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SUBMIT A CASE
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The Filing Party is:
*
- Please Select The Filing Party is* -
Claim Representative
Plaintiff Attorney
Defense Attorney
Legal Assistant
Defendant
Insured
Claim #
Claim Representative
Insurance Company
Structured to be
Phone Number
Email Address
Defense Attorney
Defense Attorney Email
Legal Assistant
Legal Assistant Email
Firm
Phone Number
Plaintiff
Claimant(s)
Attorney
Firm
File #
Phone Number
Email Address
Will a Structured Settlement Broker be attending? If yes, please list in "Other Parties" section
- Please Select Will a Structured Settlement Broker be attending? If yes, please list in "Other Parties" section -
No
Yes
Other Parties
Select Type
- Please Select -
Plaintiff
Defendant
Structure Broker
Lien Holder
Insured / Claimant
Representative / Attorney / Broker
Insurance Company / Firm
Claim / File #
Phone Number
Email Address
Other Parties
Select Type
- Please Select -
Plaintiff
Defendant
Structure Broker
Lien Holder
Insured / Claimant
Representative / Attorney / Broker
Insurance Company / Firm
Claim / File #
Phone Number
Email Address
Case Information
Procedure Requested
- Please Select Procedure Requested -
Mediation
Arbitration
Global Settlement Conference
Court Case Number
Court Venue
Have all Parties Agreed to this Procedure?
- Please Select Have all Parties Agreed to this Procedure? -
No
Yes
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