Adjuster report templates
Captioned Report Template & Example (Adjuster Report Format)
Last updated 2026-08-03
A captioned report is read by someone who was not there. That single fact decides almost everything about how it should be written: what has to be defined, what cannot be assumed, and why the sentence "the damage was consistent with the reported cause" is worth almost nothing without the observations that led to it.
The structure below is the one a reviewing examiner expects, in the order they expect it. Its length is not padding. The sections that make a report long are the ones that make it reviewable: what was observed, what was said, what was measured, what could not be determined, and what follows from all of it.
The worked example further down is written against a fictional water loss, and it deliberately leaves one question open. Reports that resolve everything cleanly are the ones that teach the wrong habit, because real files usually contain at least one thing the adjuster could not settle.
Jurisdiction
Written primarily against US first-party property practice. Claim handling is regulated state by state — acknowledgment and response deadlines, prompt-payment requirements, adjuster licensing and unfair claims practices standards all differ — and the policy actually issued governs the claim. Where a page cites a statute, model act or regulation, confirm what applies in the state where the loss occurred. Outside the US, treat the structure as transferable and the legal references as not.
Captioned Report template
Free Word download, no email required. Or open it in Professional Drafter — it lands in your template library, ready to draft against.
When to use this document
- Any loss where the file may be reviewed by someone other than the assigning examiner.
- Losses involving a coverage question, a disputed cause, or a reserve above the desk-adjusting threshold.
- Any claim likely to be reinsured, audited, litigated, or reopened.
Worked example
Fictional scenario: a water loss at a single-family dwelling, inspected four days after the reported date of loss. The cause is established; the duration of the leak is not, and the report says so rather than estimating it.
Assignment
This will acknowledge receipt of the assignment on 15 July 2026. We contacted the insured, Mr D. Okonjo, by telephone on 15 July and inspected the damage on 18 July 2026.
The three-day interval to inspection reflects the insured's first available access date; he was out of state 15-17 July and declined a key release. Noted here because the interval bears on the moisture readings recorded under Cause & Origin.
Coverage
Policy HO-4471903, term 1 March 2026 to 1 March 2027, in force at the date of loss. Dwelling limit $310,000; other structures $31,000; unscheduled personal property $155,000; additional living expense 12 months actual loss sustained. All-peril deductible $2,500, applied once to this occurrence.
Two provisions are identified for the examiner under Cause & Origin below. No coverage position is taken in this report.
Date, time and location of loss
Date of loss: reported 14 July 2026, discovered approximately 07:15. Time of onset not established; see Cause & Origin.
Location of loss is the risk address, 118 Harbour Lane. No catastrophe number; this is an isolated loss, not storm-related.
Cause and origin
The cause of the loss is a failed braided stainless supply line to the water heater, which separated at the crimped fitting at the heater end. The fitting and adjacent line were retained and photographed (images 3-9).
The insured stated the dwelling was last occupied at approximately 18:00 on Friday 11 July and that he found standing water on returning at 07:15 on 14 July, an interval of roughly 61 hours. Moisture readings taken 18 July with a Delmhorst BD-2100, wood scale, on the slab at 4, 8, 12 and 16 feet from the closet: 18.4%, 16.1%, 14.8%, 11.2%. Baseline in the far bedroom, approximately 40 feet from the source: 9.6%.
The duration of the release is NOT established, and this is material. The gradient is consistent with a release of many hours but does not distinguish twelve from sixty. Three things that might have resolved it were unavailable: there is no water sub-meter, municipal supply is billed quarterly with the next read due September, and there is no alarm or occupancy log. I am recording this as undetermined rather than estimating it, because the repeated-seepage exclusion turns on duration and an estimate offered here would be read downstream as a finding.
