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{"id":544,"date":"2023-03-08T22:31:47","date_gmt":"2023-03-08T22:31:47","guid":{"rendered":"https:\/\/axidentlawyers.com\/?page_id=544"},"modified":"2023-05-18T05:56:16","modified_gmt":"2023-05-18T05:56:16","slug":"assessment","status":"publish","type":"page","link":"https:\/\/axidentlawyers.com\/index.php\/assessment\/","title":{"rendered":"Assessment"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"544\" class=\"elementor elementor-544\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7810b92 elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"7810b92\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container 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elementor-section-height-default\" data-id=\"004cfff\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-fcb5593\" data-id=\"fcb5593\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-32eea8a elementor-widget elementor-widget-heading\" data-id=\"32eea8a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">AXIDENT LAWYERS FREE CASE VALUE ASSESSMENT TOOL<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f6c6787 elementor-widget-divider--view-line 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You have selected correct answer.\",\"quick_result_wrong_answer_text\":\"Wrong! You have selected wrong answer.\",\"quiz_processing_message\":\"\",\"not_allow_after_expired_time\":\"\",\"scheduled_time_end\":false,\"error_messages\":{\"email_error_text\":\"Not a valid e-mail address!\",\"number_error_text\":\"This field must be a number!\",\"incorrect_error_text\":\"The entered text is not correct!\",\"empty_error_text\":\"Please complete all required fields!\",\"url_error_text\":\"The entered URL is not valid!\",\"minlength_error_text\":\"Required atleast %minlength% characters.\",\"maxlength_error_text\":\"Maximum %maxlength% characters allowed.\"},\"first_page\":true}\n                    <\/script><div class='qsm-quiz-container qsm-quiz-container-1 qmn_quiz_container mlw_qmn_quiz  quiz_theme_default  '>\n\t\t\t\t\t<form name=\"quizForm1\" id=\"quizForm1\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/544\" method=\"POST\" class=\"qsm-quiz-form qmn_quiz_form mlw_quiz_form\" novalidate enctype=\"multipart\/form-data\">\n\t\t\t\t<input type=\"hidden\" name=\"qsm_hidden_questions\" id=\"qsm_hidden_questions\" value=\"\">\n\t\t\t\t<div id=\"mlw_error_message\" class=\"qsm-error-message qmn_error_message_section\"><\/div>\n\t\t\t\t<span id=\"mlw_top_of_quiz\"><\/span>\n\t\t\t\t\t\t\t<section class=\"qsm-page \">\n\t\t\t\t<div class=\"quiz_section quiz_begin\">\n\t\t\t\t\t<div class='qsm-before-message mlw_qmn_message_before'>\n\t\t\t<p>Let's start to know the value of the case<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"qsm_contact_div qsm-contact-type-text\">\n\t\t\t\t\t\t\t\t\t\t<span class='mlw_qmn_question qsm_question'>NAME<\/span>\n\t\t\t\t<input type='text' class=''  name='contact_field_0' id='contact_field_0'  value=''  placeholder='NAME'  \/>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_contact_div qsm-contact-type-text\">\n\t\t\t\t\t\t\t\t\t\t<span class='mlw_qmn_question qsm_question'>PHONE<\/span>\n\t\t\t\t<input type='text' class='mlwPhoneNumber'  name='contact_field_1' id='contact_field_1'  value=''  onkeydown='return event.keyCode !== 69'  placeholder='PHONE'  \/>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_contact_div qsm-contact-type-email\">\n\t\t\t\t\t\t\t\t\t\t<span class='mlw_qmn_question qsm_question'>EMAIL<\/span>\n\t\t\t\t<input type='email' class='mlwEmail '  name='contact_field_2' id='contact_field_2'  value=''  placeholder='EMAIL'  \/>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_contact_div qsm-contact-type-text\">\n\t\t\t\t\t\t\t\t\t\t<span class='mlw_qmn_question qsm_question'>ADDRESS:<\/span>\n\t\t\t\t<input type='text' class=''  name='contact_field_3' id='contact_field_3'  value=''  placeholder='ADDRESS:'  \/>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_contact_div qsm-contact-type-date\">\n\t\t\t\t\t\t\t\t\t\t<span class='mlw_qmn_question qsm_question'>Date of Birth<\/span>\n\t\t\t\t<input type='date' class=''  name='contact_field_4' id='contact_field_4'  value=''  value='' \/>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/section>\n\t\t\t\t\t\t\t<section class=\"qsm-page  qsm-page-1\"\n\t\t\t\t\t\tdata-pid=\"1\" data-prevbtn=\"0\" style='display: none;'>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-55  category-section-id-c10' data-qid='55'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>DO YOU HAVE AN ATTORNEY REPRESENTING YOU RIGHT NOW ON THIS CASE? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class=\"qmn_radio_answers qmn_radio_horizontal_answers \">\n\t\t\t\t\t\t\t<span class=\"mlw_horizontal_choice \">\n\t\t\t\t\t\t<input type=\"radio\" class=\"qmn_quiz_radio\" name=\"question55\" id=\"question55_1\" value=\"0\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question55_1\">\n\t\t\t\t\t\t\tYES\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"mlw_horizontal_choice \">\n\t\t\t\t\t\t<input type=\"radio\" class=\"qmn_quiz_radio\" name=\"question55\" id=\"question55_2\" value=\"1\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question55_2\">\n\t\t\t\t\t\t\tNO\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question55\" id=\"question55_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-56  category-section-id-c10' data-qid='56'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>NAME OF YOUR ATTORNEY <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<input  type=\"text\" class=\"mlw_answer_open_text \" name=\"question56\"  \/>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-57  category-section-id-c10' data-qid='57'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>PHONE NUMEBR OF THE ATTORNEY: <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<input  type=\"text\" class=\"mlw_answer_open_text \" name=\"question57\"  \/>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-58  category-section-id-c10' data-qid='58'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>WHERE YOU INVOLVED IN THE ACCIDENT YOURSELF? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question58-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question58\" id=\"question58_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question58_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question58-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question58\" id=\"question58_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question58_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question58\" id=\"question58_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-59  category-section-id-c10' data-qid='59'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>BRIEFLY DESCRIBE WHAT HAPPENNED: <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<input  type=\"text\" class=\"mlw_answer_open_text \" name=\"question59\"  \/>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/section>\n\t\t\t\t\t\t\t\t<section class=\"qsm-page  qsm-page-2\"\n\t\t\t\t\t\tdata-pid=\"2\" data-prevbtn=\"0\" style='display: none;'>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-1  category-section-id-c10' data-qid='1'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>ARE YOU MALE OR FEMALE? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question1-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question1\" id=\"question1_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question1_1\">\n\t\t\t\t\tMale\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question1-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question1\" id=\"question1_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question1_2\">\n\t\t\t\t\tFemale\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question1\" id=\"question1_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-3  category-section-id-c10' data-qid='3'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>AGE? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<input type=\"number\" class=\"mlw_answer_number \" name=\"question3\"  \/>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-4  category-section-id-c10' data-qid='4'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>WHAT STATE DID THE ACCIDENT OCCUR IN? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<select class=\"qsm_select qsm_dropdown \" name=\"question4\">\n\t<option disabled selected value>Please select your answer<\/option>\n\t\t\t\t\t\t\t<option value=\"0\">Alabama<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">Alaska<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">Arizona<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">Arkansas<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">California<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">Colorado<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">Connecticut<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"7\">Delaware<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"8\">Florida<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"9\">Georgia<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"10\">Hawaii<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"11\">Idaho<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"12\">Illinois<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"13\">Indiana<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"14\">Iowa<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"15\">Kansas<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"16\">Kentucky<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"17\">Louisiana<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"18\">Maine<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"19\">Maryland<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"20\">Massachusetts<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"21\">Michigan<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"22\">Minnesota<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"23\">Mississippi<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"24\">Missouri<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"25\">Montana<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"26\">Nebraska<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"27\">Nevada<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"28\">New Hampshire<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"29\">New Jersey<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"30\">New Mexico<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"31\">New York<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"32\">North Carolina<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"33\">North Dakota<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"34\">Ohio<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"35\">Oklahoma<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"36\">Oregon<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"37\">Pennsylvania<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"38\">Rhode Island<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"39\">South Carolina<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"40\">South Dakota<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"41\">Tennessee<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"42\">Texas<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"43\">Utah<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"44\">Vermont<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"45\">Virginia<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"46\">Washington<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"47\">West Virginia<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"48\">Wisconsin<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"49\">Wyoming<\/option>\n\t\t\t\t\t \t<\/select>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-5  category-section-id-c10' data-qid='5'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>ARE YOU ENQUIRING ON YOUR OWN BEHALF OR SOMEONE ELSE\u2019S BEHALF? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question5-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question5\" id=\"question5_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question5_1\">\n\t\t\t\t\tMY OWN\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question5-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question5\" id=\"question5_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question5_2\">\n\t\t\t\t\tSOMEONE ELSE\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question5\" id=\"question5_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-6  category-section-id-c10' data-qid='6'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>IF SOMEONE ELSE, IS THAT PERSON RELATED TO YOU? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question6-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question6\" id=\"question6_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question6_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question6-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question6\" id=\"question6_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question6_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question6-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question6\" id=\"question6_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question6_3\">\n\t\t\t\t\tN\/A\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question6\" id=\"question6_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-8  category-section-id-c10' data-qid='8'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>IF SOMEONE ELSE, DID THAT PERSON DIE AS A RESULT OF THE ACCIDENT? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question8-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question8\" id=\"question8_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question8_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question8-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question8\" id=\"question8_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question8_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question8\" id=\"question8_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-31  category-section-id-c10' data-qid='31'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>ARE YOU THE SPOUSE OF THE DECEASED? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question31-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question31\" id=\"question31_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question31_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question31-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question31\" id=\"question31_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question31_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question31\" id=\"question31_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-7  category-section-id-c10' data-qid='7'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>IF YOUR OWN, WERE YOU INJURED IN THE ACCIDENT? