Sedgwick CMS Victim Information Form

Please provide the following contact information:

 Are You a victim of Sedgwick CMS?

Are you an Employee of Sedgwick CMS?

Do you know the name and location of the Sedgwick CMS person handling your claim?

Has Sedgwick CMS lied to you?

Have you been threatened by Sedgwick CMS?

Do you have a copy of your benefits plan?

If you purchased LTDI, do you have a copy of the certificate?

Are You aware of any criminal activity perpetrated Sedgwick CMS?

Information Regarding Sedgwick CMS (Not You)

Name
Title
Sedgwick CMS Office Location
Work Phone
FAX
E-mail
URL

Your Information (if you want to be contacted)  Can we contact you?    Yes, please contact me! .. NO! I don't want to be contacted!

Name
Title
Sedgwick CMS Office Location
Work Phone
FAX
E-mail
URL

Additional Information: