latest Justice Department Statistics reveal that less than half of all Medical Malpractice cases that concluded via a verdict, are won by the plaintiff. CapTran's Consulting Attorney, who is an expert in Medical Malpractice will evaluate your case for us.

Fill out as much information as possible. We will obtain missing information from your attorney.

(CapTran does not invest in cases whose basis of venue and/or residence of claimant is Alabama, Alaska, District of Columbia, Georgia, Indiana, Iowa, Kentucky, Louisiana, Michigan, Missouri, Montana, Nevada, Ohio, Rhode Island, South Dakota, Utah, Vermont, Wyoming.)

Broker Code (if applicable):

I have a Personal Injury Lawsuit/Claim/Action

I have retained an attorney

I do not have a criminal record

Step 1. Personal Information

Victim's Full Name:

Email Address:

Address:

Apartment/Suite:

City:

State:

Zip:

Home Phone:

Work Phone:

Date of Birth:

Education:

Amount being requested?

Step 2. Description of Event That Gives Rise To The Medical Malpractice Claim (If you do not know all of the medical providers names we will obtain them later.)
Date of Malpractice Event:
Medical Procedure:		Hospital:
City:	State:		Zip:
Describe what you believe the malpractice was:

Step 3. Injuries/Damages
What physical and/or mental injuries did you suffer as a result of the Medical Malpractice?:
What are your current medical complaints?:
What injuries do you believe are permanent?:

Step 4. Attorney Information
Name:	Firm:
Address:	Address 2:
City:	State:	Zip:
Telephone:	Fax:
Paralegal:	Phone:

Step 5. Records Release Authorization
In order to obtain information about your case you provide your attorney with authorization to release your case records and information to us. We cannot proceed without it.
Dear : Enter your Attorney’s name here
I hereby request and authorize your firm to cooperate and release to Capital Transaction Group Inc (Captran) any and all information and documents pertaining to my current case. I additionally ask that you share your candid opinion regarding this action with the above firm. I acknowledge that I understand the benefits of non-recourse funding. I further acknowledge I understand the effects of disclosing the contents of my file, including waiver of the attorney-client and work product privileges. Thank you in advance for your cooperation in this matter.
Enter Your Full Name Here:
Enter Today’s Date Here:
By clicking here you indicate that you have read and agree to the Records Release Authorization. You must check this box to have your application processed. This gives us permission to contact your attorney and review your file. All information is held strictly confidential.

Disclaimer: The material published at this site is for informational purposes only and is not intended to be legal advice. Transmission of the information is not intended to create, and receipt does not constitute, an attorney-client relationship between any parties whatsoever. Readers, whether or not attorneys, should not act upon this information without seeking professional advice or doing independent legal research. CapTran disclaims any liability whatsoever for any consequences that may flow from any material published here.
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Pre-Settlement Funding Financing Justice®

Pre-Settlement Funding
Financing Justice®