Claim Assignments - Accept Claims Online

  • Please provide as much information about the claim as possible
  • Required fields are marked by the * symbol and a yellow background.
  • If you do not have the information for a required field, please enter "unknown"
  • File Details and Assignment Instructions
    * Claim/File #
    *Loss Date
    * Type of Assignment
    Video Surveillance
    Activities Check
    * General Assignment Instructions
    Specify days for conducting surveillances
    Any Day Sunday Monday Tuesday
    Wednesday Thursday Friday Saturday
    No. of days authorized:
    Date range:
    Authorized budget for assignment:
    * Preliminary Investigation - please check all needed
    Location Investigation Activities Check Previous Comp Claims
    Civil History Criminal History Business Information
    Driving Records Asset Searches Notes/Other
    Client Information/Reporting Address
    * Client Company Name
    * First Name
    * Last Name
    Mailing Address
    * Phone #
    Fax #
    * E-Mail
    * Would you like to add a 2nd contact,
    such as an attorney (for reporting purposes)?
    Yes No