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Workers Compensation Alternative Delivery Directions
For Workers Compensation cases in each of the following states: AK, CA, DC, HI, MA, MD, MN, MI, NC, NJ, NV, NY, OR, PA, TX, UT, VA, WA, WI, WY-
1st Choice Funding has spearheaded modifying payment delivery methods in order to achieve funding for workers compensation cases in these states. Without modification to the delivery of payment, lawsuit funding can not occur. Lawsuit Funding is also dependent on factors such as
1. You MUST HAVE AN UNDISPUTED CLAIM
2. Your insurance company must be cooperative.
While 1st Choice Funding makes no guarantee funding can occur, each case is evaluated individually and modifications of future payments can make it possible to receive funding NOW.
Please carefully follow the steps outlined in order to achieve lawsuit funding.
Copy & Print The Following Instructions Following Each As Outlined;
Check When This Step is Complete_____________ Step 1. Contact your Insurance Company Adjuster or Workers Compensation Office. Request your State Approved "Alternative Delivery Form" or "Modified Delivery Payment Form". What ever the form is called explain you're in need the form that change who receives your final award. Tell them you want to change it to your attorney. Ask them to send to you A.S.A.P. the form.
Check When This Step is Complete______________Step 2. When you have the form in hand completed it and either submit such to your insurance adjuster direct or through your attorney. Submit this form with the letter below. Be sure to Copy & Print the letter below requesting a executed copy ASAP.
Check When This Step is Complete______________Step 3. After receiving the executed modification agreement along WITH THIS LETTER, submit BOTH to 1st Choice Funding by fax 775.258.5387 or email: application.services(at@)1stchoicefunding.com.
Check When This Step is Complete______________Step 4. Complete the lawsuit funding application located at http://1stchoicefunding.com/lawsuit-loan-app.html
Check When This Step is Complete______________Step 5. Please Follow through with your attorney to ensure we receive all requested documents.
Check When This Step is Complete______________Step 6. As soon as we have your file, and if your case is accepted, you will receive a contract within 3 working days. When you receive a contract both you and your attorney will execute the agreement. Money is available in most instances within 1 business day.
THIS LETTER MUST BE COMPLETED BY YOUR INSURANCE COMPANY. COPY & PRINT THE LETTER IN ITS ENTIRETY. REQUEST THE ADJUSTER COMPLETE AND RETURN AN AUTHORIZED VERSION OF THIS LETTER ON COMPANY LETTERHEAD
(beginning of letter)
I as a representative of_____________________________________________ hereby agree to forward all cash settlement proceeds issued to_________________________________________ to claimants
attorney__________________________________________ of________________________________________________________Law Firm. As the recipient
of the claimants settlement proceeds, if and when a cash settlement is agreed upon between the claimant_________________________________and____________________________________________ , at such time all settlement monies
shall be distributed according to these directives. I hereby state I received written authorization from the claimant__________________________________ regarding these instructions. This agreement has full force and effect of the law. I acknowledge this payment modification request was issued from the claimant__________________________________to me and as such, I will execute per the terms of these directions any and all money if and when a cash settlement is issued to claimant according to these directives.
Date__________________
_______________________________________
(Insurance Company Authorized Agent)
(end of letter)
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