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Brookside Consultants Insta-Referral

As a convenience to our customers, Brookside now offers an abbreviated referral process for claims for which we have E-Case access. If BCI has E-Case access, simply answer the following questions, and we will get this scheduled for you ASAP.

For all other cases, please use our standard referral request.

Adjuster Name:
Adjuster Company:
Claim Number:
Claimant Name:
WCB Number:
Established injury site(s):
If causal relationship is to be addressed, please indicate below what site(s) must be examined in addition to what is already established for this claim.
Specialty Requested:
Rush Request:
Is there a pending MG-2/C-4 Authorization request/Hearing that would make this examination a rush?
Yes No
Cover Letter Questions:
Questions Below Cover Letter Questions to Follow