Whistleblower Case Inquiry Form

The law provides remedies to employees who provide information regarding fraudulent practices of employers. It also protects employees against retaliation for reporting to the employer or to the government certain types of wrongdoing or waste by the employer. If you would like a WCB lawyer to help determine whether you have a whistleblower claim, please submit the following information, which we will keep confidential.

* denotes required fields

Personal Information

* Name

* Address

City

State

Zip Code

Daytime Phone Number

Evening Phone

Mobile Phone

* E-mail Address

Case Information

Employee Fraud

Does your employer receive a substantial portion of its income, directly or indirectly, from the federal government?

Yes
No

From a state or local government

Yes
No

Do you have documentation or other information that the employer has received funds for services it did not give, or based on false information given to the government

Yes
No

Retaliation for Whistleblowing Activity

Have you been fired or demoted, or suffered another negative employment action because you complained or reported waste or fraud, a safety or environmental violation, or other wrongdoing?

Yes
No

If yes, describe your whistleblowing activity, and what happened to you as a result.

Describe the losses or damages you suffered as a result

* By typing "agree" into the below box you are confirming that you wish to send your information to Williams Cuker Berezofsky.