Have Your Claim Reviewed For Free

Let us review your claim documents for free to determine if the insurance company incorrectly denied your claim. There is absolutely no obligation to you for this complimentary service and we will provide you a courtesy opinion regarding your claim.

Rest assured that your claim documents are safe. They are downloaded into our private and secure server. No one besides the attorneys at BABINSKY NEIMAND TRIAL FIRM, P.A. will see your claim documents.

Scan or take a clear photo of your documents and submit them with this form.

NOTE: *There are many free scan apps for Android and Apple available if you don't have a scanner.

Contact Information

Name

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Claim Details

Your Pet Insurance Company

Insurance Policy

Upload requirements

Bill or Invoice

This is the bill or invoice showing the charge(s) that was submitted by you or your vet to the insurance company
Upload requirements

Declarations Page

This is a document that summarizes the coverage of your policy. It will indicate who the named insured is, policy number, effective dates of the policy, what the deductible is, the policy limits, etc.
Upload requirements

Document Sent By Insurance

Please provide us any documents sent to you by the insurance company in response to the claim you submitted. That is, any EOBs (explanations of benefits) or EORs (explanation of reimbursement/review) or any other documents sent to you by the insurance company in response to your claim.
Upload requirements

Document Sent By You [1/3]

Please provide copies of any claims applications/forms or correspondence submitted by you to the insurance company. Do not send any medical records at this time. If needed, we will ask you for them.
Upload requirements

Document Sent By You [2/3]

Document Sent By You [3/3]