Claims Pages
claimspages

Non-Waiver Agreement

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 (21KB) Forms Property & Casualty

Adjuster's Log Sheet

Daily log to document adjuster activity on a specific claim.
  PDF (26KB) Forms Property & Casualty

Timeline Template - Horizontal

Create your own time line using this Microsoft Excel template. Just enter dates and labels.
  XLS (57KB) Forms Property & Casualty

Personal Property Summary Chart

The personal property summary itemizes rooms and areas in a house, with columns to calculate repair cost, actual cash value and replacement cost.
  PDF (79KB) Forms Property & Casualty

Claim Activity Log

This MS Word form is used to document activity on an individual claim.
  DOC (39KB) Forms Property & Casualty

Insured's Release

The release form identifies all parties to a claim, states the date of the occurrence, 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 action against the insurer for the claim event in question.
  PDF (23KB) Forms Property & Casualty

Claim Acknowledgement Letter

A basic MS Word template letter sent as a best practice for the protection of all parties involved. The letter acknowledges receipt of the claim and requests contact with the insured or claimant.
  DOC (17KB) Letters

Digital Photo Sheet 1

Form for digital photo documentation for an adjuster's file.
  DOC (25KB) Forms Property & Casualty

Affidavit-Lightning Losses

This affidavit is filled out by a service provider who inspects a property and certifies lightning damage as the sole source of the loss. A notorized signature and witnesses are required.
  PDF (26KB) Forms Property & Casualty


Acknowledgement Of Representation

This is an MS Word template letter to acknowledge notification of legal representation of a claimant. Most commonly used in PIP or bodily injury claims, where there is a potential for coverage dispute litigation.
  DOC (17KB) Letters

Memorandum For Appraisal

Memorandum for Appraisal is used in property damage situations where insured and insurer disagree on actual cash value, and is binding on the parties as to the amount of loss.
  PDF (35KB) Forms Property & Casualty

Building Terminology Chart

Dozens of common building terms and their definitions.
  PDF (34KB) General Reference

Schedule Of Contents

A contents inventory form, with columns to itemize place and date of purchase, cost, condition, actual value and amount claimed.
  PDF (58KB) Forms Property & Casualty

Adjuster Status Report

Short form for reporting the current status of a claim. Typically used by an independent adjuster.
  PDF (30KB) Forms Property & Casualty
Monty Fire Investigations LLCKelmar GlobalSeekNowChurchill Claims Services