SUBMIT CLAIM FOR REVIEW

This is step one in the process of having ROC take your claim after our free claim review.

1. Fill out both LOR & POA below and submit.

2. Our team will review the claim in 24/48 hrs.

3. After our review, our team will contact you to discuss your claim and the claim process.

4. Our team will then file all accepted claims with your insurance company.

5. Our team will complete all aspects of the claim process.

6. Our team will provide updates along the way.

PLEASE COMPLETE THE ROC ESIGN LETTER OF REPRESENTATION AND LIMITED POWER

OF ATTORNEY BELOW AND SUBMIT FOR REVIEW. THIS IS NOT AN ACCEPTANCE OF THE

CLAIM, BUT A FREE CLAIM REVIEW. AFTER OUR REVIEW ROC WILL CALL