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Auto Defense

Confidential Intake Form
Defense

Information Regarding Defendants

Defendant(s) - Individual(s)

Defendant(s) - Organization(s)

Information Regarding Defense Representatives

Is coverage contested?

Information Regarding Plaintiff(s) and Representative(s)

Did they agree to participate in InstaResolve?

Information Regarding Accident¹

Is there a police report
Did the police ascribe fault?

Information Regarding Property Damage

Type of vehicle.

Describe type of damage and amount.

Has property damage been paid?
Should property damage be included in InstaResolve proposal?

Liability Positions

Is liability contested?
Do you attribute comparative fault to Plaintiff?

Information Regarding Injuries

Did you hire a defense medical expert?
Did you share copy of defense medical report with Plaintiff?

Medical Bills Positions

Irrespective of causation, please provide the following and reasonable value of those services:

1.

2.

3.

4.

5.

6.

7.

8.

Plaintiff’s Settlement Demands

CCP 998?
CCP 998?
CCP 998?
CCP 998?

Defense Settlement Offers

CCP 998?
CCP 998?
CCP 998?
CCP 998?

Other Information

Upload Documents
Upload Images
Upload Videos

Thanks for submitting!

1. If desired, upload Brief with additional information, photo(s)/video(s).

2. If desired, upload the defense medical report.

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