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Agent Forms

 

 

 

 

 

 

 

 

Auto Claim Reporting Form

 

 

 

 

 

 

 

 

 

 

 

 

Property Claim Reporting Form

 

 

 

 

 

 

 

 

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WC Claims Reporting Worksheet

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How to Report a Claim


Claim Reporting  Personal Auto   Home   Commercial Auto   Property   Liability   Workers Comp

What To Do in the Event of an Auto Accident                                                     
Move out of the way of traffic and turn on your hazard warning lights.                               

Call the police even in a minor accident. If someone is injured, request medical assistance. If fire is involved, request fire

department aid.

Do not discuss the accident with anyone other than the police or your Insurance Company agent.

Exchange necessary information with the other driver(s). Be sure to write down the other driver's name, address, phone

number, license plate number and insurance information. Also write down the contact information of all witnesses.

Report the accident to your Insurance Company as soon as possible.

                     

What To Do After a Loss to Your Home
Promptly report the loss to your Insurance Company.

Protect property from further damage by arranging for reasonable temporary repairs as soon as possible. For example,

if windows are broken, have them boarded up to protect your home and property against vandalism or weather damage.

Keep an accurate record of all temporary repair expenses (e.g., bills and/or material receipts) so that you can add the

amount to your claim. Also, keep an accurate record of any and all expenses incurred to be considered for possible reimbursement.  

 

Please do not make any permanent repairs until the insurance adjuster has had a chance to review the damage.

Determine the damage to your personal property (contents). Make a written list of what was damaged. To be as accurate

as possible, please include the manufacturer, brand name and the place and date of purchase. We recommend beginning

this process by dividing your list into broad categories such as location (e.g., living room, bedroom #1, bedroom #2).

If available, photographs, videotapes or personal property inventories are valuable resources during the itemization process.

Separate damaged and undamaged property. In order to complete a full assessment of the loss, your Travelers claim

representative will need to inspect all damaged property. If possible, place damaged items in a secure area where they can

be inspected. If you are unsure about any item, please include it with the damaged property.

 


Reporting an Auto Claim
In case of a commercial motor vehicle loss
  • Take precautions necessary to protect the scene of the accident from further accidents.

  • Call the police. If someone is injured, request medical assistance. If fire is involved, request fire department aid.

  • Be courteous. Answer police questions. Give identifying information to the other party involved, but make no comments about assuming responsibility.

  • As soon as possible, report the accident to the Claim Reporting Center using the toll-free number provided.


Reporting a Property Claim  

We hope this never happens but...

If your business suffers a building loss (fire, windstorm, etc.)                                        
 

  • Take emergency measures to protect your property from further damage. Use tarps to keep rain out, board up windows, etc.

  • Save any bills/receipts from emergency repairs.

  • Don't throw away any damaged items until you have talked to your claim representative.


Reporting a Liability Claim

There are three very different types of General Liability claims. By properly identifying the type of claim, our customer service

representative will be able to gather critical information relating to that specific type of General Liability claim.
 

1) Product liability claims

  • Injury to a person or damage to property (other than property owned by the insured) that was caused by a product YOU manufactured or distributed.

  • Food poisoning allegations stemming from a food product you manufactured or distributed.
     

         Important!

         Save the product involved for inspection.
         Do not destroy.

2) Slip, trip or fall claims

  • A person (other than an account employee) slips, trips or falls on property you own or are responsible for.
     

         Important!

         Address any hazardous situations immediately.
         Document all facts regarding any incident.

3) Other liability claims

  • Injury or property damage to others that does not fall within the above two scenarios, e.g.:

    • a box falls from a shelf and strikes someone other than an employee

    • a claim of libel or slander

    • virtually any other allegation of negligence that relates to your business operations

 


Reporting a Workers' Compensation Claim

When an employee is injured, the most important thing is to secure appropriate medical treatment. Once this has been done, the claim should be called into the Insurance Company As soon as possible.
                                                                                                                                      

Gather the facts

Look in the Workers' Compensation Policy Packet  for reference.                                                           

 

Worksheets are provided for your convenience. It is not necessary to write answers to questions you know. The worksheet is a tool to help reduce the amount of time you are on the telephone to report a claim.

Remember, the objective is to report the claim quickly. We need the employee's name, social security number and a description of the accident. Try to gather as much information as possible, but don't worry if you do not have the answers to each and every question.
 

Call the Insurance Company's Claims Department


The questions are grouped in three sections:
 

  • General Questions
    This section contains questions specific to you, your employee and the accident. These questions will be asked on every claim.

  • State-Specific Questions

    California
    • State Unemployment Insurance Account Number (UIAN)
    • Date employee was provided claim form
  • Additional Comments and Information
    If you would like to provide additional information not covered elsewhere, the customer service representative will record this in a free form area.

Let Your Employee Know

Before you hang up, the customer service representative will give you a claim number. Using the claim number will help expedite handling the rest of the claim. Please include the claim number with all future correspondence, such as wage statements or medical bills. Please be sure to give this number to your employee.

 


*The above information was provided by Travelers Property & Casualty Insurance

Copyright ⓒ 2004 Coex Insurance & Financial Services, Inc.  CA Department of Insurance License No. 0E36306.  All rights reserved.  

3807 Wilshire Blvd., #1012, Los Angeles, CA 90010 Tel:213)380-1221

Send mail to webmaster@coexinsurance.com with questions or comments about this web site.  Last modified: 08/01/06