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Initial File Submission Form

Discovery Submission Form       (* required information )
First Name *
Last Name *
Address
Address 2
City/State
Zip Code
Email Address *
Phone
FAX
Billing Information   (if different)
Name
Address
City/State
Zip Code
Phone
FAX
Case Information
Date Needed
Company Name
Company/Attorney Handling Claims
File/Claim Number
Case Number
Party/Parties Represented (list all)
Other Firms/Ins Companies (list all)
Type of Case
Type of Injury
Date of Incident
Type of Service Requested
Comments or Special Instructions  

 

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Discovery Medical Legal Consulting Inc. practices neither law nor medicine, nor does it provide legal or medical advice. Instead, Discovery Medical Legal Consulting Inc. provides a medical record review service to attorneys, insurance companies and related specialties in the handling of bodily injury or medical negligence cases. The services offered by Discovery Medical Legal Consulting Inc. are not intended to substitute for nor do they replace professional analysis and handling by the referring attorney or insurance company, nor are its reports or analyses a substitute for retention of healthcare experts when appropriate. The attorney handling the case retains all decision-making authority and responsibility for use of the review service and the information and analysis provided. Any suggestions or recommendations made by DMLC for further investigation or for use of information are strategic only, and their use by the attorney is subject to the attorney’s judgment. Because the services offered by Discovery Medical Legal Consulting Inc. are essentially a summary and distillation of a much greater volume of information, Discovery Medical Legal Consulting Inc. cannot be responsible for the content, and it is recognized and understood that DMLC uses its best judgment as to whether certain information is included or excluded in the summaries and chronologies, but the importance or significance of the information may be subjective to any reader of the records and the chronologies, and therefore it is agreed and understood that Discovery Medical Legal Consulting Inc. shall have no liability to attorneys or insurers that retain it, nor to their clients or insureds. This agreement shall in all respects be governed by the laws of the State of Illinois.
   

          © 2008 Discovery Medical Legal Consulting Inc.