Submit Case

Please fill in all the fields regarding the investigation assignment.
A Rayburn Fire Scene Investigations representative will confirm your message via email.

Which company do you represent?
 Accenture Acuity Allstate American Family Atlantic Mutual Burk Wise Morrissey & Kaveny Chubb Cincinnati Insurance Clausen Miller CNA Insurance Cozen O’Connor Denenberg Tuffley Encompass Erie Insurance Farmers Fireman’s Fund Fisher Kanaris GEICO General Casualty Grotefeld & Denenberg Hinshaw & Culbertson Indiana Farmers Mutual Johnson & Bell Kemper L.J. Shaw & Company Leahy Eisenberg & Fraenkel Levin & Perconti Metlife Mulherin, Rehfeldt & Varchetto Nationwide Nielsen, Zehe & Antas Pekin Insurance Progressive QBE North America Querrey & Harrow Rockford Mutual Safeco SmithAmundsen Sneckenberg, Thompson & Brody State Farm Sudekum, Cassidy & Shulruff Travelers VeriClaim West Bend Yost & Baill Zurich Other

If other, please enter company name here:

Case Name / Contact (required):

Case Name/ Contact Phone Numbers (required):




Date of the Fire Incident:

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Time of the Fire Incident:

Address of the Fire Loss (required):

City of the Fire Loss (required):

Name of Person Submitting this Assignment / Claim Rep (required):

Claim Number (required):

Claim Representative (required):

Contact Phone Number (required):

Billing Address, New Clients Only (required):

Attorney Assigned to this Case:

Attorney Phone Number:

Email of Person Submitting this Assignment (required)

Enter any additional relevant information here if you wish:

Is there a public or independent adjuster? (If YES, please complete the fields below)

Public or Independent Adjuster Name:

Public or Independent Adjuster Phone Number:

Public or Independent Adjuster Email Address:

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