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.
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.
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.
Used as a general release form which is signed by insureds and specifies payment to settle a claim. The release contains a statement that, as a condition of the settlement, prevents any further claim or legal action against the insurer for the loss event.
A legal form signed by an insured acknowledging receipt of settlement and release of all subrogation rights to the insurer.
