Refer A Case workers’ compensation claim defense form

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Dear Clients

Please complete this workers’ compensation claim defense form and click the “submit” button at the bottom to refer your file for defense handling to the Law Firm of Hanna & Brophy. Hanna & Brophy handles, through this referral system, only the defense of workers’ compensation claims, so do not submit this referral form if you are an injured worker looking for attorney representation.

After completing and submitting this form, please mail a copy of your file to our scanning center, P. O. Box 12488, Oakland, CA 94604-2488, and upon receipt, the new file will be set up for immediate defense handling.

* Denotes required field

Case Type
Hearing Information

Type of Hearing


Date & Time

Case Information

Employee Name*

Date of Birth


Policy Period*

Date of Injury*

Body Parts

Employee's Attorney

Application Filed On

Denial Letter Issued On/Denial Due Date

File Answer*



Hanna Brophy Office*

Hanna Brophy Attorney*

Benefits Paid
Defense Discovery Requested

Depose Applicant*

Schedule Medical Exam*


Subpoena Records Source

File Upload