Report Of Public Liability Accident (Spanish)
This report form provides notice and details of a public premise accident.
PDF (70KB)
Auto
Liability
Spanish
Forms Property & Casualty
PIP Wage & Salary Verification (Spanish)
This form is used to verify wage and salary information of a person who has applied for personl injury protection (PIP) benefits after an automobile accident.
PDF (35KB)
Liability
Spanish
Forms Property & Casualty
Request For Medical Docs/Bills From Dr. (Spanish)
A form letter requesting medical documents and bills from a physician providing treatment to a claimant, sent with a medical authorization.
DOC (45KB)
Liability
Spanish
Workers' Compensation
Letters
Parent/Guardian Release (Spanish)
This legal form for Parent/Guardian releases an insurer from any liability or indemnity claim for damages or injuries resulting from an accident involving a minor in exchange for a monetary settlement.
PDF (85KB)
Liability
Spanish
Forms Property & Casualty
Release & Authorization Of Payment (Spanish)
Used as a general release form which is signed by insureds and specifies payment to settle a claim. The release contains a statement that, as a condition of the settlement, prevents any further claim or legal action against the insurer for the loss event.
PDF (40KB)
Auto
Liability
Property
Spanish
Workers' Compensation
Forms Property & Casualty
Corporation Release (Spanish)
A release and indemnity agreement for a corporation, which releases insurer from liability which arose out of an accident, casualty or event. The release form identifies all parties to a claim, states the date and location of the event, and details the terms of settlement of a claim. The release contains a statement that, as a condition of the settlement, prevents any further claim or legal action against the insurer.
PDF (45KB)
Liability
Spanish
Forms Property & Casualty
Witness Report Of Accident (Spanish)
Witness statement describing an accident in detail.
PDF (63KB)
Auto
Liability
Spanish
Forms Property & Casualty
Attending Physician's Report (Spanish)
A form which is filled out by the attending physician in order to qualify for medical benefits under an automobile insurance policy. (Spanish version of English form 3160F)
PDF (80KB)
Liability
Spanish
Workers' Compensation
Forms Property & Casualty
Reservation Of Rights Agreement (Spanish)
A reservation of insurer's rights to discovery, settlement, or defense in denial of a claim for loss and damages, agreed to by insured.
PDF (92KB)
Auto
Liability
Property
Spanish
Special Investigations
Forms Property & Casualty
Claim Acknowledgement Letter (Spanish)
A basic MS Word template letter sent as a best practice for the protection of all parties involved. The letter acknowledges receipt of the claim and requests contact with the insured or claimant.
DOC (51KB)
Auto
Liability
Property
Spanish
Workers' Compensation
Letters
Employment-Wage Authorization (Spanish)
A person uses this form to authorize an employer to release his or her employment and wage records to a third party.
PDF (86KB)
Liability
Spanish
Workers' Compensation
Forms Property & Casualty
General Authorization (Spanish)
This form authorizes release of information, and requires a notary signature.
PDF (85KB)
Liability
Spanish
Special Investigations
Workers' Compensation
Forms Property & Casualty
