Claims Pages
claimspages

Employment, Wage & Med. Authorization (Spanish)

An employee authorization form allowing release of employment, wage and medical information to another party.
  PDF (85KB) 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) Letters


General Release (Husband & Wife) (Spanish)

A legal form that absolves an insurer from any further liability for a claim upon acceptance of a settlement amount by a married couple.
  PDF (105KB) Forms Property & Casualty

Insured's Release (Spanish)

The release form identifies all parties to a claim, states the date of the occurrence, 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 action against the insurer for the claim event in question.
  PDF (95KB) Forms Property & Casualty

Request For Accident Report (Spanish)

Form letter used by an adjuster requesting an accident report.
  DOC (39KB) Letters

Notice Of Loss - Inland Marine (Spanish)

The inland marine notice of loss form describes the circumstances and amount of loss, and is prepared by an adjuster and presented to the insurer.
  PDF (35KB) 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) Forms Property & Casualty

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) Forms Property & Casualty

Notice Of Plate Glass Loss (Spanish)

The notice of plate glass loss details the circumstances and description of loss. Included is an estimate for lowest replacement cost by a glazier.
  PDF (59KB) 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) Forms Property & Casualty

Automobile Accident Report - NY (Spanish)

Report form, customized for New York, that is given to vehicle owners and drivers to capture the details of an accident. Includes occupants, injuries, property damages, crash diagram, driver's account of accident, and witnesses.
  PDF (55KB) Forms Property & Casualty

Reservation Of Rights Letter (Spanish)

The reservation of rights letter notifies the policyholder that the insurer reserves the right to deny coverage of a claim, in whole or part, pending outcome of a claims investigation.
  DOC (57KB) Letters

Witness Report Of Accident (Spanish)

Witness statement describing an accident in detail.
  PDF (63KB) Forms Property & Casualty
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