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Suspected Fraudulent Claim Referral
Suspected Fraudulent Claim Referral
Suspected Fraudulent Claim Referral
Reporting Party
Phone Number
Email Address
State the facts (who, what, when, where, how, why) that support your suspicion of fraudulent claim activity including any material misrepresentation(s). Provide details regarding any prior history of fraudulent insurance claim by any of the parties. If known, include relevant claim numbers.
Synopsis
Supporting Documents and Photos
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Max. file size: 5 MB, Max. files: 20.
Maximum number of files is 20. Maximum file size is 5MB.
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