Scope of damages
a. Dwelling. Utility closet: remove and replace water heater surround, 6 SF. Hallway and living room: drywall wet to 14 inches above slab along 31 LF of the south and west walls, wicking line photographed (images 11-18); remove and replace to 24 inches, replace base trim, clean and dry slab. Detach and reset shelving in the affected run.
b. Adjacent structures (APS). Detached garage inspected; no water intrusion observed, photographed for completeness (image 27).
c. Unscheduled personal property (UPP). Fourteen cartons of stored books on the floor of the hallway closet, water-stained to varying heights, photographed individually (images 30-44). Remaining contents on racking six inches above slab were dry. Inventory provided by the insured on 18 July, not yet priced.
d. Additional living expense (ALE). None claimed. The dwelling remained habitable throughout; kitchen, bathrooms and bedrooms were unaffected.
Expert investigation
No expert retained. I do not presently recommend one. The failure mode is visible in the retained fitting, and the only open question is duration, which a metallurgist would not resolve. If the examiner takes a different view on the exclusion, a plumbing consultant could be instructed, and I would want written authorization before doing so.
Salvage
No salvage of value. The fourteen cartons of books are water-damaged throughout and have no resale value; the insured has been asked to retain them pending disposition and has agreed. No salvage vendor engaged and no permission sought, since none is warranted.
Subrogation
Potential subrogation against the installer. The water heater was replaced 11 months before the loss by Feldstrom Plumbing under invoice 20941, dated 3 August 2025, a copy of which the insured provided. The braided line appears to have been supplied and fitted as part of that work.
The theory is defective installation of the crimped fitting rather than product failure, though the two are not yet distinguishable on inspection alone. The fitting and line have been retained and are in our possession, tagged and photographed. No notice has yet been given to Feldstrom. Referred to the recovery unit on 20 July with a recommendation that notice issue before the components are examined further, so that any inspection can be conducted jointly.
Photographs
Enclosed are 47 photographs of the risk and damage, labelled and keyed to the observations above. These include one photograph of each elevation, one of the street address, four of the origin and the retained components, and an overview of each undamaged room including the unaffected bedrooms and garage.
Diagrams
Enclosed is a floor plan of the affected area, dimensioned, showing the utility closet, the four moisture reading locations with their values, and the 31 linear feet of affected wall marked in red. Reading locations are numbered to match the values recorded under Cause & Origin.
Advance payment request
None requested. The insured has not sought an advance and the dwelling remains habitable. Recorded here so the file shows the question was addressed rather than overlooked.
Further activities
1. Chase the contents inventory pricing from the insured — requested 18 July, target 25 July.
2. Obtain a legible copy of the Feldstrom invoice; the copy provided is partly illegible at the line-item detail. Requested 18 July, target 25 July.
3. Confirm with the examiner whether the duration question warrants a plumbing referral. My view is that it does not, since the maximum possible interval is well inside the exclusion's threshold. Awaiting response, requested 20 July.
4. Coordinate with the recovery unit on notice to Feldstrom before any further examination of the retained components. Referred 20 July.
Anticipated completion of the adjustment: 8 August 2026, subject to item 3.
Section-by-section guide
What each section is for, what a good one contains, and where they typically go wrong.
1.Assignment
Three dates in one paragraph: when you received the assignment, when you contacted the insured, and when you inspected. A reviewer reads this block to check the clock, because contact and inspection timeliness is the first thing a market conduct examiner tests. If any interval looks long, explain it here rather than leaving the gap to speak for itself.
2.Coverage
The policy, the forms, the limits, the deductible and how it applies. State what the policy provides; do not decide contested coverage here. A captioned report is a reporting instrument, and a coverage position stated in the field before the file is complete is a position that may have to be withdrawn.
3.Date, time and location of loss
Losses do not always happen at the location of the risk, so state both when they differ. Include the catastrophe number where one applies.
4.Cause and origin
Be descriptive. Say what took place, not merely what peril it is filed under. Where the cause is established, say so and say on what evidence; where it is not, record what would have determined it and why that was unavailable. An honest 'not established' is a stronger file than a determination the evidence will not carry.
5.Scope of damages
Four fixed subsections, in this order, every time: Dwelling, Adjacent or other structures (APS), Unscheduled personal property (UPP), and Additional living expense (ALE). Keep the scope room-ordered and free of pricing — pricing is a separate layer, and merging them means a disagreement about one reopens the other.
