Consolidated Claim Service

A Division of Stephen J Boyko Inc.

Automobile – Disability – General Liability – Workers Compensation

811 Old Country Road, Plainview, NY, 11803  (800) 735-6699  Fax (516) 935-4259  cclaims@i-2000.com

 
Download Assignment sheet Fill it out and fax it back to us or fill out the online form below and submit it electronically.
Claim Type Auto Disability General Liability Workers Comp Other  
Region NYC 5 Boros, LI Upstate NY New Jersey Connectiut Florida Other

Claimant
First Name Last Name
Address City
State Zip
Phone Occupation
DOB SSN
Height Hair
Weight Eyes
Other    

Insured
First Name Last Name
Company    
City State
Zip    
Phone Contact Name
Accident Details
Date of Accident Injury

Assignment
Full Investigation Surveillance
Insured Investigation Flat Rate Surveillance
Claimant Investigation Flat Rate Activity Check
Witness Investigation Flat Rate Covert Activity Check
15.8 Investigation Trial Prep, Subpoena's
Other    
Due Date
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