Claims Pages
claimspages


Emergency / Temporary Work Repair Summary (Spanish)

An emergency/temporary repair work order, including cost, provided in support of a property claim.
  PDF (35 KB) Forms Property & Casualty


Proof Of Loss (Mobile Home) (Spanish)

A legal form documenting a claimant's property loss involving a mobile home.
  PDF (67 KB) Forms Property & Casualty

General Authorization (Spanish)

This form authorizes release of information, and requires a notary signature.
  PDF (85 KB) Forms Property & Casualty


Automobile Proof Of Loss (Spanish)

A policyholder must provide this sworn statement in support of an automobile claim. The notarized form documents the date and cause of loss, vehicle identification, settlement amount, and reserves subrogation and other rights of the insurer.
  PDF (86 KB) 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 (35 KB) Forms Property & Casualty

Denial - Less Than Deductible (Spanish)

A denial letter used when the value of a claim submitted is determined to be less than the insured's deductible.
  DOC (55 KB) Letters

Non-Waiver Agreement / Reservation Of Rights (Spanish)

The non-waiver agreement is signed by the policyholder; its purpose is to protect the insurer. Insurer reserves all of its rights under the policy to investigate and defend a claim without admission of any liability for loss.
  PDF (65 KB) Forms Property & Casualty

Release & Subrogation Receipt (Spanish)

A legal form signed by an insured acknowledging receipt of settlement and release of all subrogation rights to the insurer.
  PDF (96 KB) Forms Property & Casualty

Affidavit-Lightning Losses (Spanish)

This affidavit is filled out by a service provider who inspects a property and certifies lightning damage as the sole source of the loss. A notorized signature and witnesses are required.
  PDF (50 KB) Forms Property & Casualty