Your Company
Claim Number
Adjuster
Date of Loss
Address
Tel
City
Fax
State
Zip
Email
Insured
Other/Atty
Contact
Contact
Address 1
Address 1
Address 2
Address 2
City
City
State
Zip
State
Zip
Tel
Tel
Claimant
Other/Atty
Contact
Contact
Address 1
Address 1
Address 2
Address 2
City
City
State
Zip
State
Zip
Tel
Tel
R/S claimant (s)
Estimate on any property damage
Photographs (parties/vehicles)
Index bureau form
Medical authorization
Obtain a release
Medical bills
3599 Underwriting report
Loss wage statements
Advise if ROR should be sent
Wage Authorization
Personal effects list
Physicians report
Fire department report
Police report
Coroner's report
R/S witness
Obtain engineer report
Diagram accident scene
Photographs of animals
R/S insured owner
Document depository review
R/S insured driver
Job file, contracts
Scene canvass
Scope of damages
Photos/invest. accident scene
Attend MSC/VSC/Mediation
Video photagraphy
Construction analyst
Interview police officer & R/S
Site inspection
Interview-R/S W/tow truck driver
Expert (s)/ engineering reports
Interview -R/S paramedics
Affidavit of no insurance
Copy of newspaper photos
AOE/COE investigation
Copy of death certificate
Public records search
Copy of burial bills
Statute filings
Subrogation-proof/ subro receipt
Property appraisal (homeowner/commercial)
Send first notice subrogation
Vehicle inspection/total loss evaluation
Non-waiver, if any coverage questions
Other/Comments
