New Case Intake

Case Details

Case Status

File Number

Attorney First Name

Attorney Last Name

Attorney Email

Attorney Fee Percentage

Patient First Name

Patient Last Name

Patient Email

Date of Loss

Accident Type

Number of Providers

Medical Total Amount

Target Reduced Saving Amount

Settlement Amount

Was PIP Exhausted?

Document Upload

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Authorizations

I acknowledge that a HIPAA release will be sent separately from medical@rocklegal.com and will ensure the patient signs it within 24 hours. Data Retention Policy: To maintain HIPAA compliance and security, all case documents and uploaded files will be automatically deleted 90 days after upload. Please download your final “Lien Reduction Summary” for your records before this date. I understand that Rock legal provides negotiation services but cannot guarantee a specific reduction percentage or the acceptance of a settlement offer by the lienholder. I certify that the itemized bills and ledger provided are the final versions and include all known charges to date. I authorize Rock legal to act as my representative for the sole purpose of communicating with lienholders, insurance carriers, and providers.

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New Case Intake

Document Upload

Authorizations

Resolved Case Ledger