PIP Files

Empower Your Practice: Seamless PIP File Uploads with WesetTheStandards ©

Please fill out the following form

Clinic Corporation Name *

Clinic Email Address when we need to contact you *

Patient First Name *

Patient Last Name *

Date of Loss *

Insurance Company Name *

Claim Number *

You can upload the documents as one pdf with all the information or into three sections. Either way works for us.
You have the choice of uploading one pdf or breaking it up into two or three pdfs.

Final Billing Ledger

Your Assignment of Benefits Form

At Least One Explanation of Benefits (the more, the merrier)

Anything Extra You Want Us to Know About This Claim

By clicking “send” you are authorizing our law firm to send a demand letter to the insurance company on your behalf. Our costs for this service are 25%.

56968

Please follow the steps below to

First Name *

Last Name *

Cellphone *

Email *

License Number *

Address *

City *

State *

Zip Code *

Final Billing Ledger

Your Assignment of Benefits Form

At Least One Explanation of Benefits (the more, the merrier)

Anything Extra You Want Us to Know About This Claim

56968

PIP Files

Empower Your Practice: Seamless PIP File Uploads with WesetTheStandards ©

Please fill out the following form

Please follow the steps below to

We Set The Standards ™

Office Locations

Find us

Find us

Find us

Find us

Contact Us

Quick Links