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Case Submission

The Filing Party is
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Defendant

Insured
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Claim #
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Claim Representative
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Insurance Company
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Street Address
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City
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State
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Zip Code
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Phone
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Fax
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Email Address
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Defense Attorney
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Defense Attorney Email
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Legal Assistant
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Legal Assistant Email
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Firm
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File #
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Street Address
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City
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State
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Zip Code
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Phone
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Fax
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Plaintiff

Claimant(s)
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Attorney
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Firm
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File #
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Street Address
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City 3
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State
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Zip Code
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Phone
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Fax
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Email Address
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Will a Structured Settlement Broker be attending? If yes, please list in "Other Parties" section.
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Other Parties

Select Type
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Insured/Claimant
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Representative/Attorney/Broker
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Insurance Company/Firm
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Claim/File #
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Street Address
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City
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State
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Zip Code
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Phone
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Fax
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Email Address
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Case Information


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In Suit
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Last Offer
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Last Demand
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Type of Dispute
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Issues: Liability
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Issues: Damages
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Procedure Requested
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Special Instructions
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(*)
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Dispute Resolution Systems

No Trial designs, implements and manages your organization's ADR processes, which may include mandatory arbitration procedures.

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