• buy here https://viagrageneriquefr24.com/viagra-sans-ordonnance/

Wiltz Law

Wiltz Law

Attorney Van Wiltz

T (214) 214-9653
Email: van.wiltz@wiltzlaw.com

Wiltz Law
3131 McKinney Ave, Suite 600, Dallas, Texas 75204

Open in Google Maps
QUESTIONS? CALL: 214.477.3774
  • REVIEWS
  • ABOUT US
  • PRACTICE AREAS
  • LOCATIONS
  • CONTACT US
  • ATTORNEY REFERRAL
CONTACTUS 24/7
  • Home
  • View
  • Merge PDF
January 26, 2021

Merge PDF

Merge PDF

by bhagirath / Monday, 02 March 2020 / Published in

Download Excel

Download PDF Entry

Case Status

4 - Litigation

Case Status

case status

LOP FORM

LOP MP – 1 | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 State Farm Fire Claims | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Aaron Jones

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Baylor Scott & White Medical Center | |
LOP MP – 2 Accident Centers of Texas (No Record) | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 GAINSCO Auto Insurance | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 No Ins | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Baylor Scott & White Medical Center | |
Request For Medical Records and Affidavit MP - 2 Accident Centers of Texas (No Record) | medical record provider requested |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Baylor Scott & White Medical Center | |
Reduction Request MP – 2 Accident Centers of Texas (No Record) | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Andrea Johnson

Case Status

5 - Discovery

Case Status

case status

LOP FORM

LOP MP – 1 Erin E. Shrago, Psy.D., LLC | |
LOP MP – 2 Dr. Randy Gibson | |
LOP MP – 3 Highland Dermatology | |
LOP MP – 4 Dr. Stephanie Hiraki | |
LOP MP – 5 CareNow Urgent Care | |
LOP MP – 6 Doctor Care Clinic | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 EarthX | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 5 - Discovery

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Erin E. Shrago, Psy.D., LLC | |
Request For Medical Records and Affidavit MP - 2 Dr. Randy Gibson | |
Request For Medical Records and Affidavit MP - 3 Highland Dermatology | |
Request For Medical Records and Affidavit MP - 4 Dr. Stephanie Hiraki | |
Request For Medical Records and Affidavit MP - 5 CareNow Urgent Care | |
Request For Medical Records and Affidavit MP - 6 Doctor Care Clinic | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Erin E. Shrago, Psy.D., LLC | |
Reduction Request MP – 2 Dr. Randy Gibson | |
Reduction Request MP – 3 Highland Dermatology | |
Reduction Request MP – 4 Dr. Stephanie Hiraki | |
Reduction Request MP – 5 CareNow Urgent Care | |
Reduction Request MP – 6 Doctor Care Clinic | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Coverage
  • PIP Coverage

Download PDF Entry

Client Name

Antonio Shelton

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Baylor Scott&White Medical Center | |
LOP MP – 2 Accident Centers of Texas (No Record, Client cancelled appointment) | |
LOP MP – 3 MDN Injury Care | lop provider sent | lop provider received
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | | lor received
LOR 3rd Party – 1 GAINSCO Auto Insurance | lor sent | lor received
LOR 3rd Party – 2 | | lor received
LOR 3rd Party – 3 No Ins | | lor received

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Baylor Scott&White Medical Center | |
Request For Medical Records and Affidavit MP - 2 Accident Centers of Texas (No Record, Client cancelled appointment) | |
Request For Medical Records and Affidavit MP - 3 MDN Injury Care | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Baylor Scott&White Medical Center | |
Reduction Request MP – 2 Accident Centers of Texas (No Record, Client cancelled appointment) | |
Reduction Request MP – 3 MDN Injury Care | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Antonio Spencer

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Dr Bryan Weddle | |
LOP MP – 2 Dr. Charles Willis, M.D, P.A. | |
LOP MP – 3 CVS Pharmacy | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Health Scope | |
LOR 3rd Party – 1 American Access Casualty Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Dr Bryan Weddle | |
Request For Medical Records and Affidavit MP - 2 Dr. Charles Willis, M.D, P.A. | |
Request For Medical Records and Affidavit MP - 3 CVS Pharmacy | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Dr Bryan Weddle | |
Reduction Request MP – 2 Dr. Charles Willis, M.D, P.A. | |
Reduction Request MP – 3 CVS Pharmacy | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

April Adeoye

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Revive My Spine | lop provider sent |
LOP MP – 2 MRI Centers of Texas | lop provider sent |
LOP MP – 3 Dallas Radiology | lop provider sent |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Alinsco Insurance | |
LOR 3rd Party – 1 GEICO County Mutual Insurance Company | lor sent |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Revive My Spine | medical record provider requested |
Request For Medical Records and Affidavit MP - 2 MRI Centers of Texas | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 3 Dallas Radiology | medical record provider requested |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Revive My Spine | |
Reduction Request MP – 2 MRI Centers of Texas | |
Reduction Request MP – 3 Dallas Radiology | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Astrid Ulloa

Case Status

2 - Gathering Medical Records

Case Status Note

3rd party denied liability

Case Status

case status

LOP FORM

LOP MP – 1 Parkland Hospital | |
LOP MP – 2 Core Wellness & Rehab Center | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party AssuranceAmerica | |
LOR 3rd Party – 1 GeiCO County Mutual Insurance Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Parkland Hospital | |
Request For Medical Records and Affidavit MP - 2 Core Wellness & Rehab Center | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Parkland Hospital | |
Reduction Request MP – 2 Core Wellness & Rehab Center | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Asuncion, Luciano Alvarado

Case Status

2 - Gathering Medical Records

Case Status Note

3rd party accepted 100% liability.

Case Status

case status

LOP FORM

LOP MP – 1 Revive My Spine (didn't went to this provider) | |
LOP MP – 2 HK Radiology | lop provider sent | lop provider received
LOP MP – 3 MRI Centers of Texas (DIDN'T WENT FOR IMAGING) | lop provider sent | lop provider received
LOP MP – 4 Epic Pain & Orthopedics | lop provider sent | lop provider received
LOP MP – 5 Mira Vista Pharmacy | lop provider sent | lop provider received
LOP MP – 6 Core Wellness & Rehab Center | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 State Farm | lor sent |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Revive My Spine (didn't went to this provider) | |
Request For Medical Records and Affidavit MP - 2 HK Radiology | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 3 MRI Centers of Texas (DIDN'T WENT FOR IMAGING) | |
Request For Medical Records and Affidavit MP - 4 Epic Pain & Orthopedics | | medical record provider received
Request For Medical Records and Affidavit MP - 5 Mira Vista Pharmacy | medical record provider requested |
Request For Medical Records and Affidavit MP - 6 Core Wellness & Rehab Center | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Revive My Spine (didn't went to this provider) | |
Reduction Request MP – 2 HK Radiology | |
Reduction Request MP – 3 MRI Centers of Texas (DIDN'T WENT FOR IMAGING) | |
Reduction Request MP – 4 Epic Pain & Orthopedics | |
Reduction Request MP – 5 Mira Vista Pharmacy | |
Reduction Request MP – 6 Core Wellness & Rehab Center | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Brandie Johnson

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Revive Injury and Rehab | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 Kroger Co | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Revive Injury and Rehab | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Revive Injury and Rehab | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Brantley, Christopher

Case Status

Mediation

Case Status

case status

LOP FORM

LOP MP – 1 Progressive Medical Evaluations | |
LOP MP – 2 67 Pain & Injury | |
LOP MP – 3 Mira Vista Apothecary | |
LOP MP – 4 MRI Centers of Texas | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party FEDERAL INSURANCE / Gallager Basset | |
LOR 3rd Party – 1 OLD AMERICAN COUNTY MUTUAL / Connect Insurance | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage Mediation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Progressive Medical Evaluations | |
Request For Medical Records and Affidavit MP - 2 67 Pain & Injury | |
Request For Medical Records and Affidavit MP - 3 Mira Vista Apothecary | |
Request For Medical Records and Affidavit MP - 4 MRI Centers of Texas | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Progressive Medical Evaluations | |
Reduction Request MP – 2 67 Pain & Injury | |
Reduction Request MP – 3 Mira Vista Apothecary | |
Reduction Request MP – 4 MRI Centers of Texas | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Britni Johnson

Case Status

3 - Demand Pending

Case Status

case status

LOP FORM

LOP MP – 1 MDN Injury Care | |
LOP MP – 2 MRI of Texas | |
LOP MP – 3 Actnow1 | |
LOP MP – 4 Dallas Radiology, P.A. | |
LOP MP – 5 North Texas X-Ray | |
LOP MP – 6 people First Pharmacy | |
LOP MP – 7 Baylor University Medical Center Dallas | |
LOP MP – 8 Momentum Spine & joint | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 Geico | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 3 - Demand Pending

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 MDN Injury Care | |
Request For Medical Records and Affidavit MP - 2 MRI of Texas | |
Request For Medical Records and Affidavit MP - 3 Actnow1 | |
Request For Medical Records and Affidavit MP - 4 Dallas Radiology, P.A. | |
Request For Medical Records and Affidavit MP - 5 North Texas X-Ray | |
Request For Medical Records and Affidavit MP - 6 people First Pharmacy | |
Request For Medical Records and Affidavit MP - 7 Baylor University Medical Center Dallas | |
Request For Medical Records and Affidavit MP - 8 Momentum Spine & joint | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 MDN Injury Care | |
Reduction Request MP – 2 MRI of Texas | |
Reduction Request MP – 3 Actnow1 | |
Reduction Request MP – 4 Dallas Radiology, P.A. | |
Reduction Request MP – 5 North Texas X-Ray | |
Reduction Request MP – 6 people First Pharmacy | |
Reduction Request MP – 7 Baylor University Medical Center Dallas | |
Reduction Request MP – 8 Momentum Spine & joint | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Britni Johnson

Case Status

case status

LOP FORM

LOP MP – 1 Baylor University Dallas | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Baylor University Dallas | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Baylor University Dallas | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Chris Cline

Case Status

5 - Discovery

Case Status

case status

LOP FORM

LOP MP – 1 Desoto Injury Rehab | |
LOP MP – 2 SOAR Institute PLLC | |
LOP MP – 3 ASP Cares | lop provider sent | lop provider received
LOP MP – 4 MRI Centers of Texas | |
LOP MP – 5 Pain Clarity LLC | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party AAA | |
LOR 3rd Party – 1 Progressive County Mutual Insurance Company | lor sent | lor received
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 5 - Discovery

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Desoto Injury Rehab | |
Request For Medical Records and Affidavit MP - 2 SOAR Institute PLLC | |
Request For Medical Records and Affidavit MP - 3 ASP Cares | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 4 MRI Centers of Texas | |
Request For Medical Records and Affidavit MP - 5 Pain Clarity LLC | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Desoto Injury Rehab | |
Reduction Request MP – 2 SOAR Institute PLLC | |
Reduction Request MP – 3 ASP Cares | |
Reduction Request MP – 4 MRI Centers of Texas | |
Reduction Request MP – 5 Pain Clarity LLC | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Christian Torres Francisco's son

Case Status

5 - Discovery

Case Status

case status

LOP FORM

LOP MP – 1 Med Post Urgent Care Rockwall | |
LOP MP – 2 Baylor Scott&White Lake Pointe | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 5 - Discovery

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Med Post Urgent Care Rockwall | |
Request For Medical Records and Affidavit MP - 2 Baylor Scott&White Lake Pointe | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Med Post Urgent Care Rockwall | |
Reduction Request MP – 2 Baylor Scott&White Lake Pointe | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Christopher Brantley

Case Status

5 - Discovery

Case Status

case status

LOP FORM

LOP MP – 1 Dallas Radiology | |
LOP MP – 2 67 Pain & Injury | |
LOP MP – 3 Mira Vista Apothecary | |
LOP MP – 4 Foundation Physicians Group | |
LOP MP – 5 Renaissance Radiology | |
LOP MP – 6 Priority Imaging | |
LOP MP – 7 Progressive Medical Evaluations | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party USAA | |
LOR 3rd Party – 1 OLD AMERICAN COUNTY MUTUAL / Connect Insurance | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 5 - Discovery

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Dallas Radiology | |
Request For Medical Records and Affidavit MP - 2 67 Pain & Injury | |
Request For Medical Records and Affidavit MP - 3 Mira Vista Apothecary | |
Request For Medical Records and Affidavit MP - 4 Foundation Physicians Group | |
Request For Medical Records and Affidavit MP - 5 Renaissance Radiology | |
Request For Medical Records and Affidavit MP - 6 Priority Imaging | |
Request For Medical Records and Affidavit MP - 7 Progressive Medical Evaluations | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Dallas Radiology | |
Reduction Request MP – 2 67 Pain & Injury | |
Reduction Request MP – 3 Mira Vista Apothecary | |
Reduction Request MP – 4 Foundation Physicians Group | |
Reduction Request MP – 5 Renaissance Radiology | |
Reduction Request MP – 6 Priority Imaging | |
Reduction Request MP – 7 Progressive Medical Evaluations | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Cindy Thepsombandith

Case Status

2 - Gathering Medical Records

Case Status Note

3rd Party deny coverage.

Case Status

case status

LOP FORM

LOP MP – 1 Accident Centers of Texas | lop provider sent | lop provider received
LOP MP – 2 Infinity Care Medical Group | lop provider sent | lop provider received
LOP MP – 3 North Texas X-Ray Services, Inc. | lop provider sent | lop provider received
LOP MP – 4 Prime Diagonstic Imaging (No record available) | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Progressive Insurance Company | |
LOR 3rd Party – 1 Infinity Insurance | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Accident Centers of Texas | |
Request For Medical Records and Affidavit MP - 2 Infinity Care Medical Group | |
Request For Medical Records and Affidavit MP - 3 North Texas X-Ray Services, Inc. | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 4 Prime Diagonstic Imaging (No record available) | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Accident Centers of Texas | |
Reduction Request MP – 2 Infinity Care Medical Group | |
Reduction Request MP – 3 North Texas X-Ray Services, Inc. | |
Reduction Request MP – 4 Prime Diagonstic Imaging (No record available) | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Coverage
  • No PIP Coverage

Download PDF Entry

Client Name

D'Andra Parish-Warren

Case Status

5 - Discovery

Case Status

case status

LOP FORM

LOP MP – 1 Wellness Center of Texas | |
LOP MP – 2 MRI Centers of Texas | |
LOP MP – 3 Lakewood Anesthesia C/O EZ MED GROUP | |
LOP MP – 4 Uptown Radiology Associates | |
LOP MP – 5 Epic Pain & Orthopedics | |
LOP MP – 6 Preferred Imaging | |
LOP MP – 7 Code 3 ER & Urgent care at Mesquite | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Liberty Mutual | |
LOR 3rd Party – 1 Travelers Insurance | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 5 - Discovery

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Wellness Center of Texas | |
Request For Medical Records and Affidavit MP - 2 MRI Centers of Texas | |
Request For Medical Records and Affidavit MP - 3 Lakewood Anesthesia C/O EZ MED GROUP | |
Request For Medical Records and Affidavit MP - 4 Uptown Radiology Associates | |
Request For Medical Records and Affidavit MP - 5 Epic Pain & Orthopedics | |
Request For Medical Records and Affidavit MP - 6 Preferred Imaging | |
Request For Medical Records and Affidavit MP - 7 Code 3 ER & Urgent care at Mesquite | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Wellness Center of Texas | |
Reduction Request MP – 2 MRI Centers of Texas | |
Reduction Request MP – 3 Lakewood Anesthesia C/O EZ MED GROUP | |
Reduction Request MP – 4 Uptown Radiology Associates | |
Reduction Request MP – 5 Epic Pain & Orthopedics | |
Reduction Request MP – 6 Preferred Imaging | |
Reduction Request MP – 7 Code 3 ER & Urgent care at Mesquite | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Dale Fields

Case Status

4 - Litigation

Case Status Note

Demand Sent.

Case Status

case status

LOP FORM

LOP MP – 1 Accident Care and Treatment Center of TX, P.A. | |
LOP MP – 2 Champions Rehabilitation | |
LOP MP – 3 PeopleFirst Pharmacy | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Farmers Insurance | |
LOR 3rd Party – 1 Allstate Insurance | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Accident Care and Treatment Center of TX, P.A. | |
Request For Medical Records and Affidavit MP - 2 Champions Rehabilitation | |
Request For Medical Records and Affidavit MP - 3 PeopleFirst Pharmacy | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Accident Care and Treatment Center of TX, P.A. | |
Reduction Request MP – 2 Champions Rehabilitation | |
Reduction Request MP – 3 PeopleFirst Pharmacy | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Coverage
  • No PIP Coverage

Download PDF Entry

Client Name

Delailah Chaparro

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 First Class Medical Clinics-Gateway Medical&Pain | |
LOP MP – 2 Southwest X-ray Downtown (No Records) | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 First Class Medical Clinics-Gateway Medical&Pain | |
Request For Medical Records and Affidavit MP - 2 Southwest X-ray Downtown (No Records) | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 First Class Medical Clinics-Gateway Medical&Pain | |
Reduction Request MP – 2 Southwest X-ray Downtown (No Records) | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Denise Keller

Case Status

case status

LOP FORM

LOP MP – 1 | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Erlene Mundy

Case Status

4 - Litigation

Case Status Note

Demand Sent

Case Status

case status

LOP FORM

LOP MP – 1 Revive My Spine | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Farmers | |
LOR 3rd Party – 1 Diamond Specialty | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Revive My Spine | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Revive My Spine | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Eromosele Borha

Case Status

5 - Discovery

Case Status

case status

LOP FORM

LOP MP – 1 Texas Health Plano Emergency | |
LOP MP – 2 Vivis Inc. dba ReMed | |
LOP MP – 3 Integrative Pain Management Center, PLLC | |
LOP MP – 4 Dallas MRI Center, LLC | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party State Farm Mutual Automobile Insurance Company | lor sent | lor received
LOR 3rd Party – 1 GEICO County Mutual Insurance Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 5 - Discovery

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Texas Health Plano Emergency | |
Request For Medical Records and Affidavit MP - 2 Vivis Inc. dba ReMed | |
Request For Medical Records and Affidavit MP - 3 Integrative Pain Management Center, PLLC | |
Request For Medical Records and Affidavit MP - 4 Dallas MRI Center, LLC | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Texas Health Plano Emergency | |
Reduction Request MP – 2 Vivis Inc. dba ReMed | |
Reduction Request MP – 3 Integrative Pain Management Center, PLLC | |
Reduction Request MP – 4 Dallas MRI Center, LLC | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Esmeralda Rodriguez Francisco's Daughter

Case Status

5 - Discovery

Case Status

case status

LOP FORM

LOP MP – 1 Med Post Urgent Care Rockwall | |
LOP MP – 2 Baylor Scott&White Lake Pointe | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 5 - Discovery

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Med Post Urgent Care Rockwall | |
Request For Medical Records and Affidavit MP - 2 Baylor Scott&White Lake Pointe | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Med Post Urgent Care Rockwall | |
Reduction Request MP – 2 Baylor Scott&White Lake Pointe | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Freida Rivera Coronel

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Baylor Scott&White | |
LOP MP – 2 Southwest Injury Center Inc. | |
LOP MP – 3 Epic Pain & Orthopedics | |
LOP MP – 4 MRI Centers of Texas | |
LOP MP – 5 Data mgnt | |
LOP MP – 6 Mira Vista Apothecary | |
LOP MP – 7 Dallas Radiology, P.A. | |
LOP MP – 8 Lakewood Anesthesia | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party United Automobile Insurance Company | |
LOR 3rd Party – 1 Progressive County Mutual Insurance Company | |
LOR 3rd Party – 2 Texas Farm Bureau Insurance | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Baylor Scott&White | |
Request For Medical Records and Affidavit MP - 2 Southwest Injury Center Inc. | | medical record provider received
Request For Medical Records and Affidavit MP - 3 Epic Pain & Orthopedics | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 4 MRI Centers of Texas | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 5 Data mgnt | |
Request For Medical Records and Affidavit MP - 6 Mira Vista Apothecary | |
Request For Medical Records and Affidavit MP - 7 Dallas Radiology, P.A. | | medical record provider received
Request For Medical Records and Affidavit MP - 8 Lakewood Anesthesia | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Baylor Scott&White | |
Reduction Request MP – 2 Southwest Injury Center Inc. | |
Reduction Request MP – 3 Epic Pain & Orthopedics | |
Reduction Request MP – 4 MRI Centers of Texas | |
Reduction Request MP – 5 Data mgnt | |
Reduction Request MP – 6 Mira Vista Apothecary | |
Reduction Request MP – 7 Dallas Radiology, P.A. | |
Reduction Request MP – 8 Lakewood Anesthesia | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Gabrielle Ford

Case Status

3 - Demand Pending

Case Status

case status

LOP FORM

LOP MP – 1 Cornerstone Chiropractic | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Allstate | |
LOR 3rd Party – 1 Liberty Mutual | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 3 - Demand Pending

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Cornerstone Chiropractic | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Cornerstone Chiropractic | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Georges P. Nagassa

Case Status

1 - Medical Treatment and Recovery

Case Status

case status

LOP FORM

LOP MP – 1 | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 Progressive Insurance Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 1 - Medical Treatment and Recovery

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Georgianna Wanjiru

Case Status

4 - Litigation

Case Status Note

3rd Party accepted 100% liability.

Case Status

case status

LOP FORM

LOP MP – 1 Southwest injury Center | |
LOP MP – 2 Epic Pain and Orthopedics | |
LOP MP – 3 Walmart Pharmacy | |
LOP MP – 4 DFW MRI | lop provider sent |
LOP MP – 5 Pro Med, Inc. | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 Progressive County Mutual Insurance Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Southwest injury Center | |
Request For Medical Records and Affidavit MP - 2 Epic Pain and Orthopedics | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 3 Walmart Pharmacy | |
Request For Medical Records and Affidavit MP - 4 DFW MRI | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 5 Pro Med, Inc. | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Southwest injury Center | |
Reduction Request MP – 2 Epic Pain and Orthopedics | |
Reduction Request MP – 3 Walmart Pharmacy | |
Reduction Request MP – 4 DFW MRI | |
Reduction Request MP – 5 Pro Med, Inc. | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Gordon R. Ellis

Case Status

case status

LOP FORM

LOP MP – 1 MDN Injury Clinic | |
LOP MP – 2 Accident Centers of Texas | |
LOP MP – 3 PeopleFirst Pharmacy | |
LOP MP – 4 MRI Centers of Texas | |
LOP MP – 5 North Texas X-ray | |
LOP MP – 6 Momentum Spine & Joint | |
LOP MP – 7 Uptown Radiology | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party State Farm Mutual Automobile Insurance Company | |
LOR 3rd Party – 1 Progressive County Mutual Ins. Co | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 MDN Injury Clinic | |
Request For Medical Records and Affidavit MP - 2 Accident Centers of Texas | |
Request For Medical Records and Affidavit MP - 3 PeopleFirst Pharmacy | |
Request For Medical Records and Affidavit MP - 4 MRI Centers of Texas | |
Request For Medical Records and Affidavit MP - 5 North Texas X-ray | |
Request For Medical Records and Affidavit MP - 6 Momentum Spine & Joint | |
Request For Medical Records and Affidavit MP - 7 Uptown Radiology | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 MDN Injury Clinic | |
Reduction Request MP – 2 Accident Centers of Texas | |
Reduction Request MP – 3 PeopleFirst Pharmacy | |
Reduction Request MP – 4 MRI Centers of Texas | |
Reduction Request MP – 5 North Texas X-ray | |
Reduction Request MP – 6 Momentum Spine & Joint | |
Reduction Request MP – 7 Uptown Radiology | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Coverage
  • PIP Coverage

Download PDF Entry

Client Name

Hayden Adams

Case Status

4 - Litigation

Case Status Note

Demand Sent.

Case Status

case status

LOP FORM

LOP MP – 1 Baylor Scott & White Mc Kinney | |
LOP MP – 2 Accident Centers of Texas | lop provider sent | lop provider received
LOP MP – 3 MRI Centers of Texas | lop provider sent | lop provider received
LOP MP – 4 Data Managment DMC Medical Billing | |
LOP MP – 5 People First Pharmacy | lop provider sent | lop provider received
LOP MP – 6 Infinity Care Medical Group | lop provider sent | lop provider received
LOP MP – 7 Momentum Spine and Joint | lop provider sent | lop provider received
LOP MP – 8 Memorial Care Pharmacy | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 Farmers Insurance- National Document Center | lor sent |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 No Ins/Danise Ins | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Baylor Scott & White Mc Kinney | medical record provider requested |
Request For Medical Records and Affidavit MP - 2 Accident Centers of Texas | | medical record provider received
Request For Medical Records and Affidavit MP - 3 MRI Centers of Texas | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 4 Data Managment DMC Medical Billing | |
Request For Medical Records and Affidavit MP - 5 People First Pharmacy | medical record provider requested |
Request For Medical Records and Affidavit MP - 6 Infinity Care Medical Group | medical record provider requested |
Request For Medical Records and Affidavit MP - 7 Momentum Spine and Joint | |
Request For Medical Records and Affidavit MP - 8 Memorial Care Pharmacy | | medical record provider received
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Baylor Scott & White Mc Kinney | |
Reduction Request MP – 2 Accident Centers of Texas | |
Reduction Request MP – 3 MRI Centers of Texas | |
Reduction Request MP – 4 Data Managment DMC Medical Billing | |
Reduction Request MP – 5 People First Pharmacy | |
Reduction Request MP – 6 Infinity Care Medical Group | |
Reduction Request MP – 7 Momentum Spine and Joint | |
Reduction Request MP – 8 Memorial Care Pharmacy | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Hien Nguyen

Case Status

case status

LOP FORM

LOP MP – 1 Allen Pain & Injury | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party USAA | |
LOR 3rd Party – 1 USAA General Indemnity Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Allen Pain & Injury | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Allen Pain & Injury | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Hiramer J Jacobs

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Dr.Ventakta S Chilakapati, MD | |
LOP MP – 2 Wilbarger General Hospital | |
LOP MP – 3 United Regional Healthcare Hospital | |
LOP MP – 4 PAM Rehabilitation Hospital Allen | |
LOP MP – 5 Belmont At Twin Creeks | |
LOP MP – 6 McKinney Medical Center | |
LOP MP – 7 MckinneyCare Pharmacy | |
LOP MP – 8 Complete Heart Care, P.A. | |
LOP MP – 9 AMADA Senior Care Services DONE | |
LOP MP – 10 Albertsons Pharmacy | |

LOR FORM

LOR 1st Party Blue Cross Blue Shield | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Dr.Ventakta S Chilakapati, MD | |
Request For Medical Records and Affidavit MP - 2 Wilbarger General Hospital | |
Request For Medical Records and Affidavit MP - 3 United Regional Healthcare Hospital | |
Request For Medical Records and Affidavit MP - 4 PAM Rehabilitation Hospital Allen | |
Request For Medical Records and Affidavit MP - 5 Belmont At Twin Creeks | |
Request For Medical Records and Affidavit MP - 6 McKinney Medical Center | |
Request For Medical Records and Affidavit MP - 7 MckinneyCare Pharmacy | |
Request For Medical Records and Affidavit MP - 8 Complete Heart Care, P.A. | |
Request For Medical Records and Affidavit MP - 9 AMADA Senior Care Services DONE | |
Request For Medical Records and Affidavit MP - 10 Albertsons Pharmacy | |

Reduction Request Form

Reduction Request MP – 1 Dr.Ventakta S Chilakapati, MD | |
Reduction Request MP – 2 Wilbarger General Hospital | |
Reduction Request MP – 3 United Regional Healthcare Hospital | |
Reduction Request MP – 4 PAM Rehabilitation Hospital Allen | |
Reduction Request MP – 5 Belmont At Twin Creeks | |
Reduction Request MP – 6 McKinney Medical Center | |
Reduction Request MP – 7 MckinneyCare Pharmacy | |
Reduction Request MP – 8 Complete Heart Care, P.A. | |
Reduction Request MP – 9 AMADA Senior Care Services DONE | |
Reduction Request MP – 10 Albertsons Pharmacy | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Hoan Huynh

Case Status

case status

LOP FORM

LOP MP – 1 | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 H-Mart | |
LOR 3rd Party – 2 KC Distributor's | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Ikenna Chris Onunkwo

