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Referrals

Workers' Compensation File Transmittal

If you prefer to speak with someone directly, please call our office at 310-981-1202.
  • Referring Administrator/Carrier

  • Date Format: MM slash DD slash YYYY
  • If you have more than one claim number, separate them with commas
  • Claimant Info

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
    Check all that apply.
  • Hearing

  • Date Format: MM slash DD slash YYYY
  • :
  • Investigation

  • Check all that apply.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • If you have more than one QME, separate them with commas
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