Claims Pages
claimspages

Covenant Not To Sue

Thus is an agreement by an injured party to not pursue a lawsuit against another party in exchange for a settlement.
  PDF (21KB) Forms Property & Casualty

Report Of Public Liability Accident

This report form provides notice and details of a public premise accident.
  PDF (40KB) Forms Property & Casualty


Texas Limited POA For Eligible Motor Vehicle Transactions VTR-271 (8/17)

This document gives the insurance company legal authority to transfer title of a vehicle that has been declared a total loss, and sell it for salvage.
  PDF (24KB) Forms Property & Casualty

Automobile Arbitration Filing Form

An Arbitration Forums, Inc. form which is used by insurance companies when submitting an automobile claim for subrogation. Shows the Applicant and Respondent information, and includes a list of contentions setting forth the legal argument that the claim is owed with supporting evidence.
  DOC (91KB) Forms Property & Casualty

Florida WC Forms

A collection of workers' compensation forms which are authorized to be used in the state of Florida.
  PDF (0KB) Forms Property & Casualty

Subrogation Receipt (Spanish)

A subrogation receipt is signed by the insured upon payment of a claim, and assigns the insurer to the right to recovery for the loss.
  PDF (28KB) Forms Property & Casualty

Receipt & Release Medical Payments Coverage (Spanish)

This form is signed by those who qualify as insureds under a policy when collecting medical payments coverage. Used as both a receipt and a release.
  PDF (25KB) Forms Property & Casualty

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 (65KB) Forms Property & Casualty

Power Of Attorney (Auto) (Spanish)

This is a limited power of attorney which grants the insurer permission to transfer title for a specific vehicle on the owner's behalf.
  PDF (65KB) Forms Property & Casualty

Automobile Accident/Loss Notice (Spanish)

A loss report form filled out by insureds and/or agents when reporting an automobile accident. Includes information on occupants, injuries, damages, accident description and witnesses.
  PDF (78KB) 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) Forms Property & Casualty


Request For Transcript Of Tax Return IRS Form 4506-T (7/17)

IRS Form 4506-T Request for Transcript of Tax Return
  PDF (44KB) Forms Property & Casualty
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