Refer A Case

Referring a case has never been easier. Simply visit the locations area of our website to contact your local CGS office or submit the referral form below. We take pride in offering you superior service and will respond to your request via-email in a very timely fashion. Thank you!
Referral Form
E-Mail To:

Your Email: First Settlement Offer: Yes , No
Date of Request: Claim #:
Insurer: Insured:
Branch: Claim Type: Liability Workers Compensation
Underwriting Name:   Other:
Adjuster: Date of Injury:
Telephone: , X Type of Injury:
Fax: Litigation: Yes , No
Claimant: Location of Accident:
Date of Birth:    
Male:  Female:  Plaintiff Counsel Name:
Social Security #: Telephone:
    Fax:
    Email:
Claimant Address:    
       
Policy Limit: Defense Counsel Name:
Total Offer: Telephone:
Lien Total: Fax:
1/3 Attorney Fees:    Yes , No Email:
Up front Cash:    
Total for Structure:    
 
SEND PROPOSALS TO: Adjuster, Plaintiff Counsel, Defense Counsel

Other
 
Comments:



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