Dynamic Claims Services, Inc.™

Causality Investigation

    • Please provide as much information about the claim as possible.
    • Required fields are marked by the * symbol and must be completed in order to process your request.  If required fields are not completed in full, submission of form may take you to an error page.  Your information will not be saved and will have to be reentered.
    • If you do not have the information for a required field, please enter "unknown".
    • If you are having any technical difficulties using this form, please see the message at the bottom of this screen.

    Claim Details and Assignment Type

    Special Instructions for Statements/Interviews (optional below).


    Client's Information/Reporting Address

    -
    -
    -
    -
    -
    -


    Insured's Name and Contact Information

    -
    -
    -
    -
    -
    -


    Claimant's Information - Primary

    -
    -
    -
    -
    -
    -
    Max file size: 20MB
    Max file size: 20MB
    Max file size: 20MB
Due to the security setting of some web browsers, there may be technical difficulties in submitting an assignment using the above form.  Please note that DCS always sends an assignment confirmation e-mail.  If you do not receive a confirmation e-mail or if you are having technical difficulties using our online form, please download the DCS Assignment Referral form below.
dcs_assignment_referral_form.pdf
File Size: 188 kb
File Type: pdf
Download File