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
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)
Auto
Subrogation
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
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
Certificate Of Satisfaction (Spanish)
The insured signs this form which certfies his/her satisfaction with damage repairs performed, directs claim payment to that service provider, and closes the claim.
PDF (22KB)
Auto
Liability
Property
Spanish
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)
Auto
Liability
Spanish
Forms Property & Casualty
Texas WC Forms
A collection of workers' compensation forms which are authorized to be used in the state of Texas.
PDF (0KB)
Workers' Compensation
Forms Property & Casualty
Non-Auto Liability Accident Notice
Non- auto liability accident notice form details personal injuries and accident circumstances.
PDF (40KB)
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
Ohio WC Forms
A collection of workers' compensation forms which are authorized to be used in the state of Ohio.
PDF (0KB)
Workers' Compensation
Forms Property & Casualty
New Jersey WC Forms
A collection of workers' compensation forms which are authorized to be used in the state of New Jersey.
PDF (0KB)
Workers' Compensation
Forms Property & Casualty
Affidavit Of Salvage Retention (Spanish)
Acknowledgment by the current owner that his vehicle has been declared a total loss, and that he/she has elected to retain the salvage for a specific sum of monies. Towing and storage charges are also specified.
PDF (68KB)
Auto
Salvage
Spanish
Forms Property & Casualty
