Disclaimer for Online Forms or Email

• Privacy and Security Warning: This communication method (e.g., email, online form) is not secure. For your own protection and privacy, DO NOT include any Protected Health Information (PHI). This includes medical records, diagnoses, treatment plans, or any other health-related data. Any information sent through this non-secure channel is done at your own risk.

HIPAA-Specific Disclaimer

• Important HIPAA Notice: This communication channel is not compliant with the Health Insurance Portability and Accountability Act (HIPAA) for transmitting Protected Health Information (PHI). Under no circumstances should you send medical information, health records, or other PHI through this form or in an email to us. Sharing PHI in this manner is a violation of your privacy and may jeopardize your claim. Please wait for your adjuster to provide a secure, HIPAA-compliant method for sharing this information.