PLEASE INCLUDE: DEMOGRAPHIC INFORMATION, FIRST REPORT OF INJURY AND ATTACH PERTINENT MEDICAL FILES (PDF)

AREAS OF COVERAGE

FIELD CASE MANAGEMENT: ILLINOIS, NORTHEAST WISCONSIN, NORTHWEST INDIANA

TELEPHONIC CASE MANAGEMENT: ALABAMA, ARIZONA, ARKANSAS, COLORADO, DELAWARE, FLORIDA, GEORGIA, IDAHO, ILLINOIS, INDIANA, IOWA, KANSAS, KENTUCKY, LOUISIANA, MAINE, MARYLAND, MISSISSIPPI, MISSOURI, MONTANA, NEBRASKA, NEW HAMPSHIRE, NEW JERSEY, NEW MEXICO, NORTH CAROLINA, NORTH DAKOTA, OKLAHOMA, SOUTH CAROLINA, SOUTH DAKOTA, TENNESSEE, UTAH, VIRGINIA, WEST VIRGINIA, WISCONSIN, WYOMING