Disclaimer

Not legal advice, and not a coverage opinion

Everything here is general information about how insurance claim documents are commonly structured. It is not legal advice, does not create an attorney–client relationship, and is not a coverage opinion on any policy or claim. Nothing on this site tells you whether a loss is covered, what a reserve should be, or what position to take. