G&H Claims Professionals

Independent Claim Service Professionals & OSHA Certified Risk Management Specialists

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Limited Assignment Liability

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Police Report Only

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Online Assignment Forms - Workers Compensation
Below is a Form to submit investigation assignments pertaining to Workers Compensation Claims. All assignments are acknowledged within 24 hours of receipt. If an Acknowledgement is not received within 24 business hours, please contact Office Manager, Tracie Mattox, at 800-300-5435. G&H Claims Professionals sincerely appreciates your business!
Company Contact
Company Claim/Policy #
Company Name & Contact Information
Date of Loss
Insured
Insured Contact
Insured Contact Information
Employee/Claimant Name
Employee Contact Information
Nature of Injury
Description of Incident
witnesses?
Claimant Attorney Represented?
Instructions
Additional Instructions/Comments
Office Use Only - WC Invest

Independent Claims Service Professionals & OSHA Certified Risk Management Services