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Refer a Claim

Refer a Claim

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CASE MANAGEMENT FORM

First name*

Email*

CASE TYPE

Date

Your File Number:

Loss Date:

Claim Number:

CLAIM INFORMATION

Facts of Accident:

Injuries Sustained:

CASE STATUS

Suit Filed:

Yes

No

Mediation Date:

Trial Date:

Jurisdiction:

Demands:

Offers:

SETTLEMENT DETAILS

Total Settlement/Verdict (or anticipated): $

Attorney Fees and Costs: $

Have structured settement been received?

Yes

No

CLAIMANT INFORMATION

Injured Party Name:

Address:

Phone:

Email Address:

DOB:

Gender:

Male

Female

Marital Status:

Yes

No

Annual Income: $

Dependant’s Names:

DOBs:

PLAINTIFF ATTY INFORMATION

Name:

Firm:

Email:

Phone:

Address:

Attorney Fee Structure:

Yes

No

Amount of Fee Structure: $

DEFENSE BROKER INFORMATION

Name:

Firm:

Phone:

Email:

Split Agreement?

STRUCTURE REQUIREMENTS

Income Needs:

Near-Term (1-5 years):

Mid-Term (5-15 years):

Long-Term (15-life):

Retirement:

Life Insurance:

Life Insurance Premiums:

Lump Sum Needs:

Immediate/Upfront Cash:

Intended Use:

(i.e. Education, Medical, Gifts, Trips, etc)

DEFENSE ATTY INFORMATION

Name:

Firm:

Phone:

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Quick Link

Structured LLC is a leading settlement planning firm dedicated to assisting clients in navigating claims resolution. We specialize in providing personalized financial solutions for attorneys and claims industry professionals. Our expertise in Tax-Free Structured Settlement, trust administration and government benefits planning ensures that our clients achieve financial security and stability. Let us help you get ahead of objections to settlement and streamline the claims process.

Contact Us

954-372-1071

Structured LLC – 401 E Las Olas Blvd., Suite 1400

Fort Lauderdale, FL 33301

Training & Professional Development

info@structuredllc.com

Contact Us

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