Consumer
Information
Request

The form below may be submitted by consumers in any state. ICW Group will respond in accordance with its applicable legal obligations under the laws of the state in which the consumer resides.

• Be sure to clarify specifically what you want and explain your request in sufficient detail to that we can understand, evaluate and respond to your request.
• You will need to generally describe the information involved, the nature of your request, the type of relationship the consumer has with ICW Group (injured worker, claimant, job applicant, employee, etc.), provide the consumer’s name, street address of the consumer’s primary residence, and contact information.
• Only you or someone legally authorized to act on your behalf may submit a request. You should be prepared to identify yourself as the individual about whom ICW Group has collected information by providing proper identification or through other reliable means. We may ask you to confirm one or more pieces of information from our files to verify the consumer’s identity.
• If you are submitting a request on behalf of a consumer other than yourself, you will need to explain your relationship to the consumer, provide your name and contact information, and be prepared to submit a power-of-attorney form or other authorization signed by the consumer or issued by a court of law designating you as the consumer’s lawful representative for purposes of making requests of this nature. This information will be required in addition to information sufficient to verify the identity of the applicable consumer.