Case Status

4 - Litigation

Case Status Note

3rd Party accepted 100% liability. Demand Sent

Case Status

case status

LOP FORM

LOP MP – 1 Southwest Injury Center | |
LOP MP – 2 Epic Pain and Orthopedics | lop provider sent | lop provider received
LOP MP – 3 Prime Diagnostic Imaging | | lop provider received
LOP MP – 4 PeopleFirst Pharmacy | |
LOP MP – 5 Pro Med Inc. | |
LOP MP – 6 Elite Anesthesia in care of EZ Med Group | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Commonwealth Insurance Company | |
LOR 3rd Party – 1 State Farm Claims | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Southwest Injury Center | |
Request For Medical Records and Affidavit MP - 2 Epic Pain and Orthopedics | |
Request For Medical Records and Affidavit MP - 3 Prime Diagnostic Imaging | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 4 PeopleFirst Pharmacy | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 5 Pro Med Inc. | |
Request For Medical Records and Affidavit MP - 6 Elite Anesthesia in care of EZ Med Group | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Southwest Injury Center | |
Reduction Request MP – 2 Epic Pain and Orthopedics | |
Reduction Request MP – 3 Prime Diagnostic Imaging | |
Reduction Request MP – 4 PeopleFirst Pharmacy | |
Reduction Request MP – 5 Pro Med Inc. | |
Reduction Request MP – 6 Elite Anesthesia in care of EZ Med Group | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

James Linzer

Case Status Note

Third Party has 30/60 Policy

Case Status

case status

LOP FORM

LOP MP – 1 Breeze MRI | |
LOP MP – 2 FB Surgical Associates | |
LOP MP – 3 Ache Institute of Houston | |
LOP MP – 4 Purim Chiropractic | |
LOP MP – 5 People First Pharmacy | |
LOP MP – 6 Houston Methodist Sugar Land Hospital | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Quality Distribution Inc. | |
LOR 3rd Party – 1 Progressive County Mutual Insurance | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 Acord not an ins company | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Breeze MRI | |
Request For Medical Records and Affidavit MP - 2 FB Surgical Associates | | medical record provider received
Request For Medical Records and Affidavit MP - 3 Ache Institute of Houston | |
Request For Medical Records and Affidavit MP - 4 Purim Chiropractic | |
Request For Medical Records and Affidavit MP - 5 People First Pharmacy | |
Request For Medical Records and Affidavit MP - 6 Houston Methodist Sugar Land Hospital | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Breeze MRI | |
Reduction Request MP – 2 FB Surgical Associates | |
Reduction Request MP – 3 Ache Institute of Houston | |
Reduction Request MP – 4 Purim Chiropractic | |
Reduction Request MP – 5 People First Pharmacy | |
Reduction Request MP – 6 Houston Methodist Sugar Land Hospital | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Coverage
  • No PIP Coverage

Download PDF Entry

Client Name

James Stroud

Case Status

1 - Medical Treatment and Recovery

Case Status

case status

LOP FORM

LOP MP – 1 Baylor Scott&White | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 1 - Medical Treatment and Recovery

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Baylor Scott&White | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Baylor Scott&White | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Jessica Pagan

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Accident Centers of Texas | |
LOP MP – 2 MRI Centers of Texas | |
LOP MP – 3 Data Management | |
LOP MP – 4 PeopleFirst Pharmacy | |
LOP MP – 5 Infinity Care Medical Group | |
LOP MP – 6 Methodist Hospital | |
LOP MP – 7 Momentum Spine and Joint | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party ACCC | |
LOR 3rd Party – 1 Allstate | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Accident Centers of Texas | |
Request For Medical Records and Affidavit MP - 2 MRI Centers of Texas | |
Request For Medical Records and Affidavit MP - 3 Data Management | |
Request For Medical Records and Affidavit MP - 4 PeopleFirst Pharmacy | |
Request For Medical Records and Affidavit MP - 5 Infinity Care Medical Group | |
Request For Medical Records and Affidavit MP - 6 Methodist Hospital | |
Request For Medical Records and Affidavit MP - 7 Momentum Spine and Joint | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Accident Centers of Texas | |
Reduction Request MP – 2 MRI Centers of Texas | |
Reduction Request MP – 3 Data Management | |
Reduction Request MP – 4 PeopleFirst Pharmacy | |
Reduction Request MP – 5 Infinity Care Medical Group | |
Reduction Request MP – 6 Methodist Hospital | |
Reduction Request MP – 7 Momentum Spine and Joint | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Jesus Perez

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Accident Centers of Texas | |
LOP MP – 2 MRI Centers of Texas | |
LOP MP – 3 Data Management | |
LOP MP – 4 Infinity Care Medical Group | |
LOP MP – 5 PeopleFirst Pharmacy | |
LOP MP – 6 Methodist Hospital | |
LOP MP – 7 Momentum Spine and Joint | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party ACCC | |
LOR 3rd Party – 1 Allstate Insurance Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Accident Centers of Texas | |
Request For Medical Records and Affidavit MP - 2 MRI Centers of Texas | |
Request For Medical Records and Affidavit MP - 3 Data Management | |
Request For Medical Records and Affidavit MP - 4 Infinity Care Medical Group | |
Request For Medical Records and Affidavit MP - 5 PeopleFirst Pharmacy | |
Request For Medical Records and Affidavit MP - 6 Methodist Hospital | |
Request For Medical Records and Affidavit MP - 7 Momentum Spine and Joint | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Accident Centers of Texas | |
Reduction Request MP – 2 MRI Centers of Texas | |
Reduction Request MP – 3 Data Management | |
Reduction Request MP – 4 Infinity Care Medical Group | |
Reduction Request MP – 5 PeopleFirst Pharmacy | |
Reduction Request MP – 6 Methodist Hospital | |
Reduction Request MP – 7 Momentum Spine and Joint | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Joel Lopez

Case Status

4 - Litigation

Case Status Note

Demand Sent.

Case Status

case status

LOP FORM

LOP MP – 1 PeopleFirst Pharmacy | |
LOP MP – 2 Gateway Medical and Pain Center | |
LOP MP – 3 Southwest X-Ray | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Statefarm | |
LOR 3rd Party – 1 Loya Insurance Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 PeopleFirst Pharmacy | |
Request For Medical Records and Affidavit MP - 2 Gateway Medical and Pain Center | |
Request For Medical Records and Affidavit MP - 3 Southwest X-Ray | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 PeopleFirst Pharmacy | |
Reduction Request MP – 2 Gateway Medical and Pain Center | |
Reduction Request MP – 3 Southwest X-Ray | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

John Calloway (III) 11/22/2019

Case Status

case status

LOP FORM

LOP MP – 1 Cornerstone Chiropractic | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | lop provider sent | lop provider received
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party USAA | lor sent |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Cornerstone Chiropractic | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | medical record provider requested |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Cornerstone Chiropractic | reduction request sent | reduction request received
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

John Calloway III

Case Status

case status

LOP FORM

LOP MP – 1 Cornerstone Chiropractic | |
LOP MP – 2 5- Park Ambulatory Surgery Center | |
LOP MP – 3 Texas Anesthesia Group, PLLC | |
LOP MP – 4 Texas Pain Relief Group | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party USAA | |
LOR 3rd Party – 1 GEICO County Mutual Insurance Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Cornerstone Chiropractic | |
Request For Medical Records and Affidavit MP - 2 5- Park Ambulatory Surgery Center | |
Request For Medical Records and Affidavit MP - 3 Texas Anesthesia Group, PLLC | |
Request For Medical Records and Affidavit MP - 4 Texas Pain Relief Group | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Cornerstone Chiropractic | |
Reduction Request MP – 2 5- Park Ambulatory Surgery Center | |
Reduction Request MP – 3 Texas Anesthesia Group, PLLC | |
Reduction Request MP – 4 Texas Pain Relief Group | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Jorge Gutierrez II

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 PeopleFirst Pharmacy | |
LOP MP – 2 Gateway Medical and Pain Center | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party State Farm Insurance Company | |
LOR 3rd Party – 1 Loya Insurance Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 PeopleFirst Pharmacy | |
Request For Medical Records and Affidavit MP - 2 Gateway Medical and Pain Center | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 PeopleFirst Pharmacy | |
Reduction Request MP – 2 Gateway Medical and Pain Center | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Jose Hernandez

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Methodist Dallas Medical Center | |
LOP MP – 2 Elite Healthcare South Dallas Clinic | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 Gainsco, Inc. (DENIED COVERAGE FOR DEFENDANT) | |
LOR 3rd Party – 2 Falcon Ins. | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Methodist Dallas Medical Center | |
Request For Medical Records and Affidavit MP - 2 Elite Healthcare South Dallas Clinic | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Methodist Dallas Medical Center | |
Reduction Request MP – 2 Elite Healthcare South Dallas Clinic | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Joshua Holden

Case Status

4 - Litigation

Case Status Note

Demand Sent

Case Status

case status

LOP FORM

LOP MP – 1 Southwest Injury Center | |
LOP MP – 2 Epic Pain & Orthopedics- Dallas | |
LOP MP – 3 Mira Vista Pharmacy | |
LOP MP – 4 Prime Diagnostic Imaging | lop provider sent | lop provider received
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Nationwide Mutual Insurance Company | |
LOR 3rd Party – 1 Nationwide Mutual Insurance Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Southwest Injury Center | |
Request For Medical Records and Affidavit MP - 2 Epic Pain & Orthopedics- Dallas | |
Request For Medical Records and Affidavit MP - 3 Mira Vista Pharmacy | |
Request For Medical Records and Affidavit MP - 4 Prime Diagnostic Imaging | | medical record provider received
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Southwest Injury Center | |
Reduction Request MP – 2 Epic Pain & Orthopedics- Dallas | |
Reduction Request MP – 3 Mira Vista Pharmacy | |
Reduction Request MP – 4 Prime Diagnostic Imaging | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Katherine Mims McDaniel

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Texas Health Harris Methodist Hospital Southwest Ft Worth | |
LOP MP – 2 Progressive Integrated Healthcare | |
LOP MP – 3 DFW pain injury Centers- Burleson Pain and Injury Center (DONE) | |
LOP MP – 4 Mira Vista Apothecary (DONE) | |
LOP MP – 5 Dalla Radiology, PA (DONE) | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 ACCC | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Texas Health Harris Methodist Hospital Southwest Ft Worth | |
Request For Medical Records and Affidavit MP - 2 Progressive Integrated Healthcare | |
Request For Medical Records and Affidavit MP - 3 DFW pain injury Centers- Burleson Pain and Injury Center (DONE) | |
Request For Medical Records and Affidavit MP - 4 Mira Vista Apothecary (DONE) | |
Request For Medical Records and Affidavit MP - 5 Dalla Radiology, PA (DONE) | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Texas Health Harris Methodist Hospital Southwest Ft Worth | |
Reduction Request MP – 2 Progressive Integrated Healthcare | |
Reduction Request MP – 3 DFW pain injury Centers- Burleson Pain and Injury Center (DONE) | |
Reduction Request MP – 4 Mira Vista Apothecary (DONE) | |
Reduction Request MP – 5 Dalla Radiology, PA (DONE) | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Katrina Cartwright

Case Status

1 - Medical Treatment and Recovery

Case Status

case status

LOP FORM

LOP MP – 1 Purim Chiropractic | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 1 - Medical Treatment and Recovery

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Purim Chiropractic | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Purim Chiropractic | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Kenyan Mims

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Texas Health Harris Methodist Hospital Southwest Ft Worth | |
LOP MP – 2 Progressive Integrated Healthcare | |
LOP MP – 3 DFW Pain & Injury Centers | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 ACCC | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Texas Health Harris Methodist Hospital Southwest Ft Worth | |
Request For Medical Records and Affidavit MP - 2 Progressive Integrated Healthcare | |
Request For Medical Records and Affidavit MP - 3 DFW Pain & Injury Centers | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Texas Health Harris Methodist Hospital Southwest Ft Worth | |
Reduction Request MP – 2 Progressive Integrated Healthcare | |
Reduction Request MP – 3 DFW Pain & Injury Centers | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Kiriath Lumpkin

Case Status

1 - Medical Treatment and Recovery

Case Status

case status

LOP FORM

LOP MP – 1 | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 1 - Medical Treatment and Recovery

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Kyna Wiltz

Case Status

case status

LOP FORM

LOP MP – 1 Cornerstone Chiropratic | |
LOP MP – 2 ASP Cares | |
LOP MP – 3 DFW Open MRI | |
LOP MP – 4 MDN, P.A. | |
LOP MP – 5 Pro Med, Inc. | |
LOP MP – 6 Richardson/Garland Injury Rehab | |
LOP MP – 7 Village Physical Therapy | |
LOP MP – 8 Up & Open Imaging | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Progressive County Mutual Ins Co | |
LOR 3rd Party – 1 Progressive County Mutual Ins. Co. | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Cornerstone Chiropratic | |
Request For Medical Records and Affidavit MP - 2 ASP Cares | |
Request For Medical Records and Affidavit MP - 3 DFW Open MRI | |
Request For Medical Records and Affidavit MP - 4 MDN, P.A. | |
Request For Medical Records and Affidavit MP - 5 Pro Med, Inc. | |
Request For Medical Records and Affidavit MP - 6 Richardson/Garland Injury Rehab | |
Request For Medical Records and Affidavit MP - 7 Village Physical Therapy | |
Request For Medical Records and Affidavit MP - 8 Up & Open Imaging | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Cornerstone Chiropratic | |
Reduction Request MP – 2 ASP Cares | |
Reduction Request MP – 3 DFW Open MRI | |
Reduction Request MP – 4 MDN, P.A. | |
Reduction Request MP – 5 Pro Med, Inc. | |
Reduction Request MP – 6 Richardson/Garland Injury Rehab | |
Reduction Request MP – 7 Village Physical Therapy | |
Reduction Request MP – 8 Up & Open Imaging | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Laureen Abbo Nono

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Lemnyuy Nyuykongi

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Revive My Spine | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Geigo | |
LOR 3rd Party – 1 State Farm Claims | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Revive My Spine | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Revive My Spine | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Levi Young

Case Status

case status

LOP FORM

LOP MP – 1 PeopleFirst Pharmacy | lop provider sent |
LOP MP – 2 Baylor Scott & White Medical Center | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 PeopleFirst Pharmacy | |
Request For Medical Records and Affidavit MP - 2 Baylor Scott & White Medical Center | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 PeopleFirst Pharmacy | |
Reduction Request MP – 2 Baylor Scott & White Medical Center | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Lister Ziemi

Case Status

case status

LOP FORM

LOP MP – 1 Accident Centers of Texas | |
LOP MP – 2 North Texas X-Ray Service Inc. | |
LOP MP – 3 PeopleFirst Pharmacy | |
LOP MP – 4 MRI Centers of Texas and Data Management | |
LOP MP – 5 Infinity Care Medical Group | |
LOP MP – 6 Momentum Spine and Joint (DIDN'T WENT) | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 Hertz Self Insurance | |
LOR 3rd Party – 2 State Farm Claims | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Accident Centers of Texas | |
Request For Medical Records and Affidavit MP - 2 North Texas X-Ray Service Inc. | |
Request For Medical Records and Affidavit MP - 3 PeopleFirst Pharmacy | |
Request For Medical Records and Affidavit MP - 4 MRI Centers of Texas and Data Management | |
Request For Medical Records and Affidavit MP - 5 Infinity Care Medical Group | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 6 Momentum Spine and Joint (DIDN'T WENT) | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Accident Centers of Texas | |
Reduction Request MP – 2 North Texas X-Ray Service Inc. | |
Reduction Request MP – 3 PeopleFirst Pharmacy | |
Reduction Request MP – 4 MRI Centers of Texas and Data Management | |
Reduction Request MP – 5 Infinity Care Medical Group | |
Reduction Request MP – 6 Momentum Spine and Joint (DIDN'T WENT) | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Macailyn wilder

Case Status

case status

LOP FORM

LOP MP – 1 | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Maria R Ugarte

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 DMC Healthcare | |
LOP MP – 2 Prime Diagnostic Imaging | |
LOP MP – 3 Momentum Spine and Joint | |
LOP MP – 4 North Texas Radiology Consultants | |
LOP MP – 5 JTP Diagnositcs (Prime Imaging is same) | |
LOP MP – 6 Dr. Asad Kahn | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 National General Insurance | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 DMC Healthcare | |
Request For Medical Records and Affidavit MP - 2 Prime Diagnostic Imaging | |
Request For Medical Records and Affidavit MP - 3 Momentum Spine and Joint | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 4 North Texas Radiology Consultants | |
Request For Medical Records and Affidavit MP - 5 JTP Diagnositcs (Prime Imaging is same) | |
Request For Medical Records and Affidavit MP - 6 Dr. Asad Kahn | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 DMC Healthcare | |
Reduction Request MP – 2 Prime Diagnostic Imaging | |
Reduction Request MP – 3 Momentum Spine and Joint | |
Reduction Request MP – 4 North Texas Radiology Consultants | |
Reduction Request MP – 5 JTP Diagnositcs (Prime Imaging is same) | |
Reduction Request MP – 6 Dr. Asad Kahn | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Marie Bell-Rosemond

Case Status

4 - Litigation

Case Status

case status

LOP FORM

LOP MP – 1 Texas Health Harris Methodist Hospital | |
LOP MP – 2 Accident Centers of Texas | |
LOP MP – 3 PeopleFirst Pharmacy | |
LOP MP – 4 Vertex Pain & Orthopedic (bill) | |
LOP MP – 5 MDN (8/10/19 ONE VISIT MISSING AND 6/27/2019 ONE VISIT MISSING) | |
LOP MP – 6 Uptown Radiology Associates (bill) P9/Radiology Associates of North TX p9 | |
LOP MP – 7 MRI Centers of Texas (done) | |
LOP MP – 8 Medstar Mobile Healthcare BILL | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 Sedgwick | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Texas Health Harris Methodist Hospital | |
Request For Medical Records and Affidavit MP - 2 Accident Centers of Texas | |
Request For Medical Records and Affidavit MP - 3 PeopleFirst Pharmacy | |
Request For Medical Records and Affidavit MP - 4 Vertex Pain & Orthopedic (bill) | |
Request For Medical Records and Affidavit MP - 5 MDN (8/10/19 ONE VISIT MISSING AND 6/27/2019 ONE VISIT MISSING) | |
Request For Medical Records and Affidavit MP - 6 Uptown Radiology Associates (bill) P9/Radiology Associates of North TX p9 | |
Request For Medical Records and Affidavit MP - 7 MRI Centers of Texas (done) | |
Request For Medical Records and Affidavit MP - 8 Medstar Mobile Healthcare BILL | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Texas Health Harris Methodist Hospital | |
Reduction Request MP – 2 Accident Centers of Texas | |
Reduction Request MP – 3 PeopleFirst Pharmacy | |
Reduction Request MP – 4 Vertex Pain & Orthopedic (bill) | |
Reduction Request MP – 5 MDN (8/10/19 ONE VISIT MISSING AND 6/27/2019 ONE VISIT MISSING) | |
Reduction Request MP – 6 Uptown Radiology Associates (bill) P9/Radiology Associates of North TX p9 | |
Reduction Request MP – 7 MRI Centers of Texas (done) | |
Reduction Request MP – 8 Medstar Mobile Healthcare BILL | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Marie Bell-Rosemond

Case Status

case status

LOP FORM

LOP MP – 1 Texas Health Harris Methodist Hospital | |
LOP MP – 2 Accident Centers of Texas | |
LOP MP – 3 MRI Centers of Texas | |
LOP MP – 4 Vertex Interventional Physicians | |
LOP MP – 5 MDN Injury Care | |
LOP MP – 6 People First Pharmacy | |
LOP MP – 7 Radiology Associates of North America | |
LOP MP – 8 Med Star Mobile Healthcare | |
LOP MP – 9 Uptown Radiology Associates | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 Sedwick | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Texas Health Harris Methodist Hospital | | medical record provider received
Request For Medical Records and Affidavit MP - 2 Accident Centers of Texas | | medical record provider received
Request For Medical Records and Affidavit MP - 3 MRI Centers of Texas | | medical record provider received
Request For Medical Records and Affidavit MP - 4 Vertex Interventional Physicians | | medical record provider received
Request For Medical Records and Affidavit MP - 5 MDN Injury Care | | medical record provider received
Request For Medical Records and Affidavit MP - 6 People First Pharmacy | | medical record provider received
Request For Medical Records and Affidavit MP - 7 Radiology Associates of North America | | medical record provider received
Request For Medical Records and Affidavit MP - 8 Med Star Mobile Healthcare | | medical record provider received
Request For Medical Records and Affidavit MP - 9 Uptown Radiology Associates | | medical record provider received
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Texas Health Harris Methodist Hospital | |
Reduction Request MP – 2 Accident Centers of Texas | |
Reduction Request MP – 3 MRI Centers of Texas | |
Reduction Request MP – 4 Vertex Interventional Physicians | |
Reduction Request MP – 5 MDN Injury Care | |
Reduction Request MP – 6 People First Pharmacy | |
Reduction Request MP – 7 Radiology Associates of North America | |
Reduction Request MP – 8 Med Star Mobile Healthcare | |
Reduction Request MP – 9 Uptown Radiology Associates | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Mario Nguyen

Case Status

case status

LOP FORM

LOP MP – 1 Allen Pain & Injury | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party USAA | |
LOR 3rd Party – 1 USAA Claims Department | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Allen Pain & Injury | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Allen Pain & Injury | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Melissa Fields

Case Status

4 - Litigation

Case Status Note

Demand Sent

Case Status

case status

LOP FORM

LOP MP – 1 Accident Care and Treatment Center of TX, P.A. | |
LOP MP – 2 Champions Rehabilitation | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 Allstate Insurance | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Accident Care and Treatment Center of TX, P.A. | |
Request For Medical Records and Affidavit MP - 2 Champions Rehabilitation | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Accident Care and Treatment Center of TX, P.A. | |
Reduction Request MP – 2 Champions Rehabilitation | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Coverage
  • No PIP Coverage

Download PDF Entry

Client Name

Melissa Rodriguez Francisco's Daughter

Case Status

case status

LOP FORM

LOP MP – 1 Med Post Urgent Care Rockwall | |
LOP MP – 2 Baylor Scott&White Lake Pointe | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Med Post Urgent Care Rockwall | |
Request For Medical Records and Affidavit MP - 2 Baylor Scott&White Lake Pointe | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Med Post Urgent Care Rockwall | |
Reduction Request MP – 2 Baylor Scott&White Lake Pointe | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Michael W. Langford

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Legacy ER & Urgent Care | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Legacy ER & Urgent Care | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Legacy ER & Urgent Care | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Miguel Sanchez

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Element Health & Wellness – Dallas | |
LOP MP – 2 MRI Centers of Texas | |
LOP MP – 3 Uptown Radiology | |
LOP MP – 4 Baylor Scott&White | |
LOP MP – 5 Pro Med, Inc. | |
LOP MP – 6 Epic Pain and Orthopedics | |
LOP MP – 7 Evolve Healthcare | |
LOP MP – 8 Dallas Radiology, P.A | |
LOP MP – 9 Frontline ER Whiterock- Emergency Department | |
LOP MP – 10 City of Dallas- BLS emergency / 11. Century Integrated Partners, Inc. | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 State Farms | |
LOR 3rd Party – 2 Progressive | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Element Health & Wellness – Dallas | | medical record provider received
Request For Medical Records and Affidavit MP - 2 MRI Centers of Texas | | medical record provider received
Request For Medical Records and Affidavit MP - 3 Uptown Radiology | |
Request For Medical Records and Affidavit MP - 4 Baylor Scott&White | | medical record provider received
Request For Medical Records and Affidavit MP - 5 Pro Med, Inc. | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 6 Epic Pain and Orthopedics | | medical record provider received
Request For Medical Records and Affidavit MP - 7 Evolve Healthcare | |
Request For Medical Records and Affidavit MP - 8 Dallas Radiology, P.A | |
Request For Medical Records and Affidavit MP - 9 Frontline ER Whiterock- Emergency Department | | medical record provider received
Request For Medical Records and Affidavit MP - 10 City of Dallas- BLS emergency / 11. Century Integrated Partners, Inc. | |

Reduction Request Form

Reduction Request MP – 1 Element Health & Wellness – Dallas | |
Reduction Request MP – 2 MRI Centers of Texas | |
Reduction Request MP – 3 Uptown Radiology | |
Reduction Request MP – 4 Baylor Scott&White | |
Reduction Request MP – 5 Pro Med, Inc. | |
Reduction Request MP – 6 Epic Pain and Orthopedics | |
Reduction Request MP – 7 Evolve Healthcare | |
Reduction Request MP – 8 Dallas Radiology, P.A | |
Reduction Request MP – 9 Frontline ER Whiterock- Emergency Department | |
Reduction Request MP – 10 City of Dallas- BLS emergency / 11. Century Integrated Partners, Inc. | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Mirna Hernandez

Case Status

4 - Litigation

Case Status Note

Demand Sent

Case Status

case status

LOP FORM

LOP MP – 1 Gateway Medical | |
LOP MP – 2 Omni HealthCare ( Omi and Southwest X-ray are same) | |
LOP MP – 3 Southwest X-Ray Downtown | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 Travelers Insurance | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Gateway Medical | |
Request For Medical Records and Affidavit MP - 2 Omni HealthCare ( Omi and Southwest X-ray are same) | |
Request For Medical Records and Affidavit MP - 3 Southwest X-Ray Downtown | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Gateway Medical | |
Reduction Request MP – 2 Omni HealthCare ( Omi and Southwest X-ray are same) | |
Reduction Request MP – 3 Southwest X-Ray Downtown | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Nana Bonsu

Case Status

4 - Litigation

Case Status Note

Demand Sent

Case Status

case status

LOP FORM

LOP MP – 1 Revive Injury and Rehab | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 Falcon insurance | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Revive Injury and Rehab | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Revive Injury and Rehab | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Nancy Rounds

Case Status

case status

LOP FORM

LOP MP – 1 MedPost Urgent Care- McKinney | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 MedPost Urgent Care- McKinney | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 MedPost Urgent Care- McKinney | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Natalie Cline

Case Status

1 - Medical Treatment and Recovery

Case Status

case status

LOP FORM

LOP MP – 1 Desoto Injury Rehab | lop provider sent | lop provider received
LOP MP – 2 Pain Clarity | lop provider sent | lop provider received
LOP MP – 3 SINA RX Pharmacy | lop provider sent | lop provider received
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 1 - Medical Treatment and Recovery

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Desoto Injury Rehab | |
Request For Medical Records and Affidavit MP - 2 Pain Clarity | |
Request For Medical Records and Affidavit MP - 3 SINA RX Pharmacy | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Desoto Injury Rehab | |
Reduction Request MP – 2 Pain Clarity | |
Reduction Request MP – 3 SINA RX Pharmacy | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Nathaniel K. Craighead

Case Status

4 - Litigation

Case Status Note

3rd Party accepted 100% liability. Demand sent.

Case Status

case status

LOP FORM

LOP MP – 1 PRIME Diagnostic Imaging | |
LOP MP – 2 Epic Pain & Orthopedics | |
LOP MP – 3 Southwest Injury Center, Inc. | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Allstate Insurance Company | |
LOR 3rd Party – 1 USAA- United Services Automobile Assn. | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 PRIME Diagnostic Imaging | |
Request For Medical Records and Affidavit MP - 2 Epic Pain & Orthopedics | |
Request For Medical Records and Affidavit MP - 3 Southwest Injury Center, Inc. | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 PRIME Diagnostic Imaging | reduction request sent |
Reduction Request MP – 2 Epic Pain & Orthopedics | reduction request sent |
Reduction Request MP – 3 Southwest Injury Center, Inc. | reduction request sent |
Reduction Request MP – 4 | reduction request sent |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Nhung Nguyen

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Rockwall Injury Rehab | |
LOP MP – 2 ASP Cares | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Allstate Insurance Company | |
LOR 3rd Party – 1 Farmers Insurance | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Rockwall Injury Rehab | |
Request For Medical Records and Affidavit MP - 2 ASP Cares | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Rockwall Injury Rehab | |
Reduction Request MP – 2 ASP Cares | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Nina Wendy

Case Status

case status

LOP FORM

LOP MP – 1 | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Quinton Ledaris Williams

Case Status

case status

LOP FORM

LOP MP – 1 Pedro Nosnik, M.D., P.A. | |
LOP MP – 2 Richardson Injury Rehab | |
LOP MP – 3 DFW Open MRI Plano | |
LOP MP – 4 Preferred Imaging | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party GEICO Indemnity Company | |
LOR 3rd Party – 1 ACCC Insurance Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Pedro Nosnik, M.D., P.A. | |
Request For Medical Records and Affidavit MP - 2 Richardson Injury Rehab | |
Request For Medical Records and Affidavit MP - 3 DFW Open MRI Plano | |
Request For Medical Records and Affidavit MP - 4 Preferred Imaging | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Pedro Nosnik, M.D., P.A. | |
Reduction Request MP – 2 Richardson Injury Rehab | |
Reduction Request MP – 3 DFW Open MRI Plano | |
Reduction Request MP – 4 Preferred Imaging | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Richard Cetrone

Case Status

case status

LOP FORM

LOP MP – 1 | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Old American Indemnity Company | |
LOR 3rd Party – 1 Gieco | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Robert Holt

Case Status

4 - Litigation

Case Status Note

3rd party accepted 100% liability. Demand Sent.

