Insurance Discovery / Cursory Requests

Today's Date

Welcome to Pacific!

Your trusted partner in Personal Injury.

Disclaimer: Pacific Liability in no way accepts responsibilty for the processing of duplicate requests, (multiple submissions of the same case by requester). Our staff will do our due diligence in identfying potential duplicates and contact the client if one is identified. However, if the duplicate is missed and the client's request is processed by our research department, payment will be expected in full and invoice will be ineligible for discount or waiver.

Insurance Discovery Requests

Disclaimer: We cannot guarantee liability limits will be included on results with policies found with USAA insurance.

Have you worked with us before?*

YesNo

Requester Information

Your Name*

First NameLast Name

Your Phone Number*

Please enter a valid phone number.

Your Email*

example@example.com

Your Law Firm or Company*

Law Firm or Company Address*

Street Address

Street Address Line 2

CityState / Province

Is there an additional email you would like your results sent to?*

YesNo

Please provide a secondary email if necessary

A copy of your results will be sent to this email.

Do you know the insurance carrier?*

YesNo

You have selected a Policy Limit Assessment search.

Indicating that you have the carrier name and policy or claim number required to conduct this search. You do not require an Insurance Discovery search. To submit a Policy Limit Assessment request, click the link below to be directed to the correct form.

https://pacificliability.jotform.com/222801734318957

You have selected to process an Insurance Discovery search.

This means you do not have any insurance information for the at-fault party and would like us to open an investigation to obtain this information for you. To process Insurance Discovery requests, we require a $150 non-refundable deposit to be paid before we can begin our research. Collecting this deposit allows our team to adequately process your request and utilize the many resources we have available to increase the likelihood of obtaining your results in a timely manner.

Upon receipt of successful results, the $150 deposit paid will be deducted from the total invoice amount. If our search returns inconclusive, you will receive a detailed Summary of Findings from our Research Development Department and there will be no further charges to you.

Insurance Discovery's standard processing time is 2 weeks.

Insurance Discovery - Main Policy Requested:*

Additional Policies Requested: (Processed at additional standard rates)

Umbrella / Excess policy - $195UM/UIM (Personal) - $175Personal Injury Protection (PIP) - $175Property Damage - $60

Cursory Search - Main Policy Requested:*

Additional Policies Requested: (Processed at additional standard rates)

Umbrella / Excess - $140UM/UIM (Personal) - $120Personal Injury Protection (PIP) - $120Property Damage - $30

Case Information

Your Client and/or Case Number (for reference only)*

Date of Loss*

Date

Is this case currently in litigation?*

YesNo

What is the county this case was filed in?

What is the date this case was filed?

Date

Disclaimer: Cases in litigation are assessed an additional $30 for successful search results. If in litigation, your client's case must be handled with sensitivity and appropriately in order to maintain anonymity and our standard of accuracy & service.

We are not accepting commercial cases at this time. Only Personal/Individual cases will be processed until further notice.*

Individual

Case Incident*

Please describe the incident and include any details you think will be useful in our investigation:

Defendant Information

Defendant Name*

Defendant Date of Birth

Date

Defendant Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Defendant Phone Number

Please enter a valid phone number.

Business / Business Professional / Commercial Entity Information

Name of company in question:

Address Incident Occurred or Corporate Headquarters

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

FEIN # or Occupational License #

Name of Parent Company (if applicable)

Name of driver

First NameLast Name

Driver's License number

Vehicle year, make & model

VIN Number

License Plate number

DOT # (if applicable)

Is Defendant information the same as Policyholder information?*

YesNo

Policyholder Information (if available)

Name on Policy

Please provide the named insured, if different than the defendant.

Policyholder Date of Birth

Date

Policyholder Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Policyholder Phone Number

Please enter a valid phone number.

Additional Information

Please upload any supporting documentation you may have for this case.

Supporting Documents

Please upload any supporting documents (ie., policy report, insurance letter, etc.)

Additional Notes

Please clarify any further information that may aid in our research of this case

Finalize Request

My Products

Insurance Discovery Deposit Product Image

Insurance Discovery DepositWith successful processing of request, deposit is applied as a credit to your final balance. With all "Inconclusive Results", our summary of findings is provided. The policy found must offer coverage to be considered a successful search. NO charges are assessed past the initial deposit if results returned "inconclusive". 14 days processing time for average turnaround.

$150.00

Cursory SearchThe Cursory Search offers an easy and affordable alternative to our Insurance Discovery search when needing to identify any additional coverage or supporting policies. With successful processing of request, deposit is applied as a credit to final balance. NO charges are assessed past the initial deposit if results returned "inconclusive". 14 days processing time for average turnaround time.

$75.00

Total

$0.00

Payment Methods

Credit Card

ACH Bank Transfer

Signature*

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