Refer a Case

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About the Referrer

Case Overview


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Claimant Info

Claimant's Employer

Case Details

Issues for litigation assignment (check all that apply)…

Hearing scheduled?

Wages statement, status

Personnel file, status

We have the authority to (check all that apply)…

Has this claim been denied?

Does claimant have legal representation?

Has the application already been filed?

Employer has an MPN?

QME already selected?

Case Files

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