Case Submission

Resolution Starts Here

Submit a Case

The submitting Participant is

PARTICIPANT

Participant 1

Participant 1’s Attorney (If pro se, put Participant's name.)

Participant 1’s Attorney’s Firm

Participant 1's Attorney's Phone Number

Participant 1's Attorney's Email

Legal Assistant

Legal Assistant's Email

Will a Structured Settlement Broker be attending? If yes, please list in "Other Parties" section

Will a non-interested party be attending? If yes, please list in "Other Parties" section

PARTICIPANT 2

Participant 2

Client Representative

Insurance Company

Participant 2's Attorney

Participant 2's Firm

Participant 2's Attorney's Phone Number

Participant 2's Attorney's Email

Legal Assistant

Legal Assistant's Email

Will a Claims Representative be attending? If yes, please list in "Other Parties" section

Will a non-interested party be attending? If yes, please list in "Other Parties" section

OTHER PARTICIPANTS

Participant #3 Name

Relationship to case

Participant #3 Attorney

Participant #3 Firm

Participant #3 Attorney's Phone Number

Participant #3 Attorney's Email

Participant #3 Legal Assistant

Participant #3 Legal Assistant's Email

Participant #3 Name

Relationship to case:

Participant #4 Attorney

Participant #4 Firm

Participant #4 Attorney's Phone Number

Participant # 4 Attorney's Email

Participant #4 Legal Assistant

Participant #4 Legal Assistant's Email

CASE INFORMATION

Service Requested

Is this Mediation Court Ordered

Court Case Number (If pre-suit, enter "pre-suit".)

Case Name (If pre-suit, enter "pre-suit".)

Have all Parties Agreed to this Process?

Comments or Special Instructions