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STATE OF CALIFORNIA DEPARTMENT OF INSURANCE Ricardo Lara, Insurance CommissionerHEALTH CLAIMS BUREAU 300 SOUTH SPRING STREET, SOUTH TOWER LOS ANGELES, CA 90013 www.insurance.ca.govCSD003IMR Eff: 01/07/2019APPLICATION
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It is a mandatory service information form for attorneys.
All attorneys who are providing services must file this form.
You can fill out the form electronically or manually and submit it online or by mail.
The purpose is to provide information about the services provided by attorneys for regulatory purposes.
Attorneys must report details about the services provided, clients served, and fees charged.
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