6.Expert investigation
Only if an expert has been retained, and only after written authorization. Name the discipline, the firm, the date instructed and what they were asked to determine. If you are recommending rather than reporting a retention, say so plainly so nobody reads it as already done.
7.Salvage
Whether salvage exists, its likely disposition, and who has been engaged. Secure permission before employing any salvage vendor, and record that permission here.
8.Subrogation
Explain your theory. Not merely that a potential recovery exists, but against whom, on what basis, and what has been done to preserve it — evidence retained, notice given, deadlines diarised. A subrogation caption that says 'none apparent' with no reasoning is the one a recovery unit later asks about.
9.Photographs
State the count and confirm they are labelled. The convention is one photograph per elevation, one of the address, at least one of the origin, and an overview of each undamaged room — the undamaged rooms matter because they establish what you did look at.
10.Diagrams
The sketch or plan, with dimensions, keyed to the scope. State what is enclosed rather than referring vaguely to 'a diagram'.
11.Advance payment request
Only where one is being sought. State the amount, what it is for, and what it is being applied against, so the eventual settlement reconciles without reconstruction.
12.Further activities
What you will do, when you will do it, and the anticipated completion date. This is the caption most often written as a shrug — 'will continue to monitor' — and it is the one a file reviewer uses to judge whether the claim is being run or merely observed. Each item gets an owner and a date.
Common mistakes
The failure modes that show up most often when this document is reviewed later.
Writing the cause as a fact when the evidence supports only an inference.
It is the sentence that gets quoted back at you. If the file later has to retreat from it, the retreat is what the reviewer remembers, not the original caution you failed to write.
Blending observations and analysis into a single narrative.
A reviewer who disagrees with your conclusion should still be able to rely on your observations. Merge them and disagreement with one becomes distrust of both.
Taking a coverage position in a field report.
The report's job is to establish facts and identify the questions. A position taken before the file is complete is a position that may have to be withdrawn, and withdrawing one is materially worse than never having stated it.
Omitting what you tried to obtain and could not.
An unexplained gap looks like carelessness. The same gap with a date, a request and a reason reads as a decision, which is what it was.
Setting a reserve without a stated basis.
The next person to review the file cannot test a number they cannot trace, so they replace it with their own. The rationale is what makes the figure yours.
Questions
- How long should a loss report be?
- Long enough that a stranger can follow it, and no longer. Completeness is about scope, evidence, analysis and outcome all being present — not about page count. A four-page report containing all four is complete; a twelve-page report that merges observation with conclusion is not.
- Should the report state a coverage position?
- Usually not. Identify the provisions engaged and the questions they raise, and leave the position to the examiner or coverage counsel. The exception is where you have been expressly assigned to give one, in which case say so in the scope section.
- What if the cause cannot be determined?
- Say so, and say what would have determined it and why that was unavailable. An honest 'not established' with the avenues documented is a stronger file than a determination the evidence does not carry. The worked example above does exactly this with the leak duration.
The blank template
Exactly what is in the Word download, so you can see the structure before deciding whether you want it.
Assignment
Coverage
Date, time and location of loss
Cause and origin
Scope of damages
- Dwelling — room by room, with measurements
- Adjacent or other structures (APS)
- Unscheduled personal property (UPP)
- Additional living expense (ALE)
Expert investigation
Salvage
Subrogation
Photographs
Diagrams
Advance payment request
Further activities
Download this template
Free Word download, no email required. Or open it in Professional Drafter — it lands in your template library, ready to draft against.
Sources
- NAIC — Unfair Property/Casualty Claims Settlement Practices Model Regulation (Model 902, 1991 amendment, July 1997 print)
- NAIC — Market Conduct Record Retention and Production Model Regulation (Model 910, January 2004)
- NAIC — Market Regulation Handbook: Examination Standards Summary, 2025 Edition
- N.Y. Insurance Law §3404 — standard fire policy (statutory text)
This page is a documentation aid, not legal advice and not a coverage opinion. Claim-handling requirements vary by state and by policy wording, and a template cannot tell you what your file requires. The worked example describes a fictional loss.