Automobile Proof Of Loss
A policyholder must provide this sworn statement in support of an automobile claim. The notarized form documents the date and cause of loss, vehicle identification, settlement amount, and reserves subrogation and other rights of the insurer.
PDF (46KB)
Auto
Liability
Forms Property & Casualty
Property Arbitration Contentions Sheet
A property subrogation arbitration form.
DOC (28KB)
Property
Subrogation
Forms Property & Casualty
Assignment Sheet
Generic form for assigning an automobile claim to an independent adjuster for investigation and handling. The form lists the insurance company, insured, claimant, endorsements, vehicle details, date and description of loss, and contact information for all parties involved.
PDF (47KB)
Auto
Liability
Forms Property & Casualty
Attending Physician's Report
A physician treating a person seeking medical benefits under an automobile insurance policy must complete this report.
PDF (55KB)
Liability
Workers' Compensation
Forms Property & Casualty
Medical Authorization (HIPAA Compliant) (Spanish)
Authorization form for disclosure of medical records, in compliance with HIPAA requirements.
PDF (76KB)
Liability
Spanish
Workers' Compensation
Forms Property & Casualty
Arbitration Contentions Sheet
The Arbitration Contentions form lists supporting evidence and damage amount in dispute, and is used by both the filing applicant and the respondent.
DOC (28KB)
Liability
Forms Property & Casualty
Certificate Of Satisfaction
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 (25KB)
Auto
Property
Forms Property & Casualty
Proof Of Loss (Mobile Home)
A legal form documenting a claimant's property loss involving a mobile home.
PDF (50KB)
Property
Forms Property & Casualty
PIP Application - Florida No Fault
Application form for Florida personal injury protection (PIP) No Fault benefits.
PDF (38KB)
Liability
Forms Property & Casualty
Automobile Accident Report (Spanish)
Report form that is given to vehicle owners and drivers to capture the details of an accident. Includes occupants, injuries, property damages and witnesses.
PDF (97KB)
Auto
Liability
Spanish
Forms Property & Casualty
Vehicle Bill Of Sale
The vehicle bill of sale is a document that records transaction between buyer and seller. Bill of sale includes vehicle type, make, year, vehicle identification number (VIN) and purchase price.
PDF (20KB)
Auto
Salvage
Forms Property & Casualty
Daily Time Sheet
A daily time sheet to record claims work, hours, mileage and expenses.
PDF (91KB)
Auto
Liability
Property
Workers' Compensation
Forms Property & Casualty
Automobile Arbitration Contentions Sheet
An Arbitration Forums, Inc. form which is used by insurance companies when submitting an automobile claim for subrogation. The contentions sheet sets forth the legal argument that the claim is owed, and lists the evidence supporting that argument.
DOC (28KB)
Auto
Subrogation
Forms Property & Casualty
General Release (Husband & Wife)
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 (26KB)
Liability
Forms Property & Casualty