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question7-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question7\" id=\"question7_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question7_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question7-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question7\" id=\"question7_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question7_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question7\" id=\"question7_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-17  category-section-id-c10' data-qid='17'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>ARE THERE INSURANCE COVERAGES IN FORCE TO COVER THE DAMAGES? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question17-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question17\" id=\"question17_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question17_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question17-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question17\" id=\"question17_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question17_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question17\" id=\"question17_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-16  category-section-id-c10' data-qid='16'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>DID YOU SEE A PHYSICIAN SHORTLY AFTER? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question16-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question16\" id=\"question16_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question16_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question16-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question16\" id=\"question16_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question16_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question16\" id=\"question16_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-19  category-section-id-c10' data-qid='19'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>DO YOU HAVE INSURANCE TO COVER YOUR DAMAGES? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question19-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question19\" id=\"question19_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question19_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question19-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question19\" id=\"question19_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question19_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question19\" id=\"question19_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-47  category-section-id-c10' data-qid='47'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>DO YOU HAVE HEALTH INSURANCE TO COVER YOUR HEALTHCARE? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question47-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question47\" id=\"question47_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question47_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question47-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question47\" id=\"question47_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question47_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question47\" id=\"question47_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-26  category-section-id-c10' data-qid='26'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>AS A RESULT OF THE INJURY DID YOU LOSE ANY PROVEABLE AMOUNT OF MONEY DIRECTLY DUE TO LOSS OF INCOME OR OTHER RELATED LOSSES? IF SO, HOW MUCH? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<input type=\"number\" class=\"mlw_answer_number \" name=\"question26\"  \/>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-27  category-section-id-c10' data-qid='27'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>AS A RESULT OF THE ACCIDENT, DID YOU INCUR ANY DIRECT PROVABLE EXPENSE? IF SO, HOW MUCH? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<input type=\"number\" class=\"mlw_answer_number \" name=\"question27\"  \/>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-28  category-section-id-c10' data-qid='28'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>AS A RESULT OF THE ACCIDENT, DO YOU EXPECT TO LOSE A PROVABLE AMOUNT OF INCOME FROM YOUR FUTURE POTENTIAL EARNINGS? IF SO, HOW MUCH? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<input type=\"number\" class=\"mlw_answer_number \" name=\"question28\"  \/>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-29  category-section-id-c10' data-qid='29'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>AS A RESULT OF THE ACCIDENT, WERE THERE ANY OTHER DIRECT PROVABLE LOSSES CAUSED BY THE ACCIDENT? IF SO, HOW MUCH? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<input type=\"number\" class=\"mlw_answer_number \" name=\"question29\"  \/>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/section>\n\t\t\t\t\t\t\t\t<section class=\"qsm-page  qsm-page-3\"\n\t\t\t\t\t\tdata-pid=\"3\" data-prevbtn=\"0\" style='display: none;'>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-42  category-section-id-c8' data-qid='42'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>WAS THE OTHER PARTY AT FAULT? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question42-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question42\" id=\"question42_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question42_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question42-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question42\" id=\"question42_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question42_2\">\n\t\t\t\t\tNOW\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question42\" id=\"question42_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-9  category-section-id-c8' data-qid='9'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>WERE THERE ANY WITNESSES? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question9-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question9\" id=\"question9_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question9_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question9-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question9\" id=\"question9_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question9_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question9\" id=\"question9_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-10  category-section-id-c8' data-qid='10'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>WERE PARAMEDICS CALLED? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question10-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question10\" id=\"question10_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question10_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question10-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question10\" id=\"question10_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question10_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question10\" id=\"question10_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-11  category-section-id-c8' data-qid='11'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>WAS THE POLICE CALLED? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question11-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question11\" id=\"question11_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question11_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question11-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question11\" id=\"question11_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question11_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question11\" id=\"question11_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-12  category-section-id-c8' data-qid='12'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>WAS A POLICE REPORT MADE? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question12-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question12\" id=\"question12_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question12_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question12-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question12\" id=\"question12_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question12_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question12\" id=\"question12_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-14  category-section-id-c8' data-qid='14'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>WERE YOU TRANSPORTERD TO A HOSPITAL\/GO TO AN URGENT CARE\/PHYSICIAN THE SAME DAY? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question14-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question14\" id=\"question14_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question14_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question14-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question14\" id=\"question14_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question14_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question14\" id=\"question14_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-18  category-section-id-c8' data-qid='18'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>DOES THE PARTY AT FAULT HAVE INSURANCE TO COVER YOUR DAMAGES? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question18-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question18\" id=\"question18_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question18_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question18-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question18\" id=\"question18_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question18_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question18\" id=\"question18_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-20  category-section-id-c8' data-qid='20'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>WERE YOU SO SEVERELY INJURED THAT YOU COULD NOT WALK AFTER THE ACCIDENT? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question20-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question20\" id=\"question20_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question20_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question20-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question20\" id=\"question20_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question20_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question20\" id=\"question20_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-21  category-section-id-c8' data-qid='21'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>DID YOU SUFFER LOSS OF CONSCIOUSNESS AFTER THE ACCIDENT? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question21-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question21\" id=\"question21_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question21_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question21-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question21\" id=\"question21_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question21_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question21\" id=\"question21_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-44  category-section-id-c8' data-qid='44'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>WOULD YOU ESTIMATE THE DAMAGES WERE MORE THAN $5000? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question44-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question44\" id=\"question44_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question44_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question44-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question44\" id=\"question44_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question44_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question44\" id=\"question44_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/section>\n\t\t\t\t\t\t\t\t<section class=\"qsm-page  qsm-page-4\"\n\t\t\t\t\t\tdata-pid=\"4\" data-prevbtn=\"0\" style='display: none;'>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-23  category-section-id-c9' data-qid='23'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>HOW MANY OF THE FOLLOWING SYMPTOMS DID YOU HAVE AFTER THE ACCIDENT? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class=\"qmn_check_answers \">\n\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_1\" value=\"0\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_1\">\n\t\t\t\t\t\t\tPANIC ATTACK\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_2\" value=\"1\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_2\">\n\t\t\t\t\t\t\tSEVERE ANXIETY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_3\" value=\"2\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_3\">\n\t\t\t\t\t\t\tDIFFICULTY SPEAKING\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_4\" value=\"3\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_4\">\n\t\t\t\t\t\t\tNAUSEA\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_5\" value=\"4\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_5\">\n\t\t\t\t\t\t\tVOMITING\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_6\" value=\"5\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_6\">\n\t\t\t\t\t\t\tHEADACHE\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_7\" value=\"6\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_7\">\n\t\t\t\t\t\t\tDIZZINESS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_8\" value=\"7\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_8\">\n\t\t\t\t\t\t\tBLURRED VISION\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_9\" value=\"8\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_9\">\n\t\t\t\t\t\t\tVISUAL PROBLEMS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_10\" value=\"9\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_10\">\n\t\t\t\t\t\t\tNECK PAIN\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_11\" value=\"10\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_11\">\n\t\t\t\t\t\t\tBACKACHE\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_12\" value=\"11\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_12\">\n\t\t\t\t\t\t\tCHESTWALL PAIN\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_13\" value=\"12\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_13\">\n\t\t\t\t\t\t\tCHEST PAIN\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_14\" value=\"13\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_14\">\n\t\t\t\t\t\t\tSHORTNESS OF BREATH\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_15\" value=\"14\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_15\">\n\t\t\t\t\t\t\tPARALYSIS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_16\" value=\"15\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_16\">\n\t\t\t\t\t\t\tBIFFICULTY WALKING\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_17\" value=\"16\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_17\">\n\t\t\t\t\t\t\tDIFFICULTY USING HANDS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_18\" value=\"17\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_18\">\n\t\t\t\t\t\t\tABDOMINAL PAIN\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_19\" value=\"18\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_19\">\n\t\t\t\t\t\t\tNOSEBLEED\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_20\" value=\"19\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_20\">\n\t\t\t\t\t\t\tBLOOD IN URINE\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_21\" value=\"20\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_21\">\n\t\t\t\t\t\t\tBLOOD FROM RECTUM OR IN FECES\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_22\" value=\"21\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_22\">\n\t\t\t\t\t\t\tANY OTHER BLEEDING\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question23[]\" id=\"question23_23\" value=\"22\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_23\">\n\t\t\t\t\t\t\tOTHERS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-25  category-section-id-c9' data-qid='25'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>AS A RESULT OF THE ACCIDENT, HOW MANY OF THE FOLLOWING DID YOU SUFFER? