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Maritime & Admiralty Intake Questionnaire

Please tell us about your injury on the water, on a dock, or on a platform. Maritime law is a separate federal system with its own deadlines — some as short as 30 days — so please answer as completely as you can and send this in promptly. There are no wrong answers. If you do not know something, skip it or write “not sure” — that is useful information too.

985-612-7220 | stephen@aertkerlegal.com | www.aertkerlegal.com | 229 N. Vermont St., Covington, LA 70433
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PLEASE READ FIRST. Submitting this questionnaire does not create an attorney-client relationship and does not by itself make you a client or prospective client of the firm. No representation begins until the firm has checked for conflicts of interest and you and the firm have signed a written engagement agreement. Do NOT include your full Social Security number anywhere on this form. Please name your employer, the vessel and its owner, and any lawyer who has already talked with you about this injury, so the firm can check for conflicts of interest. If anyone has asked you to sign anything — a statement, a release, a receipt, or an arbitration agreement — please do not sign it before a lawyer reads it. Section 10 asks about this, and it matters more than most people expect. Information you submit is handled confidentially consistent with Louisiana Rule of Professional Conduct 1.18.
1
Contact Information
Please tell us who you are and the best way to reach you.
If you are hard to reach for stretches at a time, tell us so we do not miss you.
2
What You Were Doing
This is the most important question on the form. Which body of law governs your case — and what you can recover — depends on what you were doing and where. Check every box that fits. If none fit, or you are not sure, say so; that is a normal answer and we will sort it out.
Checking a box does not decide anything. Whether you are legally a “seaman,” a “longshore worker,” or neither is a question courts decide on the facts — which is exactly what the next few sections collect.
Several maritime deadlines run from this date, and one of them can be as short as 30 days. Please send this form in as soon as you can.
3
What Happened
Tell it in your own words. Do not worry about legal terms — just what happened, in order.
Whether the water is legally “navigable” can decide which law applies.
Distance from shore can change which law applies.
What were you doing? What went wrong? What equipment was involved? Who else was there?
Broken or missing equipment, short-handed crew, weather, being rushed, no training, an unsafe order — whatever you saw. Your view matters even if you are not certain.
For dock and harbor workers this date can be critical — written notice is generally due within 30 days.
If you can get a copy, do. If they will not give you one, tell us — that is worth knowing.
Post-incident testing is routine in this industry. We ask because we need the whole picture, not because a test result ends a case.
4
Your Work & the Vessel
These questions look picky, and they are the ones that decide your case. Courts sort maritime workers into categories based on facts like these — how much time you spent aboard, whether the vessel moved, and how long your assignment was. Please answer as precisely as you can.
Needed for the conflict-of-interest check.
If yes, name both companies below. Who your legal employer is can be contested.
If someone other than your paycheck employer ran your work, say so. It can change who is responsible.
Best estimate is fine. Courts use a rough guideline of about 30% of work time in the service of a vessel — but it is only a guideline, not a cutoff, so answer honestly rather than trying to hit a number.
A barge or rig tied up in one spot for a long time may not count as a “vessel” at all.
This distinction has become decisive in recent Fifth Circuit decisions, especially for yard and shore-based tradesmen sent aboard for particular jobs.
We ask because federal law changed here. For injuries on or after December 23, 2022, aquaculture workers are treated differently than other maritime workers. If someone told you years ago what your rights were, that advice may no longer fit.
5
Maintenance & Cure (Crew Members)
If you are a crew member, your employer may owe you daily living money (“maintenance”) and payment of your medical care (“cure”) — no matter who was at fault, and even if nobody was. It is not a settlement, it is not a favor, and accepting it does not give up any other claim. This is also where injured crew are most often quietly shortchanged.
Token daily rates with no relationship to real rent and food costs are common, and they are challengeable.
Sometimes called “maximum medical improvement.” Benefits are often cut off at this point — sometimes far too early, on one visit with a company-chosen doctor.
This may not be the date you were hurt. Some people work hurt for weeks or months before they cannot anymore. That later date can matter a great deal, so give us your best recollection.
If so, tell us who said it and when in the box below. This happens, courts have seen it, and it is worth documenting.
6
Dock, Harbor & Yard Workers
Dock, terminal, shipyard, and fabrication-yard workers usually fall under a federal compensation system rather than state workers' compensation. It has short deadlines and two traps that can quietly destroy an otherwise good claim. These questions find them.
