ClaimInformation[SHK]

Claim Information

Claim information is as follows. The required information is bold. You may choose to upload information for Litigation, or Exposure History or all of them at once. Please see the requirements for each section.

• AttorneyID

  • • this is provided by CRMC

  • ContactID

  • this is provided by CRMC

• First Diagnosis Date

  • • Alleged first diagnosis date

  • AllegedDiseaseCD

    • more about AllegedDisease here

  • AffirmPOCReview

    • Yes or No response to the following statement: I have reviewed the information submitted on this claim form and all documents submitted in support of this claim. Upon information and belief, under penalty of perjury, the information submitted is accurate and complete in all material respects.

  • CopyDocs

    • Yes or No. Will copy all available medical documents that the claimant may already have on file to the newly created claim.

  • [Litigation Information]

    • see about Litigation Information here

  • [Exposure Information]

    • see about Exposure Information here