Medical Investigation Group, Inc.
Medical Investigation Group


Upcoming Events

National Association of Insurance Commissioners
December 2-5, 2017
Hawaii Hilton Hawaiian Village and Convention Center
Honolulu, HI
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Coalition Against Insurance Fraud Annual Membership Meeting
December 13, 2017
Omni Shoreham Hotel
Washington, D.C. 20008
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The 19th Annual Windstorm Insurance Conference
January 15-19, 2018
Rosen Shingle Creek Inn
Orlando, FL
View Details

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CASE REFERRAL FORM

* Required Fields

Analyst Information

Claimant/Insured Information

Services Requested (choose at least one) *

Facility Inspection
Provider Interview/EUO
"Cold Call" to Provider
Medical Record/Chart Review
Medical Records/Film Retrieval
License Check
Initial Review
Case selection consult
Credential Check
Background Check
Recorded Statement
Surveillance
Corporate Check
Other
Retainer (TBD)
Database scan

Case Description/Circumstances of Claim Injury *


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Provider Names/Locations

Attorney Information (optional)