| Chat with BWC |
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| *indicates required field |
| Please complete the information below. |
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| *First name |
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MI |
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*Last |
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Suffix |
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| Daytime phone # |
()- Ext
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| *Email address |
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| Claim number |
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| Policy number |
-
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| Provider number |
-
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| *Customer type |
Injured worker
Employer
Medical provider
Auth rep/TPA
Other
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| *Nature of inquiry |
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*Please type your question or comment here. Also, keep in mind the more information you provide, the better we'll be able to serve you.
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