Denial - No Coverage (Spanish)
This form letter identifies the claimant, insurer, adjuster and date of loss; it is a claim denial for lack of coverage under the insured's policy.
DOC (45KB)
Letters
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)
Forms Property & Casualty
Automobile Accident Promissory Note (Spanish)
Customized automobile subrogation promissory note which allows the insurance company to notify DMV/BMV in case of default by the tortfeasor.
PDF (56KB)
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)
Forms Property & Casualty
Non-Waiver Agreement / Reservation Of Rights (Spanish)
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 (65KB)
Forms Property & Casualty
Request For Accident Report (Spanish)
Form letter used by an adjuster requesting an accident report.
DOC (39KB)
Letters
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)
Forms Property & Casualty
Denial - Less Than Deductible (Spanish)
A denial letter used when the value of a claim submitted is determined to be less than the insured's deductible.
DOC (55KB)
Letters
Power Of Attorney (Auto) (Spanish)
This is a limited power of attorney which grants the insurer permission to transfer title for a specific vehicle on the owner's behalf.
PDF (65KB)
Forms Property & Casualty
Request For Medical Docs/Bills From Dr. (Spanish)
A form letter requesting medical documents and bills from a physician providing treatment to a claimant, sent with a medical authorization.
DOC (45KB)
Letters
Non-Auto Liability Accident Notice (Spanish)
Non- auto liability accident notice form details personal injuries and accident circumstances.
PDF (88KB)
Forms Property & Casualty
Guarantee Of Title (Spanish)
For a case involving a total loss or theft of a financed motor vehicle or boat, this is an agreement that the lien holder will provide a lien free Certificate of Title to the insurance company upon receipt of a claim payment.
PDF (20KB)
Forms Property & Casualty
