Workers Compensation Client Enquiry

First Name *

Last Name *

Phone Number

Email Address *

Insurance Company Name

Claim Number

Confirmation of Work Cover

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Case Manager Information

Please provide us with the contact information of your Case Manager.

First and Last Name *

Contact Number *

Contact Email

I consent to the exchange of information between my claim manager and treating Psychologist. To support your workers compensation claim the insurer may request supporting documentation.

YesNo