Emergency / Temporary Work Repair Summary
An emergency/temporary repair work order, including cost, provided in support of a property claim.
PDF (17KB)
Property
Forms Property & Casualty
Corporation Release
A release and indemnity agreement for a corporation, which releases insurer from liability which arose out of an accident, casualty or event. The release form identifies all parties to a claim, states the date and location of the event, and details the terms of settlement of a claim. The release contains a statement that, as a condition of the settlement, prevents any further claim or legal action against the insurer.
PDF (26KB)
Liability
Forms Property & Casualty
Claimant's Report Of Accident (Spanish)
This report form is given to claimants to record the details of an accident. Includes accident location, property damage, vehicle occupants, witnesses and an accident diagram.
PDF (87KB)
Auto
Liability
Spanish
Forms Property & Casualty
Automobile Accident/Loss Notice
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 (65KB)
Auto
Liability
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
PIP Attending Physician's Report
The attending physician report form is used by an insurer to determine if a person is due benefits under personal injury protection (PIP) law.
PDF (55KB)
Liability
Forms Property & Casualty
Notice Of Loss - Inland Marine
The inland marine notice of loss form describes the circumstances and amount of loss, and is prepared by an adjuster and presented to the insurer.
PDF (25KB)
Property
Forms Property & Casualty
General Authorization
This form authorizes release of information, and requires a notary signature.
PDF (17KB)
Liability
Special Investigations
Workers' Compensation
Forms Property & Casualty
Adjuster's Loss Certification and Apportionment of Claim
This form is used to recommend to the insurer the amount of payment for a loss, and apportionment when a property is covered by two or more insurance companies.
PDF (21KB)
Liability
Property
Forms Property & Casualty
Release & Trust Agreement (UM/UIM BI) (Spanish)
A release form signed by an insured when making an uninsured motorist or underinsured motorist claim. Requires the insured to cooperate in the recovery of funds from the responsible party.
PDF (65KB)
Auto
Liability
Spanish
Subrogation
Forms Property & Casualty
Notice Under Subrogation Rights
Claim form used to notify an individual of subrogation rights of an insurer for an auto insurance loss.
PDF (13KB)
Auto
Liability
Subrogation
Forms Property & Casualty
Reservation Of Rights Agreement
A reservation of insurer's rights to discovery, settlement, or defense in denial of a claim for loss and damages, agreed to by insured.
PDF (19KB)
Auto
Liability
Property
Special Investigations
Workers' Compensation
Forms Property & Casualty
Employment-Wage Authorization
A person uses this form to authorize an employer to release his or her employment and wage records to a third party.
PDF (12KB)
Liability
Workers' Compensation
Forms Property & Casualty
