Patient Information

* Required Field

Children

(children under 18 and in same accident)
ADD CHILD  +
 

Accident Information

* Required Field

Medical Care Needed

* Required Field

Police Report | Medical Report | Applicable Photos | Related Referrals | Prescriptions | Medical Bills

If you have any of the forms listed above, please attach them to your application. NOTE: Please upload no more than 5 files (Combined file size must be smaller than 19MB). Allowed File Types: doc, docx, pdf

Instructions

Questions, please call (801) 810-1322.

This form is not a contract, offer or promise of any kind. Once all necessary information is obtained, ICS will review the case and inform all parties of our decision. ICS does not provide medical treatment. Medical treatment is provided by medical providers assigning their A/R to ICS. ICS does not charge the billed charges of the provider’s A/R, nor is there any interest charged or fees above the medical provider’s A/R billed charges. If any treatment is enabled through ICS, the patient and his/her attorney will be required to sign the ICS Lien Agreement.

The Numbers Tell The story

ICS services Heathcare Providers Patient Services Attorney Services InjuryCareSolutions

What We Do

ICS is a (medical) funding company. We connect personal injury patients, healthcare professionals, and attorneys to help reach settlement. ICS is a no-cost solution to manage PI cases, increase revenue, and reduce expenses.

Our Network of Healthcare Providers includes

  • Chiropractic
  • Dental
  • Durable Medical Equipment
  • Ear, Nose & Throat
  • Hospitals
  • Hyperbarics & Wound Control
  • Imaging
  • Laboratory
  • Neurology
  • Orthopedics
  • Pain Management
  • Pharmacy
  • Physical Therapy
  • Plastic Surgery & Reconstruction
  • Podiatry
  • Primary Care
  • Psychiatry
  • Surgery
  • Transportation
  • Urgent & Emergency Care
  • Vision
  • Many Others

Injury Care Solutions
4516 South 700 East
Suite 300
Salt Lake City, UT 84107