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 (45 KB)
Letters
Covenant Not To Sue (Spanish)
Thus is an agreement by an injured party to not pursue a lawsuit against another party in exchange for a settlement.
PDF (40 KB)
Forms Property & Casualty
Corporation Release (Spanish)
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 (45 KB)
Forms Property & Casualty
Statement As To Replacement Cost Coverage (Spanish)
A legal form stating the values used to calculate cost coverage for repair or replacement of a property loss.
PDF (35 KB)
Forms Property & Casualty
Release & Subrogation Receipt (Spanish)
A legal form signed by an insured acknowledging receipt of settlement and release of all subrogation rights to the insurer.
PDF (96 KB)
Forms Property & Casualty
PIP Wage & Salary Verification (Spanish)
This form is used to verify wage and salary information of a person who has applied for personl injury protection (PIP) benefits after an automobile accident.
PDF (35 KB)
Forms Property & Casualty
Livestock Proof Of Loss (Spanish)
A livestock Proof of Loss and settlement document.
PDF (62 KB)
Forms Property & Casualty
Notice Of Loss Burglary-Robbery-Theft (Spanish)
A loss report form filled out by an insured when reporting a theft claim to and insurance company. Includes circumstances of the theft, and a list of items claimed as stolen with declared values.
PDF (80 KB)
Forms Property & Casualty
Proof Of Loss Medical Payment (Spanish)
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.
PDF (34 KB)
Forms Property & Casualty
Release With Medical Agreement (Spanish)
This is a contract that releases an insurer from any legal and financial responsibility for injury and liability claims after a specified time period and medical expense settlement amount is agreed upon.
PDF (75 KB)
Forms Property & Casualty
