Recorded Statement Summary
A summary of a recorded statement.
PDF (22KB)
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Liability
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Workers' Compensation
Forms Property & Casualty
Reservation Of Rights Letter
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 (19KB)
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Liability
Property
Special Investigations
Workers' Compensation
Letters
State Insurance Law Chart
State Insurance Law Chart
PDF (82KB)
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Legislation & Regulation
Liability
Property
Workers' Compensation
Legal Reference
Adjuster's Log Sheet
Daily log to document adjuster activity on a specific claim.
PDF (26KB)
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Law Digest Guides
The Insurance Law Digest is a series of PDF files that provide summaries of insurance laws for each U.S. state and the Canadian province.
PDF (KB)
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Legislation & Regulation
Liability
Property
Workers' Compensation
General Reference
Workers' Compensation Accident - Employee
Statement guideline for interviewing the employee/claimant in a workers' compensation claim. Includes initial questions and follow up questions based on responses given.
PDF (15KB)
Workers' Compensation
Statement Guides
Medical Authorization (HIPAA Compliant)
Authorization form for disclosure of medical records, in compliance with HIPAA requirements.
PDF (16KB)
Liability
Workers' Compensation
Forms Property & Casualty
Digital Photo Sheet 1
Form for digital photo documentation for an adjuster's file.
DOC (25KB)
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Request For Medical Docs/Bills From Dr.
A form letter requesting medical documents and bills from a physician providing treatment to a claimant, sent with a medical authorization.
DOC (17KB)
Liability
Workers' Compensation
Letters
Claim Activity Log
This MS Word form is used to document activity on an individual claim.
DOC (39KB)
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Timeline Template - Horizontal
Create your own time line using this Microsoft Excel template. Just enter dates and labels.
XLS (57KB)
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Liability
Property
Special Investigations
Workers' Compensation
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Digital Photo Sheet 2
Form for digital photo documentation for an adjuster's file.
DOC (28KB)
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Liability
Property
Workers' Compensation
Forms Property & Casualty
Length Of Injury Table
Estimates of length of disability time for different types of injuries over a range of severities.
PDF (28KB)
Liability
Workers' Compensation
Medical Reference
Adjuster Status Report
Short form for reporting the current status of a claim. Typically used by an independent adjuster.
PDF (30KB)
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