Please enter the details of your request below and someone from our case management department will contact you within 24 hours. You will receive an email confirming your request after submission. Client InformationEnter your company information below.Company Name* Company Insured/TPA*Please enter the name of the insured. Company Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Enter your contact information:Contact Name* First Last Contact Email* Contact Phone* Case DetailsWhat type of case are you requesting?*Worker's CompensationLiabilityDomesticOtherClaim Number:Date of Loss (DOL):Injury Type: Claimant Profile InformationPlease provide as much claimant information as you can below.Claimant's Full Name* First Middle Last Clamant's Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Claimant's SSN:*US Social Security Number You may use "X" to replace unknown Digits.Claimant's Date of Birth:Format "MM/DD/YYYY". You may use "X" to replace unknown digits. Claimant's Phone NumberMedical RestrictionsPlease list the claimant's medical restrictions, if applicable.Additional Claimant InformaitonSpecial identifying markings; E.g., tattoos, piercings, scars, height, weight, build, etc. Request DetailsPlease select case services requested and provide supporting documentation, such as a photo of the claimant and/or copies of any prior investigative reports. Which service(s) are you requesting?*We recommend starting with a First Glance Report in order to establish a plan of action for further investigative efforts. You can select more than one service from the menu by holding down the "Ctrl" key on your keyboard.First Glance Report (Basic Social Media Performed Free of Charge)Open Source Media Search (In-Depth Social Media, News Articles, and Social Networking)Medical Canvass (Basic/Standard/Premium/Platinum/Platinum Plus)Comprehensive Background CheckSurveillance (specify # of days in notes section below)Virtual Investigator SurveillanceOther (Provide details in the notes section below.)NotesDoes this case require priority/rush status?YesNoDoes the claimant have upcoming medical or other known appointments?YesNoHave there been prior socal media reports?YesNoHave there been prior medical canvasses?YesNoHave there been prior surveillance efforts?YesNoRelevant Attachments Drop files here or Accepted file types: pdf, png, jpg, doc, docx. Please upload a photo of the claimant, as well as any supporting case documents (i.e. Accurint report, etc.) Maximum of (3) attachments allowed.Help us prevent spam by clicking the box below. Δ