Please fill out the form below to request an investigative assignment and attach any pertinent documents at the bottom of the form.

Customer Information

Company Name:*
Customer Name:*
E-mail:*
Address:
City, State and Zip:
Client Phone:*
Cell Phone:

Investigative Assignment

Investigative Assignment:* SurveillanceSurveillance investigations are conducted by full-time, licensed investigators who operate at the highest professional level.
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Claims Buzz™Claim Buzz™ is a proprietary investigative platform that searches and examines the web universe for relevant information pertaining to social media activities of your claimant.
Claims Buzz™ MonitoringClaims Buzz Monitoring™ provides a continuous and ongoing monitoring of an individual’s social media updates and posts.
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Background Investigation - ComprehensiveBackground Investigations provide an insight into an individual’s past that otherwise may never been known. All reports are comprehensive and offered on a national level.
Medical CanvassMedical Canvasses are conducted utilizing only dedicated, in-house licensed background Investigators and canvasses include hospital, pharmacy, clinic, gym, golf and custom canvasses, offered nationwide.
  • Hospital
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  • Pharmacy
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  • Clinic
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  • Other
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  • Custom Canvass
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Recorded Statement | InterviewRecorded statements and interviews are conducted by licensed, full-time investigators to obtain a claimant’s or witness’ account of any incident.
Scene | Field InvestigationScene | field investigations are performed by licensed field investigators in an effort to gather and collect pertinent evidence relevant to the case.
AOE | COE InvestigationAOE (arising out of employment) and COE (course of employment) investigations are conducted by field investigators to determine the details concerning the work-related incident.
SIU & Anti-Fraud InvestigationSIU & Anti- Fraud Investigations are performed by senior investigators with more than 25 years of combined experience within the SIU and law-enforcement communities.
  • Fraud Analysis and Review
  • State Fraud Submission
  • SSN Verification
  • 626 Letter Request
Activity CheckActivity Checks are conducted by field investigators AND include a claimant profile, discreet neighborhood canvass, detailed resident and neighborhood description and a surveillance feasibility assessment.
Alive & Well CheckAlive & Well Check includes face to face contact with the claimant to determine the current health status of the claimant and any medical treatment details as well as employment and over all life-style assessment.
Quick Link ™ (Downloadable video link)Quick Link's™ innovative technology allows you to download surveillance video with the single click of a link.
Comments/Instructions:

Subject Information

Type of Claim:*
Claim Number:*
Date of Loss:*
Subject Name:*
Subject Address:*
Subject City, State and Zip:*
Subject SSN:
Subject Date of Birth:
Subject Phone:
Subject Cell Phone:
Subject Email:
Injury:
Restrictions:
Subject Currently Employed: NA Yes No
Job Duty:
Employer/Insured Information:
Represented: NA Yes No

Subject Description

Sex: NA Male Female
Race:
Height:
Weight:
Hair Color:
Eye Color:
Additional Description Details:
Married: NA Yes No
Kids:
Previous Surveillance: NA Yes No
Upcoming appointments: NA Yes No
Appointment Details:

Additional Information

C.C. Party Information:
Special Instructions:

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