Case Status

case status

LOP FORM

LOP MP – 1 MRI Centers of Texas | |
LOP MP – 2 Cano Health & Rehab Clinics, P.A | |
LOP MP – 3 Epic Pain & ortho | |
LOP MP – 4 Dallas Radiology | |
LOP MP – 5 Medical City las colinas | |
LOP MP – 6 Texas Radiology Associates LLP | |
LOP MP – 7 Lone Star Neurology | lop provider sent |
LOP MP – 8 AMPM Medical Centers | |
LOP MP – 9 Tricity Pain Associates P.A | |
LOP MP – 10 Lakewood Anesthesia in the care of EZ Med Group | |

LOR FORM

LOR 1st Party MGA Insurance Company, Inc. | |
LOR 3rd Party – 1 Metropolitan Group Property and Casualty Insurance Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 MRI Centers of Texas | |
Request For Medical Records and Affidavit MP - 2 Cano Health & Rehab Clinics, P.A | |
Request For Medical Records and Affidavit MP - 3 Epic Pain & ortho | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 4 Dallas Radiology | |
Request For Medical Records and Affidavit MP - 5 Medical City las colinas | |
Request For Medical Records and Affidavit MP - 6 Texas Radiology Associates LLP | |
Request For Medical Records and Affidavit MP - 7 Lone Star Neurology | |
Request For Medical Records and Affidavit MP - 8 AMPM Medical Centers | |
Request For Medical Records and Affidavit MP - 9 Tricity Pain Associates P.A | |
Request For Medical Records and Affidavit MP - 10 Lakewood Anesthesia in the care of EZ Med Group | |

Reduction Request Form

Reduction Request MP – 1 MRI Centers of Texas | |
Reduction Request MP – 2 Cano Health & Rehab Clinics, P.A | |
Reduction Request MP – 3 Epic Pain & ortho | |
Reduction Request MP – 4 Dallas Radiology | |
Reduction Request MP – 5 Medical City las colinas | |
Reduction Request MP – 6 Texas Radiology Associates LLP | |
Reduction Request MP – 7 Lone Star Neurology | |
Reduction Request MP – 8 AMPM Medical Centers | |
Reduction Request MP – 9 Tricity Pain Associates P.A | |
Reduction Request MP – 10 Lakewood Anesthesia in the care of EZ Med Group | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Robin LouQueena Stevenson

Case Status

case status

LOP FORM

LOP MP – 1 | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Semaj Hicks

Case Status

case status

LOP FORM

LOP MP – 1 Plano Injury Rehab & Chiropractic | |
LOP MP – 2 Vital Pain Care - Addison | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Fred Loya Insurance | |
LOR 3rd Party – 1 Progressive Insurance | |
LOR 3rd Party – 2 ACCC Insurance Company | |
LOR 3rd Party – 3 Empower Insurance | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Plano Injury Rehab & Chiropractic | |
Request For Medical Records and Affidavit MP - 2 Vital Pain Care - Addison | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Plano Injury Rehab & Chiropractic | |
Reduction Request MP – 2 Vital Pain Care - Addison | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Sonia Lopez

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Dallas Regional Medical Center | |
LOP MP – 2 BSW Orthopedic Associates of Dallas | |
LOP MP – 3 Baylor Scott&White sama as provider 2 | |
LOP MP – 4 Actnow1 (Client did not go to Actnow1) | |
LOP MP – 5 North Texas X-Ray Services, Inc. DONE | |
LOP MP – 6 MDN Injury Care (Client did not go to MDN) | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Dallas Regional Medical Center | |
Request For Medical Records and Affidavit MP - 2 BSW Orthopedic Associates of Dallas | |
Request For Medical Records and Affidavit MP - 3 Baylor Scott&White sama as provider 2 | |
Request For Medical Records and Affidavit MP - 4 Actnow1 (Client did not go to Actnow1) | |
Request For Medical Records and Affidavit MP - 5 North Texas X-Ray Services, Inc. DONE | |
Request For Medical Records and Affidavit MP - 6 MDN Injury Care (Client did not go to MDN) | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Dallas Regional Medical Center | |
Reduction Request MP – 2 BSW Orthopedic Associates of Dallas | |
Reduction Request MP – 3 Baylor Scott&White sama as provider 2 | |
Reduction Request MP – 4 Actnow1 (Client did not go to Actnow1) | |
Reduction Request MP – 5 North Texas X-Ray Services, Inc. DONE | |
Reduction Request MP – 6 MDN Injury Care (Client did not go to MDN) | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Tamara T Fuller (FBO) Deanna Hammett

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 BSW Medical Center- Lake Pointe | |
LOP MP – 2 Revive Injury and Rehab | |
LOP MP – 3 MRI Centers of Texas | |
LOP MP – 4 Data Management Medical Billing | |
LOP MP – 5 Epic Pain& Orthopedics | |
LOP MP – 6 Pro Med, Inc. | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 TXFB-INS | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 BSW Medical Center- Lake Pointe | |
Request For Medical Records and Affidavit MP - 2 Revive Injury and Rehab | |
Request For Medical Records and Affidavit MP - 3 MRI Centers of Texas | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 4 Data Management Medical Billing | |
Request For Medical Records and Affidavit MP - 5 Epic Pain& Orthopedics | |
Request For Medical Records and Affidavit MP - 6 Pro Med, Inc. | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 BSW Medical Center- Lake Pointe | |
Reduction Request MP – 2 Revive Injury and Rehab | |
Reduction Request MP – 3 MRI Centers of Texas | |
Reduction Request MP – 4 Data Management Medical Billing | |
Reduction Request MP – 5 Epic Pain& Orthopedics | |
Reduction Request MP – 6 Pro Med, Inc. | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Tanya Bakari

Case Status

case status

LOP FORM

LOP MP – 1 Chiropractic Healthcare Center (a/k/a Accident Centers of Texas) | lop provider sent | lop provider received
LOP MP – 2 MDN Injury Care | |
LOP MP – 3 PeopleFirst Pharmacy | |
LOP MP – 4 MRI Centers of Texas | lop provider sent | lop provider received
LOP MP – 5 Pro Med Ortho | lop provider sent |
LOP MP – 6 North TX X'ray | |
LOP MP – 7 Vertex Interventional Physicians | |
LOP MP – 8 Accident Centers of Texas ( same as Chiropractic Healthcare) | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Progressive County Mutual Ins. Co | lor sent |
LOR 3rd Party – 1 Elephant Auto Insurance | |
LOR 3rd Party – 2 Amica | lor sent |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Chiropractic Healthcare Center (a/k/a Accident Centers of Texas) | | medical record provider received
Request For Medical Records and Affidavit MP - 2 MDN Injury Care | | medical record provider received
Request For Medical Records and Affidavit MP - 3 PeopleFirst Pharmacy | | medical record provider received
Request For Medical Records and Affidavit MP - 4 MRI Centers of Texas | |
Request For Medical Records and Affidavit MP - 5 Pro Med Ortho | |
Request For Medical Records and Affidavit MP - 6 North TX X'ray | |
Request For Medical Records and Affidavit MP - 7 Vertex Interventional Physicians | |
Request For Medical Records and Affidavit MP - 8 Accident Centers of Texas ( same as Chiropractic Healthcare) | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Chiropractic Healthcare Center (a/k/a Accident Centers of Texas) | |
Reduction Request MP – 2 MDN Injury Care | |
Reduction Request MP – 3 PeopleFirst Pharmacy | |
Reduction Request MP – 4 MRI Centers of Texas | |
Reduction Request MP – 5 Pro Med Ortho | |
Reduction Request MP – 6 North TX X'ray | |
Reduction Request MP – 7 Vertex Interventional Physicians | |
Reduction Request MP – 8 Accident Centers of Texas ( same as Chiropractic Healthcare) | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Tanya Bakari

Case Status

case status

LOP FORM

LOP MP – 1 Vertex Pain & Orthopedic | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Vertex Pain & Orthopedic | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Vertex Pain & Orthopedic | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Teresa Rodriguez Francisco's Wife

Case Status

case status

LOP FORM

LOP MP – 1 Med Post Urgent Care Rockwall | |
LOP MP – 2 Baylor Scott&White Lake Pointe | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 DTW Claims Management | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Med Post Urgent Care Rockwall | |
Request For Medical Records and Affidavit MP - 2 Baylor Scott&White Lake Pointe | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Med Post Urgent Care Rockwall | |
Reduction Request MP – 2 Baylor Scott&White Lake Pointe | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Test Client

Case Status

Demand Pending

Case Status

case status

LOP FORM

LOP MP – 1 cHIRO JIRO | |
LOP MP – 2 dCOTR 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 Allstate | |
LOR 3rd Party – 2 goVERNMENT INSURANCE 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage Demand Pending

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 cHIRO JIRO | |
Request For Medical Records and Affidavit MP - 2 dCOTR 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 cHIRO JIRO | |
Reduction Request MP – 2 dCOTR 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Coverage
  • PIP Coverage

Download PDF Entry

Client Name

Thi Huynh

Case Status

4 - Litigation

Case Status

case status

LOP FORM

LOP MP – 1 Dallas Multidisciplinary Clinic, P.A. | |
LOP MP – 2 Vital Pain Care | |
LOP MP – 3 JTP Diagnostics - Prime | |
LOP MP – 4 People First Pharmacy | |
LOP MP – 5 Radiology Consultants North Texas | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Geico | |
LOR 3rd Party – 1 State Farm | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Dallas Multidisciplinary Clinic, P.A. | |
Request For Medical Records and Affidavit MP - 2 Vital Pain Care | |
Request For Medical Records and Affidavit MP - 3 JTP Diagnostics - Prime | |
Request For Medical Records and Affidavit MP - 4 People First Pharmacy | |
Request For Medical Records and Affidavit MP - 5 Radiology Consultants North Texas | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Dallas Multidisciplinary Clinic, P.A. | |
Reduction Request MP – 2 Vital Pain Care | |
Reduction Request MP – 3 JTP Diagnostics - Prime | |
Reduction Request MP – 4 People First Pharmacy | |
Reduction Request MP – 5 Radiology Consultants North Texas | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Tiffany Edwards (fbo) Jarany Edwards

