Investigation Intake Form Select Case Type Choose the type of investigation you need ⚖️ Liability Personal injury & liability claims 🦺 Worker's Comp Workplace injury investigations 📋 Disability Disability claim investigations 🚚 Cargo Cargo theft & transport claims 🔍 Other General investigations Re-Open Case 📂 Re-Open Case enabled. You'll need to enter the MIG# on the next page. Continue → Case Information Enter the basic case details Assignment Date: Re-Opening MIG Case # * Claim Number * Date of Loss * Assignment Due Date 🚨 Rush Assignment Normal turnaround is 30 days. Assignments due within 14 days of assignment date are considered rush. ← Back Continue → Subject Information Please provide as much information as possible about the subject(s). The more details you provide, the greater our chances of successfully locating and identifying them. Subject 1 Primary First Name * Middle Name Last Name * Unknown Subject Date of Birth SSN Sex Select... Male Female Spouse / Relative Name + Add Physical Description Race / Ethnicity Height Weight Hair Color Eye Color Distinguishing Marks Subject Address Information Street Address Apt # City State Zip Subject's Phone Subject's Email Known Social Media i Additional Information + Add Another Subject (1/3) ← Back Continue → Supporting Documents Help us investigate more effectively by uploading relevant documents Documents to Include 🚗 AccidentReports 💳 Driver'sLicense 👤 Photos ofSubject 📷 ScenePhotos 🏥 MedicalRecords 📄 PoliceReports 📎 Click to select files or drag and drop PDF, Word, Excel, Images (Max 10MB each, up to 5 files) ← Back Continue → Vehicle Information Enter vehicle and accident details if applicable Vehicle Year Make Model Plate Number Subject's Driver's License Subject's Insurance Carrier Loss Location Insured Name ← Back Continue → Employer Information Enter the subject's employment details if known Subject's Employer Employer Phone Employer Street Address Employer City Employer State Employer Zip ← Back Continue → Injury Information Enter details about alleged injuries and medical treatment Alleged Injury Emergency Treatment at Treating Physician Medical Providers & Upcoming Appointments ← Back Continue → Services Requested Select services for each subject Subject 1 Primary Initial Investigation (3-Day Surv/IPR/Background) Surveillance & Desktop Investigations Surveillance 3 Days Additional Surveillance Recurring Surveillance Select Days... 30 Days 60 Days 90 Days Internet Presence Review Background Check Internet Presence Monitoring Select Days... 30 Days 60 Days 90 Days Internet Presence Audit Medical & Pharmacy Review Skip Trace Decedent Check SIU Services & Investigations Fraud Referral / Case Review Statements/Interviews/EUO Cargo/Vehicle/Trailer Theft Employment Check Subrogation (assets & income) Scene Investigation Video Retrieval Other Services* Initial Investigation (3-Day Surv/IPR/Background) Surveillance & Desktop Investigations Surveillance 3 Days Additional Surveillance Recurring Surveillance Select Days... 30 Days 60 Days 90 Days Internet Presence Review Background Check Internet Presence Monitoring Select Days... 30 Days 60 Days 90 Days Internet Presence Audit Medical & Pharmacy Review Skip Trace Decedent Check SIU Services & Investigations Fraud Referral / Case Review Statements/Interviews/EUO Cargo/Vehicle/Trailer Theft Employment Check Subrogation (assets & income) Scene Investigation Video Retrieval Other Services* Additional Instructions ← Back Continue → Client Information Enter the referring client and contact details Company Information Company Mohave Transportation Insurance Company Insured / Location * Select Insured... Swift Transportation Knight Transportation EMA Risk Services Abilene Contact Information First Name * Last Name * Email * Phone * + Add Secondary Contact Secondary Contact (CC on Reports) First Name Last Name Email Phone ← Back Submit Request
