800.747.4329
|
Email Us
Start An Assignment
MENU
800.747.4329
Email Us
Start an Assignment
Claimant\Subject Information
First Name
Last Name
Email
Phone
Street
Social Security No.
City
State
Loading...
Zip Code
Date of Birth
Name of the Insured
Date of Loss
Alleged injury?
Phone Numbers/Physical Description/Additional Comments
Type of Claim/Investigation
Loading...
Please select a type of claim
Claim/Incident/Case Number(s)
Please attach Claim Forms, Incident/Complaint Reports, MVA Collision Reports, photos, etc.. Can be .pdf, .doc, or .jpeg format.
Bundled Services
Standalone Services
Please Select at Least One Product
ClaimView 360
- Surveillance
How many days are needed for surveillance?
- SocialPro PLUS
®
Continued Online Monitoring (2 months complimentary)
Background Check Included.
- Medical Sweep
Facility Type(s) Requested
SocialPro MED®
- SocialPro PLUS
®
- Medical Sweep
Facility Type(s) Requested
Surveillance
How many days are needed for surveillance?
Surveillance PLUS
How many days are needed for surveillance?
SocialPro ELITE®
?
SocialPro PLUS®
?
Continued Online Monitoring (2 months complimentary)
Background Check Included.
Medical Sweep
Facility Type(s) Requested
Recorded Statement (AOE/COE)
Targeted Claims Investigation
(if enrolled in TCI Program)
Telephonic
In Person Statement
Alive and Well
GeoSocial Sweep
?
When did the incident occur?
Date
Time
Where did the incident occur? Please provide the address or the closest intersection in relation to the incident.
GeoSocial PLUS
When did the incident occur?
Date
Time
Where did the incident occur? Please provide the address or the closest intersection in relation to the incident.
GeoSocial ELITE
When did the incident occur?
Date
Time Copy
Where did the incident occur? Please provide the address or the closest intersection in relation to the incident. Copy
JuryPro®
?
Other Investigative Services
Use this box to describe the special investigation request
Unsure – Advisory Call
Requester Information
Your Name
Email Address
Phone
Your Company
Billing Address
Street
City
State
Loading...
Zip Code
Report and Invoice Delivery Method
Loading...
Please Select a Delivery Method
What is the Goal of This Investigation?
Defense Attorney Information - DO NOT PROVIDE APPLICANT ATTORNEY INFORMATION
Name
Phone
Email Address
Street
City
State
Loading...
Zip Code
Report and Invoice Delivery Method
Loading...
Please Select a Delivery Method
I certify that I am permitted under state and federal law to obtain the information I am requesting through DigiStream. I also certify that I will only use the information for a permissible purpose under and in accordance with applicable state and federal law.
Submit