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class=\"qmn_check_answers \">\n\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_1\" value=\"0\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_1\">\n\t\t\t\t\t\t\tSKIN AND MUSCLE INJURY to HEAD\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_2\" value=\"1\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_2\">\n\t\t\t\t\t\t\tHEAD TRAUMATIC BRAIN INJURIES WITH BRAIN FUNCTION ISSUES\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_3\" value=\"2\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_3\">\n\t\t\t\t\t\t\tMEMORY LOSS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_4\" value=\"3\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_4\">\n\t\t\t\t\t\t\tMENTAL FUNCTION CHANGES\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_5\" value=\"4\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_5\">\n\t\t\t\t\t\t\tNECK INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_6\" value=\"5\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_6\">\n\t\t\t\t\t\t\tBACK INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_7\" value=\"6\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_7\">\n\t\t\t\t\t\t\tBODY INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_8\" value=\"7\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_8\">\n\t\t\t\t\t\t\tAMPUTATION\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_9\" value=\"8\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_9\">\n\t\t\t\t\t\t\tBROKEN BONES\/FRACTURES\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_10\" value=\"9\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_10\">\n\t\t\t\t\t\t\tKNEE MENISCUS INJURIES\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_11\" value=\"10\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_11\">\n\t\t\t\t\t\t\tHIP INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_12\" value=\"11\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_12\">\n\t\t\t\t\t\t\tROTATOR CUFF INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_13\" value=\"12\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_13\">\n\t\t\t\t\t\t\tSPINAL COLUMN INJURY WITH NEUROLOGICAL PROBLEMS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_14\" value=\"13\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_14\">\n\t\t\t\t\t\t\tEYE INJURY WITH VISUAL PROBLEMS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_15\" value=\"14\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_15\">\n\t\t\t\t\t\t\tFACE INJURIES AND FACIAL DISFIGUREMENT\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_16\" value=\"15\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_16\">\n\t\t\t\t\t\t\tSKIN AND TISSUE TEARS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_17\" value=\"16\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_17\">\n\t\t\t\t\t\t\tBODY DISFIGUREMENTS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_18\" value=\"17\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_18\">\n\t\t\t\t\t\t\tNOSE INJURIY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_19\" value=\"18\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_19\">\n\t\t\t\t\t\t\tNOSE BREATHING PROBLEMS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_20\" value=\"19\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_20\">\n\t\t\t\t\t\t\tSPLEEN INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_21\" value=\"20\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_21\">\n\t\t\t\t\t\t\tLIVER INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_22\" value=\"21\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_22\">\n\t\t\t\t\t\t\tBOWEL INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_23\" value=\"22\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_23\">\n\t\t\t\t\t\t\tBLADDER INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_24\" value=\"23\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_24\">\n\t\t\t\t\t\t\tLUNGS INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_25\" value=\"24\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_25\">\n\t\t\t\t\t\t\tKIDNEY INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_26\" value=\"25\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_26\">\n\t\t\t\t\t\t\tRIB FRACTURE\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_27\" value=\"26\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_27\">\n\t\t\t\t\t\t\tOTHER ORGAN INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_28\" value=\"27\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_28\">\n\t\t\t\t\t\t\tORTHOPEDIC INJURIES\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_29\" value=\"28\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_29\">\n\t\t\t\t\t\t\tSPINAL CORD INJURIES\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_30\" value=\"29\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_30\">\n\t\t\t\t\t\t\tTRAUMATIC BRAIN INJURY (TBI)\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_31\" value=\"30\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_31\">\n\t\t\t\t\t\t\tBURN INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_32\" value=\"31\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_32\">\n\t\t\t\t\t\t\tDISFIGURMENT OF ANY KIND\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_33\" value=\"32\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_33\">\n\t\t\t\t\t\t\tLOSS OF A PART OF YOUR BODY (DISMEMBERMENT)\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_34\" value=\"33\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_34\">\n\t\t\t\t\t\t\tEYE INJURY OF ANY KIND\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_35\" value=\"34\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_35\">\n\t\t\t\t\t\t\tHAND INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_36\" value=\"35\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_36\">\n\t\t\t\t\t\t\tFOOT INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_37\" value=\"36\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_37\">\n\t\t\t\t\t\t\tHIP INJURY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_38\" value=\"37\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_38\">\n\t\t\t\t\t\t\tKNEE INJURY OF ANY KIND\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_39\" value=\"38\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_39\">\n\t\t\t\t\t\t\tHIP FRACTURE\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_40\" value=\"39\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_40\">\n\t\t\t\t\t\t\tKNEE FRACTURE\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_41\" value=\"40\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_41\">\n\t\t\t\t\t\t\tANKLE