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Childrens Medical Center | |
LOP MP – 2 Desoto Injury Rehab | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Progressive | |
LOR 3rd Party – 1 DMA Express Auto - SEAHARBOR INSURANCE AGENCY LLC | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Childrens Medical Center | |
Request For Medical Records and Affidavit MP - 2 Desoto Injury Rehab | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Childrens Medical Center | |
Reduction Request MP – 2 Desoto Injury Rehab | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Tony Fore

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Tracy Calloway

Case Status

case status

LOP FORM

LOP MP – 1 Cornerstone Chiropractic | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party USAA | |
LOR 3rd Party – 1 GEICO County Mutual Insurance Company | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Cornerstone Chiropractic | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Cornerstone Chiropractic | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Tram Nhu-Ngoc Nguyen

Case Status

case status

LOP FORM

LOP MP – 1 Texas Health Presbyterian Hospital Allen | |
LOP MP – 2 Momentum Spine & Joint | |
LOP MP – 3 ASP Cares | |
LOP MP – 4 Pain Clarity LLC | |
LOP MP – 5 Richardson/Garland Injury Rehab | |
LOP MP – 6 DFW Open MRI | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party GEICO | |
LOR 3rd Party – 1 Garrison Property & Casualty Ins, Co. | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Texas Health Presbyterian Hospital Allen | |
Request For Medical Records and Affidavit MP - 2 Momentum Spine & Joint | |
Request For Medical Records and Affidavit MP - 3 ASP Cares | |
Request For Medical Records and Affidavit MP - 4 Pain Clarity LLC | |
Request For Medical Records and Affidavit MP - 5 Richardson/Garland Injury Rehab | |
Request For Medical Records and Affidavit MP - 6 DFW Open MRI | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Texas Health Presbyterian Hospital Allen | |
Reduction Request MP – 2 Momentum Spine & Joint | |
Reduction Request MP – 3 ASP Cares | |
Reduction Request MP – 4 Pain Clarity LLC | |
Reduction Request MP – 5 Richardson/Garland Injury Rehab | |
Reduction Request MP – 6 DFW Open MRI | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Vanessa Rodriguez Francisco's Daughter

Case Status

case status

LOP FORM

LOP MP – 1 Med Post Urgent Care Rockwall | |
LOP MP – 2 Baylor Scott&White Lake Pointe | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party | |
LOR 3rd Party – 1 | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Med Post Urgent Care Rockwall | |
Request For Medical Records and Affidavit MP - 2 Baylor Scott&White Lake Pointe | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Med Post Urgent Care Rockwall | |
Reduction Request MP – 2 Baylor Scott&White Lake Pointe | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Wale Ajiboye

Case Status

2 - Gathering Medical Records

Case Status

case status

LOP FORM

LOP MP – 1 Revive Injury and Rehab | lop provider sent | lop provider received
LOP MP – 2 DFW open MRI | |
LOP MP – 3 Atlantic Diagnostics/American Imaging | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Allstate | lor sent |
LOR 3rd Party – 1 Hit and Run | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 2 - Gathering Medical Records

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Revive Injury and Rehab | |
Request For Medical Records and Affidavit MP - 2 DFW open MRI | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 3 Atlantic Diagnostics/American Imaging | medical record provider requested | medical record provider received
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Revive Injury and Rehab | |
Reduction Request MP – 2 DFW open MRI | |
Reduction Request MP – 3 Atlantic Diagnostics/American Imaging | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Willie Johnson

Case Status

case status

LOP FORM

LOP MP – 1 Cornerstone Chiropratic | |
LOP MP – 2 | |
LOP MP – 3 | |
LOP MP – 4 | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Esurance | |
LOR 3rd Party – 1 Geico | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Cornerstone Chiropratic | |
Request For Medical Records and Affidavit MP - 2 | |
Request For Medical Records and Affidavit MP - 3 | |
Request For Medical Records and Affidavit MP - 4 | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Cornerstone Chiropratic | |
Reduction Request MP – 2 | |
Reduction Request MP – 3 | |
Reduction Request MP – 4 | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

Download PDF Entry

Client Name

Yen Le

Case Status

4 - Litigation

Case Status

case status

LOP FORM

LOP MP – 1 Dallas Multidisciplinary Clinic, P.A. | |
LOP MP – 2 Vital Pain Care | |
LOP MP – 3 People First Pharmacy | |
LOP MP – 4 Radiology Consultants-North Texas, PLLC | |
LOP MP – 5 | |
LOP MP – 6 | |
LOP MP – 7 | |
LOP MP – 8 | |
LOP MP – 9 | |
LOP MP – 10 | |

LOR FORM

LOR 1st Party Geico | |
LOR 3rd Party – 1 State Farm | |
LOR 3rd Party – 2 | |
LOR 3rd Party – 3 | |

Demand Letter

Demand Letter

Client Case Status FORM

Download 1 – Client Case Status Update Your case is at stage 4 - Litigation

Request For Medical Records and Affidavit

Request For Medical Records and Affidavit MP - 1 Dallas Multidisciplinary Clinic, P.A. | |
Request For Medical Records and Affidavit MP - 2 Vital Pain Care | |
Request For Medical Records and Affidavit MP - 3 People First Pharmacy | |
Request For Medical Records and Affidavit MP - 4 Radiology Consultants-North Texas, PLLC | |
Request For Medical Records and Affidavit MP - 5 | |
Request For Medical Records and Affidavit MP - 6 | |
Request For Medical Records and Affidavit MP - 7 | |
Request For Medical Records and Affidavit MP - 8 | |
Request For Medical Records and Affidavit MP - 9 | |
Request For Medical Records and Affidavit MP - 10 | |

Reduction Request Form

Reduction Request MP – 1 Dallas Multidisciplinary Clinic, P.A. | |
Reduction Request MP – 2 Vital Pain Care | |
Reduction Request MP – 3 People First Pharmacy | |
Reduction Request MP – 4 Radiology Consultants-North Texas, PLLC | |
Reduction Request MP – 5 | |
Reduction Request MP – 6 | |
Reduction Request MP – 7 | |
Reduction Request MP – 8 | |
Reduction Request MP – 9 | |
Reduction Request MP – 10 | |

12 – Offer for Settlement – Insurance

Offer for Settlement – Insurance

About bhagirath

What you can read next

Ride-Hailing Safety – What Do You Know About Your Uber and Lyft Driver?
What Steps Should I Take After a Car Wreck?
How Much Auto Insurance Should I Get?

Recent Posts

  • What Steps Should I Take After a Car Wreck?

    What Steps Should I Take After a Car Wreck? At ...
  • How Much Auto Insurance Should I Get?

    How Much Auto Insurance Should I Get? Many cons...
  • I Just Got Hit By an Uninsured Motorist

    I Just Got Hit By an Uninsured Motorist Uninsur...
  • Letter of Protection (LOP)

    What is a Letter of Protection (LOP)? If you’ve...
  • Ride-Hailing Safety – What Do You Know About Your Uber and Lyft Driver?

    Ride-Hailing Safety – What Do You Know Ab...

Recent Comments

  • 9japotal.com on How Much Auto Insurance Should I Get?
  • Danny Marinescuo on Ride-Hailing Safety – What Do You Know About Your Uber and Lyft Driver?
  • Maroc Verica on Ride-Hailing Safety – What Do You Know About Your Uber and Lyft Driver?
  • 트럼프 카드 게임 종류 on Ride-Hailing Safety – What Do You Know About Your Uber and Lyft Driver?
  • 놀이터 먹튀 on What Steps Should I Take After a Car Wreck?

Archives

  • October 2018

Categories

  • Resources

Meta

  • Log in
  • Entries feed
  • Comments feed
  • WordPress.org

Featured Posts

  • What Steps Should I Take After a Car Wreck?

    2972 comments
  • How Much Auto Insurance Should I Get?

    2268 comments
  • I Just Got Hit By an Uninsured Motorist

    2232 comments
  • Letter of Protection (LOP)

    2649 comments
  • Ride-Hailing Safety – What Do You Know About Your Uber and Lyft Driver?

    2236 comments

Like Our Facebook Page

NEWSLETTER SIGNUP

By subscribing to our mailing list you will always be update with the latest news from us.

GET IN TOUCH

Office Address: 5435 N. Garland Ave., Suite 140 #227, Garland, TX 75040
Email: van.wiltz@wiltzlaw.com
Web: wiltzlaw.com
Tel: 214-214-9653
Fax: 888.874.5879

  • Customer Area

© 2018 All rights reserved. J.Wiltz Law PLLC is responsible for the content of this website.This website is intended solely for Texas residents and does not create any attorney-client relationship. Statements on this website are general in nature and should not be a substitute for personal legal advice.

TOP CALL NOW

In breathhold is cialis better than viagra divers, it is rinsed that impairments can face many associated with cardiac arrhythmias due to the somatic reflex. Dye cells need energy to left the modulation necessary for performance in any withdrawal sport.
At Wiltz Law, we are proud to say that other attorneys and firms in the area refer personal injury cases to our office.  Many attorneys and law firms simply do not handle personal injury matters, but often receive inquiries from potential clients harmed by a negligent person(s). Wiltz Law is open to stepping into a personal injury case at all stages of the process to help reach the best possible resolution to a case.   

For the attorney or law firm, referring a personal injury case outside their area of practice allows them to focus their time and energy on their core practice area(s).

Each referred case presents its own challenges and circumstances. Along those lines, rather than proposing a fixed referral fee, Wiltz Law is open to negotiating an equitable arrangement with referring attorneys on a case by case basis. We will always honor referral fees and we will always put the agreement in writing after obtaining a client’s informed consent. 

CALL NOW