Application for Disability Appraisal 1 Applicant: xx
20xx year x month x day
Format and precautions of the model application for disability appraisal: the application for disability appraisal can be unilaterally entrusted to a judicial appraisal institution for appraisal before prosecution. After filing the case, the application for disability appraisal shall be completed within the time limit for proof and submitted to the people's court; Submit a copy of the application materials for disability appraisal to the people's court.
Application for disability appraisal
Applicant: name, nationality, date of birth, place of birth, home address and telephone number.
Request: Request the people's court to entrust an appraisal institution to appraise the applicant's disability level, lost time, number of nurses, nursing period and follow-up treatment expenses.
Facts and reasons:
The case of the dispute between the applicant and Zhang Qianwan over the liability for motor vehicle traffic accidents has been submitted to your hospital for acceptance. The applicant was seriously injured in this accident, resulting in intracranial hemorrhage, lung contusion and laceration and fracture of the right lower limb. Application form for disability appraisal. After receiving treatment in the hospital, although the treatment ended, IQ has been affected so far. After the fracture of the right lower limb healed, the right lower limb was shorter than the left lower limb, and the movement was inflexible, so it could not return to normal function. In order to claim compensation, the applicant now needs to identify the disability level, the number and time of nurses and the follow-up treatment expenses, so as to determine the disability compensation, lost time, nursing expenses and follow-up treatment expenses. Please arrange an appraisal in your hospital.
I am here to convey
Guigang gangbei district people's court
Applicant:
date month year
Matters needing attention in writing an application for disability appraisal:
1. To apply for disability appraisal, you can unilaterally entrust a judicial appraisal institution for appraisal before prosecution.
2. After filing the case, the application for disability appraisal shall be completed within the time limit for proof and submitted to the people's court; Submit a copy of the application materials for disability appraisal to the people's court.
3. The application for disability appraisal can be signed by me or applied by an agent ad litem.
Hello, the lawyer's reply to the question you described is as follows:
First of all, for the damages caused by personal injury, please refer to Tort Liability Law, the Supreme People's Court's Interpretation on Several Issues Concerning the Application of Laws in the Trial of Personal Injury Compensation Cases and the Supreme People's Court's Interpretation on Several Issues Concerning the Determination of Civil Tort Liability for Spiritual Damage.
Secondly, after confirming the fact of personal injury, confirm the corresponding responsibility for causing personal injury and bear the corresponding responsibility according to the size of the responsibility.
Third, personal injury compensation needs to identify the disability level and confirm the specific compensation amount according to the identification results. The disability grade appraisal is appraised by a specialized appraisal institution.
Fourth, after determining the level of personal injury and disability, the main scope of compensation includes medical expenses, hospitalization expenses, nursing expenses, nutrition expenses, lost time, one-time disability allowance, mental damage compensation, etc.
Fifth, according to the average salary of local employees in the previous year, as well as the age and household registration of the victims, all kinds of compensation responsibilities are confirmed.
Sixth, you can hire a lawyer for personal injury compensation, and the lawyer's fee will also be borne by the future injuring party.
Chapter II Application for Disability Appraisal Applicant: _ _ _ _ _ _ _ _, male, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.
Application items:
1, disability grade identification;
2, follow-up treatment cost identification.
Facts and reasons:
Your hospital has accepted my case of _ _ _ _ _ _ _ _ _. In order to accurately calculate the amount of disability compensation and follow-up treatment expenses, we now apply to the people's court to entrust the relevant departments to identify the disability level and follow-up treatment expenses of _ _ _ _ _ _ _ _ _ in this accident. Please entrust!
Bring a lawsuit to the people's court of _ _ _ _ District.
Applicant: _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Chapter III Application for Disability Appraisal:
Apply for a new judicial appraisal of Zhou XX's injury.
Facts and reasons
Brief description of the case: 20xx65438+February 65438+July 20th around 0: 20, the applicant and friends went to xx Entertainment City to sing. At 4 o'clock in the morning, when the applicant checked out with the store, he found that the bookkeeping was obviously inconsistent with the actual consumption, and immediately raised an objection to the staff. Zhou XX, the boss of the karaoke bar, pushed the applicant forward to find an excuse to argue with the applicant. At that time, the applicant was weak because of drinking. Unable to break free, in order to get rid of his entanglement, the applicant picked up the beer bottle next to him and threatened Zhou XX. Zhou XX took the opportunity to grab the beer bottle in the applicant's hand and slammed it on the applicant's head. Suddenly, he was bloody, grabbed the applicant's neck and slammed it on the wall, and shouted out the casino thugs. In the struggle, the applicant touched a beer bottle to defend himself. Zhou XX still grabbed the candidate's clothes and ordered five or six thugs with steel pipes to knock the candidate to the ground. Zhou XX took the opportunity to dig the candidate's eyes, and the candidate tried his best to protect himself with both hands to avoid further injury. Then, Zhou XX fled the scene and the applicant waited for the police to handle it. After the police arrived at the scene, the applicant truthfully stated the case. Appraised by the appraisal agency, the applicant's injury is less than minor injuries. At the same time, with Zhou XX's injury certificate, Zhou XX was identified as a minor injury. 20xx1Feb. 7 17, according to * Gong Zi (20xx)020 1, it is decided that the applicant should get a guarantor pending trial and pay the weekly medical expenses first 1500 yuan. After the incident, the applicant spent RMB for treatment.
The applicant believes that Zhou XX's injury does not constitute a minor injury according to law for the following reasons:
1. According to Article 3 of the Appraisal Standard for Human Minor Injuries (Trial): "The appraisal of the degree of injury shall be based on the main damage and consequences directly caused by external factors, including the injury situation at that time, complications and sequelae caused by the injury, etc. And comprehensive analysis and evaluation. " When Zhou * did the appraisal, the injury was uncertain and the consequences were unpredictable.
2. According to the second paragraph of Article 4 of the Minor Injury Appraisal Standard (Trial), "the appraiser has the right to know the case, consult the case files, medical records and on-site inspection, and the relevant units have the responsibility to cooperate." Without knowing the case, consulting the medical records and inspecting the scene, the appraisal institution only made a minor injury conclusion based on Zhou X's injury certificate. The evidence is thin and it is difficult to convince the applicant.
To sum up, the applicant stipulated in Article 241 of the Procedures for Handling Criminal Cases by Public Security Organs that "the public security organ shall inform the criminal suspect and the victim of the appraisal conclusion used as evidence. If a criminal suspect or victim disagrees with the conclusion of the appraisal and applies, he may make supplementary appraisal or re-appraisal with the approval of the person in charge of the public security organ at or above the county level. " In order to handle this case objectively and fairly, the applicant implores you to verify the case and re-evaluate Zhou XX's injury according to law, so as to safeguard the legitimate rights and interests of the applicant.
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