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Or, you can email the assignment directly, without filling out the form, to: assignments@schneiderclaims.com

BASIC INFORMATION
Your Name:
Company:
Phone:
E-Mail:
Type of Claim:
Is this an SIU investigation?      
Is this a coverage investigation?      
Insured Name:
Claimant/Adverse Party Name:
Policy#:
Claim#:
Date of Loss:
 

>
SERVICES REQUESTED (click to expand)
Statements: Insured
Claimant
Witness
Other (describe below)
Photos: Insured Vehicle
Claimant Vehicle
Property Damage
Injury
Scene Investigation
Other (describe below)
Documents: Police Report
Medical Report
Policy File
Med. Wage/Auth
Coroner's Report
Death Certificate
Other (describe below)
Activities: Skip Trace
Locate
Attend MSC/Mediation
Policy File
Court Check
Attend Small Claims
Other (describe below)
 

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CONTACT #1 (click to expand)
Insured   Claimant   Witness  
Other (specify)
Name:
Home Phone:
Work Phone:
Cell Phone:
Street:
City:
State:
Zip:
Attorney:
Attorney Address:
Attorney Phone:
Address verified as valid
Returned mail at address
Party not responding to phone calls
Party speaks foreign language (please specify:)
 

>
CONTACT #2 (click to expand)
Insured   Claimant   Witness  
Other (specify)
Name:
Home Phone:
Work Phone:
Cell Phone:
Street:
City:
State:
Zip:
Attorney:
Attorney Address:
Attorney Phone:
Address verified as valid
Returned mail at address
Party not responding to phone calls
Party speaks foreign language (please specify:)
 

>
CONTACT #3 (click to expand)
Insured   Claimant   Witness  
Other (specify)
Name:
Home Phone:
Work Phone:
Cell Phone:
Street:
City:
State:
Zip:
Attorney:
Attorney Address:
Attorney Phone:
Address verified as valid
Returned mail at address
Party not responding to phone calls
Party speaks foreign language (please specify:)
 

>
CONTACT #4 (click to expand)
Insured   Claimant   Witness  
Other (specify)
Name:
Home Phone:
Work Phone:
Cell Phone:
Street:
City:
State:
Zip:
Attorney:
Attorney Address:
Attorney Phone:
Address verified as valid
Returned mail at address
Party not responding to phone calls
Party speaks foreign language (please specify:)
 

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VEHICLE #1 (click to expand)
Insured   Claimant  
Other (specify)
Year:
Make:
Model:
Color:
License#:
VIN#:
Location:
 

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VEHICLE #2 (click to expand)
Insured   Claimant  
Other (specify)
Year:
Make:
Model:
Color:
License#:
VIN#:
Location:
 

>
VEHICLE #3 (click to expand)
Insured   Claimant  
Other (specify)
Year:
Make:
Model:
Color:
License#:
VIN#:
Location:
 

>
VEHICLE #4 (click to expand)
Insured   Claimant  
Other (specify)
Year:
Make:
Model:
Color:
License#:
VIN#:
Location:
 

>
OTHER PROPERTY (click to expand)
  Insured   Claimant  
Other (specify)
Description of Property:
Address of Property:
Contact Person:
Contact Phone:
 


DESCRIPTION OF LOSS:
 

ADDITIONAL INSTRUCTIONS:
 

PERSONS TO BE COPIED ON REPORTS:
 
OK to hire interpreter if neccessary
 
 

ASSIGNMENT ATTACHMENTS

Would you like to attach a file to be sent to us
with this assignment (i.e., a police report or a release?)

  • To attach a file, click the Browse or Choose File button and select the file on your hard drive. When you submit the form, the file will be included (for large files, this may take some time.)
  • NOTE: max. file size: 2 MB

  

 
 
Items will be faxed (describe below)
 

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