RW Consultants Contact Us Form

CLAIMANTS INFORMATION FORM
Your Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Claim No.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
* Indicates Response Required.
ACTIVITIES CHECK:
Use at any time during claim when you need detailed information on claimants activities. Information obtained from knowledgeable outside sources. If uncertain on feasibility of surveillance complete activities check.

SURVEILLANCE:
When information available indicates activities inconsistent with diagnosis, use Surveillance to document activities via video tape.

ACCIDENT REPORT:
Order this report when you need to know the full details of an accident. Report includes recorded and transcribed statements from claimant, all pertinent witnesses and police officers if necessary. Also includes high quality photos if requested.

BACKGROUND INVESTIGATION:
A complete and thorough background check through court records, databases, MVR, financial records and interviews. When you need the full details on an individual. Hourly rate investigation fee is $65 per hour. Mileage is charged at .45 per mile - out of town expenses will apply when necessary.

SPECIAL REQUEST INVESTIGATION:
If you have a specific need not covered by previous 4 report descriptions, check this report and provide details below. This can include recorded statements, photos and scene diagrams.
Choose service:

Activities CheckAccident ReportSpecial Request InvestigationSurveillanceBackground Investigation
Claimant Name
DOB
Current Address
Nature of Injury
SSN
Home Phone
Employer
Attorney's Name
Deadline of Investigation
Limit cost of investigation to:
May we contact claimant directly?

YesNo
Special Instructions
* Indicates Response Required.
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CLAIMANTS INFORMATION FORM