New Assignment ClaimsDetective, Inc.

New Assignment

Please provide the case information below. All files uploaded are encrypted at rest using 256-bit AES encryption.Thank you for choosing ClaimsDetective.com
CLAIMANT (SUBJECT) INFORMATION
SUBJECT(S) DETAILS:
Name, Address, Phone, DOB, SSN, Vehicle/Owner/Ins Carrier, DL#
SUBJECT EMPLOYER DETAILS:
Company Name, Address, Occupation, Lost Time, Return to Work, Restrictions
CLAIM NUMBER:
DATE OF LOSS:
ASSURED:
Insured
CLAIMANT ATTORNEY:
Name, Address, Phone
INJURY DETAILS:
Injury, Hospitals, Doctor, PT, DC
CASE TYPE:
REQUESTED WORK
Requested Work:

Activities Check Bodily Injury Claims Background Complete Story Contestable Death Decedent check Disability Claim Employment Injury History Internet Monitoring Locate Online Investigations Pre-Employment Records Check Remote Surveillance Skip Tracing Statements Subrogation Surveillance Wrongful Death
UPLOAD CASE FILES:

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SPECIAL INSTRUCTIONS:
CLIENT INFORMATION
Client Name: *

First Name Last Name
Client Email: *
example@example.com
Client Phone Number: *

Area Code Phone Number
Client Company:

Client Address:

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