Written notice is generally due within 30 days. If you have not given it, call us today rather than filling this out later.
Often a form called an LS-203. Generally due within one year.
This distinction decides cases. Accepting payments under a formal award can hand your claim against other companies to your employer if suit is not filed within six months. Voluntary payments made without an award do not do that. If you are unsure, that is a good reason to call.
A six-month clock can run from this date.
Settling with another company without your employer's written approval can end your compensation and medical benefits entirely. If anyone has offered you money to sign, please call before you do.
Hearing-loss deadlines work differently — the clock generally does not start until you actually receive the audiogram and its report. If you have never had one, say so; that may be good news for your timing.
7
Offshore & Platform Work
Offshore is where the categories collide. The same company, the same field, and the same job title can land under completely different law depending on what you were standing on. These questions pin that down.
A fixed platform is generally not a vessel — which routes the whole case differently. If you were hurt getting from one to the other, that detail matters a lot.
Not sure is a perfectly good answer — we can establish it from the block number.
8
Boating & Passenger Injuries
People are often surprised that federal maritime law reaches a Saturday on the Lake. It can. It also gives boat owners a powerful move that most families have never heard of — and it runs on a clock that a single letter can start.
Tickets and rental agreements often shorten deadlines and dictate where suit must be filed. If you still have it, please attach it in Section 13.
Please tell us the date. A written demand can start a six-month clock for the boat owner to ask a federal court to cap what your family can recover at the value of the boat. Most people have no idea this exists.
If yes, contact us immediately and attach them. If a boat owner has filed to limit liability, there is a deadline to respond and it is not generous.
9
Owners & Other Companies
The most valuable part of a maritime case is often a claim against a company that is not your employer. Those claims are routinely missed. Name everyone you can — we also need this for the conflict-of-interest check.
If the answer is yes, there may be a separate claim worth far more than compensation benefits alone.
10
Anything You Have Signed
Please read this section carefully. Paperwork after an injury can quietly give away your right to a jury, or your claim altogether. Courts have enforced these documents against injured maritime workers even when the worker said he felt pressured into signing. If you have not signed yet, do not sign anything until a lawyer has read it — that is free advice and it costs you nothing to follow.
“I signed something but I do not know what it was” is a common and completely understandable answer. Check it if it fits.
If you have them, please attach them in Section 13.
Most people do not remember. That is fine — we will look.
If yes, please call us at 985-612-7220 before you sign. Do not wait for us to reach you about this form.
Who asked, when, where, what they said it was, and whether anyone explained it to you.
11
Your Injuries & Treatment
Your medical record is the backbone of the case. Tell us what was hurt and who has treated you.
Names and cities are enough. Include anyone the company sent you to.
Please be complete here, even if it feels unhelpful. Prior problems do not sink a case — but a prior problem the other side finds first, and we did not know about, can. Include anything you disclosed or were asked about on a pre-hire physical or medical questionnaire.
12
Wages, Witnesses & Other Lawyers
Maritime pay is not like shore pay, so we ask about it specifically. We also need to know who saw what — and whether another lawyer is already involved.
This affects what your daily living allowance should be.
Names, nicknames, job titles, phone numbers — whatever you have. Crews turn over fast, so even a nickname helps.
If you have photos on your phone, keep them and do not delete anything — even things you think look bad for you.
Needed for the conflict-of-interest check. It does not disqualify you.
If they have asked for a recorded statement, please talk to us first.
13
Documents & Submission
You're almost done. Attach anything you have, add whatever we did not ask about, then submit.

If you can, attach up to three documents. The most useful are: (1) anything you signed, or any court papers you received; (2) the accident or incident report, and any letter about your benefits; (3) photos of the scene or the equipment. PDF, Word, or image. Phone photos of paperwork are fine. You may bring or email more to your consultation.

Up to ~7 MB total across all files. For larger or highly sensitive files, please email them separately or bring them to your appointment. Please do not upload anything showing your full Social Security number.

For questions about this form or to reach our office, contact 985-612-7220 or stephen@aertkerlegal.com.

Learn about our Maritime & Admiralty practice

This questionnaire is confidential. Communications from prospective clients are protected under Louisiana Rule of Professional Conduct 1.18. Stephen C. Aertker, Jr. is licensed in Louisiana and Mississippi.