FRACTURE\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_42\" value=\"41\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_42\">\n\t\t\t\t\t\t\tARM FRACTURE\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_43\" value=\"42\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_43\">\n\t\t\t\t\t\t\tNECK FRACTURE\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_44\" value=\"43\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_44\">\n\t\t\t\t\t\t\tSPINAL COLUMN FRACTURE\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_45\" value=\"44\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_45\">\n\t\t\t\t\t\t\tBONE FRACTURES CUTTING THROUGH THE SKIN\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_46\" value=\"45\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_46\">\n\t\t\t\t\t\t\tBONE FRACTURES WITH BONE PIECES MOVED APART FROM EACH OTHER BUT NOT THROUGH SKIN\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_47\" value=\"46\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_47\">\n\t\t\t\t\t\t\tBONE FRCTURES WITH FINE LINE FRACTURES\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_48\" value=\"47\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_48\">\n\t\t\t\t\t\t\tMULTIPLE BONE FRACTURES\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_49\" value=\"48\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_49\">\n\t\t\t\t\t\t\tEYE INJURIES WITH VISUAL CHANGES\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_50\" value=\"49\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_50\">\n\t\t\t\t\t\t\tINJURY LEADING TO INABILITY TO WALK NEEDING WHEELCHAIR PERMANENTLY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_51\" value=\"50\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_51\">\n\t\t\t\t\t\t\tINJURY LEADING TO INABILITY TO WALK FOR A FEW WEEKS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_52\" value=\"51\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_52\">\n\t\t\t\t\t\t\tINJURY LEADING TO INABILITY TO WORK FOR A FEW WEEKS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_53\" value=\"52\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_53\">\n\t\t\t\t\t\t\tINJURY LEADING TO INABILITY TO USE ONE ARM FOR A FEW WEEKS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_54\" value=\"53\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_54\">\n\t\t\t\t\t\t\tINJURY LEADING TO INABILITY TO USE BOTH ARMS FOR A FEW WEEKS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_55\" value=\"54\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_55\">\n\t\t\t\t\t\t\tINJURY LEADING TO INABILITY TO USE BOTH ARMS PERMANENTLY\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_56\" value=\"55\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_56\">\n\t\t\t\t\t\t\tINJURY LEADING TO INABILITY TO CARE FOR YOURSELF NEEDING ASSISTANCE\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"qsm_check_answer \">\n\t\t\t\t\t\t<input type=\"checkbox\"  name=\"question25[]\" id=\"question25_57\" value=\"56\" \/>\n\t\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_57\">\n\t\t\t\t\t\t\tSPINAL CORD INJURY WITH PERMANENT NEUROLOGICAL DEFICIT TO ARMS AND LEGS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/section>\n\t\t\t\t\t\t\t\t<section class=\"qsm-page  qsm-page-5\"\n\t\t\t\t\t\tdata-pid=\"5\" data-prevbtn=\"0\" style='display: none;'>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-46  category-section-id-c9' data-qid='46'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>HOW DID THE ACCIDENT HAPPEN? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p>IF A VEHICLE WAS INVOLVED, SKIP THIS QUESTION, AND GO TO THE NEXT QUESTION, OTHERWISE HOW DID THE ACCIDENT HAPPEN?<\/p>\n\t<\/div>\n\t\t<select class=\"qsm_select qsm_dropdown \" name=\"question46\">\n\t<option disabled selected value>Please select your answer<\/option>\n\t\t\t\t\t\t\t<option value=\"0\">CAR ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">TRUCK ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">BICYCLE ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">BUS ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">CONSTRUCTION ACCIDENTAL INJURY<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">DOG BITE<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"6\">E-SCOOTER RENTAL<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"7\">UBER\/LYFT PASSENGER<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"8\">UBER\/LYFT DRIVE<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"9\">MOTORCYCLE<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"10\">PEDESTRIAN ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"11\">SLIP &amp; FALL<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"12\">TRAIN &amp; RAIL ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"13\">PREMISES ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"14\">BIG RIG ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"16\">ATV ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"17\">AVIATION ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"18\">BOATING ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"19\">ELEVATOR ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"20\">ESCALATOR ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"21\">ELECTRIC SCOOTER ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"22\">MOTORIZED SCOOTER ACCIDEDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"23\">TRAIN ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"24\">WHIPLASH INJURY ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"25\">Other<\/option>\n\t\t\t\t\t \t<\/select>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/section>\n\t\t\t\t\t\t\t\t<section class=\"qsm-page  qsm-page-6\"\n\t\t\t\t\t\tdata-pid=\"6\" data-prevbtn=\"0\" style='display: none;'>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-45  category-section-id-c9' data-qid='45'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>HOW DID THE ACCIDENT HAPPEN? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<select class=\"qsm_select qsm_dropdown \" name=\"question45\">\n\t<option disabled selected value>Please select your answer<\/option>\n\t\t\t\t\t\t\t<option value=\"0\">CAR\/VHICLE ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"1\">TRUCK\/VHICLE ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"2\">BICYCLE\/VHICLE ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"3\">BUS\/VHICLE ACCIDENT<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"4\">MOTORCYCLE\/VHICLE<\/option>\n\t\t\t\t\t\t\t\t\t\t<option value=\"5\">TRAIN &amp; RAIL ACCIDENT<\/option>\n\t\t\t\t\t \t<\/select>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-33  category-section-id-c9' data-qid='33'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>WERE YOU THE DRIVER? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question33-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question33\" id=\"question33_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question33_1\">\n\t\t\t\t\tYES\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question33-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question33\" id=\"question33_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question33_2\">\n\t\t\t\t\tNO\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question33\" id=\"question33_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-32  category-section-id-c10' data-qid='32'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>WHAT KIND OF VEHICLE? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><p><strong>IF YOUR INJURY WAS CAUSED AS A RESULT OF A MOTORCYCLE, CAR, FAMILY TRUCK, SUV ACCIDENT, PLEASE CONTINUE TO ANSWER THE FOLLOWING QUESTIONS:<\/strong><\/p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question32-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question32\" id=\"question32_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question32_1\">\n\t\t\t\t\tMOTORCYCLE\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question32-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question32\" id=\"question32_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question32_2\">\n\t\t\t\t\tCAR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question32-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question32\" id=\"question32_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question32_3\">\n\t\t\t\t\tSUV\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question32-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question32\" id=\"question32_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question32_4\">\n\t\t\t\t\tSMALL-MEDIUM PASSENGER TRUCK\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question32-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question32\" id=\"question32_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question32_5\">\n\t\t\t\t\t4X4\/LARGE PASSENGER TRUCK\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question32\" id=\"question32_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-34  category-section-id-c10' data-qid='34'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>HOW WAS YOUR VEHICLE INVOLVED IN THE ACCIDENT? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question34-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question34\" id=\"question34_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question34_1\">\n\t\t\t\t\tOUR VEHICLE HIT THE OTHER VEHICLE\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question34-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question34\" id=\"question34_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question34_2\">\n\t\t\t\t\tTHE OTHER VEHICLE HIT OUR VEHICLE\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question34\" id=\"question34_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-35  category-section-id-c10' data-qid='35'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>HOW MUCH DO YOU ESTIMATE THE DAMAGE TO YOUR VEHICLE WAS? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question35-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question35\" id=\"question35_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question35_1\">\n\t\t\t\t\tLESS THAN $1500.00\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question35-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question35\" id=\"question35_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question35_2\">\n\t\t\t\t\t$1500 TO $10,000.00\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question35-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question35\" id=\"question35_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question35_3\">\n\t\t\t\t\t$10,000.00 TO $20,000.00\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question35-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question35\" id=\"question35_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question35_4\">\n\t\t\t\t\t$20,000.00 TO $30,000.00\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question35-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question35\" id=\"question35_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question35_5\">\n\t\t\t\t\tMORE THAN $30,000.00\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question35-6 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question35\" id=\"question35_6\" value=\"5\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question35_6\">\n\t\t\t\t\tTHE VEHICLE WAS TOTALLED AND NOT DRIVABLE\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question35\" id=\"question35_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-36  category-section-id-c10' data-qid='36'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>HOW DID THE ACCIDENT HAPPEN? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question36-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question36\" id=\"question36_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question36_1\">\n\t\t\t\t\tTHE OTHER VEHICLE BROKE THE LAW AND CAUSED THE ACCIDENT\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question36-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question36\" id=\"question36_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question36_2\">\n\t\t\t\t\tTHE OTHER VEHICLE PASSED THE RED LIGHT AND CAUSED THE ACCIDENT\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question36-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question36\" id=\"question36_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question36_3\">\n\t\t\t\t\tTHE OTHER VEHICLE PULLED IN FRONT OF US INTENTIONALLY\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question36-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question36\" id=\"question36_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question36_4\">\n\t\t\t\t\tTHE OTHER VEHICLE SUDDENLY HIT THE BREAKS TO CAUSE THE ACCIDENT\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question36-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question36\" id=\"question36_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question36_5\">\n\t\t\t\t\tTHE OTHER VEHICLE SIDE SWIPED OUR CAR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question36-6 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question36\" id=\"question36_6\" value=\"5\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question36_6\">\n\t\t\t\t\tTHE OTHER VEHICLE HIT OUR CAR FROM THE BACK\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question36-7 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question36\" id=\"question36_7\" value=\"6\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question36_7\">\n\t\t\t\t\tTHE OTHER VEHICLE HIT OUR CAR FROM THE BACK AND DROVE US INTO THE CAR IN FRONT\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question36-8 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question36\" id=\"question36_8\" value=\"7\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question36_8\">\n\t\t\t\t\tOTHER\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question36\" id=\"question36_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-37  category-section-id-c10' data-qid='37'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>THE ACCIDENT HAPPENNED IN THEFREEWAY WHILE OUR CAR WAS AT: <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question37-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question37\" id=\"question37_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question37_1\">\n\t\t\t\t\tFULL STOP\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question37-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question37\" id=\"question37_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question37_2\">\n\t\t\t\t\tMOVING AT 10 -25 MILES PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question37-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question37\" id=\"question37_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question37_3\">\n\t\t\t\t\tMOVING AT 25-45 MILES PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question37-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question37\" id=\"question37_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question37_4\">\n\t\t\t\t\tMOVING