Proof Of Loss Medical Payment
A declaration by an insured person that itemizes payments made for medical services after an accident which qualify for medical expense coverage under the policy.
PDF (24KB)
Liability
Forms Property & Casualty
Nevada WC Forms
A collection of workers' compensation forms which are authorized to be used in the state of Nevada.
PDF (0KB)
Workers' Compensation
Forms Property & Casualty
New York WC Forms
A collection of workers' compensation forms which are authorized to be used in the state of New York.
PDF (0KB)
Workers' Compensation
Forms Property & Casualty
Non-Auto Liability Accident Notice (Spanish)
Non- auto liability accident notice form details personal injuries and accident circumstances.
PDF (88KB)
Liability
Spanish
Forms Property & Casualty
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)
Liability
Forms Property & Casualty
Special Arbitration Filing Form
The special arbitration form identifies the parties and allegations involved in a dispute, and lists supporting evidence.
DOC (52KB)
Liability
Subrogation
Forms Property & Casualty
California WC Forms
A collection of workers' compensation forms which are authorized to be used in the state of California.
PDF (0KB)
Workers' Compensation
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)
Workers' Compensation
Forms Property & Casualty
Georgia WC Forms
A collection of workers' compensation forms which are authorized to be used in the state of Georgia.
PDF (0KB)
Workers' Compensation
Forms Property & Casualty
Vehicle Bill Of Sale (Spanish)
The vehicle bill of sale is a document that records transaction between buyer and seller, identified by name and address. Bill of sale includes vehicle type, make, model, year, odometer reading, vehicle identification number (VIN) and purchase price.
PDF (26KB)
Auto
Salvage
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)
Auto
Liability
Ocean Marine
Property
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)
Liability
Spanish
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)
Auto
Liability
Spanish
Forms Property & Casualty
Attendance Record
Provides a daily record of an employee’s attendance and provides space/codes for noting reasons for any absences.
DOC (78KB)
Management & Underwriting
Forms Property & Casualty
Adjuster Assignment Form - Fax
Generic fax form sent to an independent adjuster with details of a claim assignment. It allows for a full or limited assignment and lists specific actions required by the adjuster, such as loss verification, photos, scene diagram, statements, subrogation investigation, vehicle appraisals, and settlements.
DOC (33KB)
Auto
Liability
Forms Property & Casualty
