Refer a case

Send us the case details and we will follow up with settlement options. Attorneys and claims professionals welcome.

Refer a Case

Fill in as much as you have. Only the attorney or adjuster name, the claimant name, and a way to reach you are required — we can gather the rest on a call.

After you submit, we will point you to our secure upload portal for any case documents. Please do not attach medical records or other sensitive documents to this form. The upload portal is the HIPAA-compliant route for those.

Who is referring

Attorney or adjuster name(required)

Firm or company, address, phone, and email

Optional if you are an existing client and nothing has changed.

Paralegal or case manager name, phone, and email

Optional if you are an existing client and nothing has changed.

Your email address(required)

Your phone number(required)

About the claimant

Claimant name(required)

Claimant date of birth

Used to price the annuity. Format: MM/DD/YYYY.

Claimant contact information

Address, phone, and email if you have them.

About the case

Date of injury

Case type

Accident description, injuries, surgeries, and other case information

A short summary is enough. Please do not paste medical records here — we will send you a secure upload link after you submit.

Carrier name or names

Employer name, address, and phone

Additional case information or special instructions