AT 45-65 MILES PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question37-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question37\" id=\"question37_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question37_5\">\n\t\t\t\t\tMOVING AT 65 MILES PER HOUR OR MORE\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question37\" id=\"question37_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-38  category-section-id-c10' data-qid='38'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>THE ACCIDENT HAPPENNED IN THE FREEWAY WHILE THE OTHER CAR WAS MOVING: <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question38-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question38\" id=\"question38_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question38_1\">\n\t\t\t\t\tMOVING AT 10 -25 MILES PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question38-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question38\" id=\"question38_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question38_2\">\n\t\t\t\t\tMOVING AT 25-45 MILES PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question38-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question38\" id=\"question38_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question38_3\">\n\t\t\t\t\tMOVING AT 45-65 MILES PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question38-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question38\" id=\"question38_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question38_4\">\n\t\t\t\t\tMOVING ABOVE 65 MOLE PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question38\" id=\"question38_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-40  category-section-id-c10' data-qid='40'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>THE ACCIDENT HAPPENNED IN THE STREET WHILE THE OTHER CAR WAS MOVING: <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question40-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question40\" id=\"question40_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question40_1\">\n\t\t\t\t\tMOVING AT 10 -25 MILES PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question40-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question40\" id=\"question40_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question40_2\">\n\t\t\t\t\tMOVING AT 25-45 MILES PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question40-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question40\" id=\"question40_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question40_3\">\n\t\t\t\t\tMOVING AT 45-65 MILES PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question40-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question40\" id=\"question40_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question40_4\">\n\t\t\t\t\tMOVING ABOVE 65 MOLE PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question40\" id=\"question40_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class='quiz_section qsm-question-wrapper question-section-id-39  category-section-id-c10' data-qid='39'>\n\t\t\t\t\t\t\t<div class='mlw_qmn_new_question'>THE ACCIDENT HAPPENNED IN THE STREET WHILE OUR CAR WAS AT: <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<div class='qmn_radio_answers '>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question39-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question39\" id=\"question39_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question39_1\">\n\t\t\t\t\tFULL STOP\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question39-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question39\" id=\"question39_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question39_2\">\n\t\t\t\t\tMOVING AT 10 -25 MILES PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question39-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question39\" id=\"question39_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question39_3\">\n\t\t\t\t\tMOVING AT 25-45 MILES PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question39-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question39\" id=\"question39_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question39_4\">\n\t\t\t\t\tMOVING AT 45-65 MILES PER HOUR\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap \" id=\"question39-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio' name=\"question39\" id=\"question39_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question39_5\">\n\t\t\t\t\tMOVING AT 65 MILES PER HOUR OR MORE\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question39\" id=\"question39_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/section>\n\t\t\t\t\t\t\t<section class=\"qsm-page\" style=\"display: none;\">\n\t\t\t\t<div class=\"quiz_section\">\n\t\t\t\t\t<div class='qsm-after-message mlw_qmn_message_end'><p>Thank you!<br \/>\nClick on submit to check the report<\/p>\n<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/section>\n\t\t\t\t\t<input type=\"hidden\" name=\"qmn_question_list\" value=\"55Q56Q57Q58Q59Q1Q3Q4Q5Q6Q8Q31Q7Q17Q16Q19Q47Q26Q27Q28Q29Q42Q9Q10Q11Q12Q14Q18Q20Q21Q44Q23Q25Q46Q45Q33Q32Q34Q35Q36Q37Q38Q40Q39Q\" \/>\n\t\t\t\t\t\t<div id=\"mlw_error_message_bottom\" class=\"qsm-error-message qmn_error_message_section\"><\/div>\n\t\t\t\t\t<input type=\"hidden\" name=\"qmn_all_questions_count\" id=\"qmn_all_questions_count\" value=\"44\" \/>\n\t\t\t\t\t<input type=\"hidden\" name=\"total_questions\" id=\"total_questions\" value=\"44\" \/>\n\t\t\t\t\t<input type=\"hidden\" name=\"timer\" id=\"timer\" value=\"0\" \/>\n\t\t\t\t\t<input type=\"hidden\" name=\"timer_ms\" id=\"timer_ms\" value=\"0\"\/>\n\t\t\t\t\t<input type=\"hidden\" class=\"qmn_quiz_id\" name=\"qmn_quiz_id\" id=\"qmn_quiz_id\" value=\"1\" \/>\n\t\t\t\t\t<input type='hidden' name='complete_quiz' value='confirmation' \/>\n\t\t\t\t\t\t\t\t\t<\/form>\n\t\t<\/div>\n\t\t<div style=\"display: none;\" class=\"qsm-popup qsm-popup-slide\" id=\"modal-3\" aria-hidden=\"false\"><div class=\"qsm-popup__overlay\" tabindex=\"-1\" data-micromodal-close=\"\"><div class=\"qsm-popup__container qmn_quiz_container\" role=\"dialog\" aria-modal=\"true\"><div class=\"qsm-popup__content\"><img decoding=\"async\" src=\"https:\/\/axidentlawyers.com\/wp-content\/plugins\/quiz-master-next\/assets\/clock.png\" alt=\"clock.png\"\/><p class=\"qsm-time-up-text\">Time is Up!<\/p><\/div><footer class=\"qsm-popup__footer\"><button class=\"qsm-popup-secondary-button qmn_btn\" data-micromodal-close=\"\" aria-label=\"Close this dialog window\">Cancel<\/button><button data-quiz_id=\"1\" class=\"submit-the-form qmn_btn\">Submit Quiz<\/button><\/footer><\/div><\/div><\/div><div style=\"display: none;\" class=\"qsm-popup qsm-popup-slide\" id=\"modal-4\" aria-hidden=\"false\"><div class=\"qsm-popup__overlay\" tabindex=\"-1\" data-micromodal-close=\"\"><div class=\"qsm-popup__container qmn_quiz_container\" role=\"dialog\" aria-modal=\"true\"><div class=\"qsm-popup__content\"><img decoding=\"async\" src=\"https:\/\/axidentlawyers.com\/wp-content\/plugins\/quiz-master-next\/assets\/clock.png\" alt=\"clock.png\"\/><p class=\"qsm-time-up-text\"> Time's up<\/p><\/div><footer class=\"qsm-popup__footer\"><button class=\"qsm-popup-secondary-button qmn_btn\" data-micromodal-close=\"\" aria-label=\"Close this dialog window\" onclick=\"location.reload();\">Cancel<\/button><\/footer><\/div><\/div><\/div><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Axident Lawyers Free A$$e$$ment Tool AXIDENT LAWYERS FREE CASE VALUE ASSESSMENT 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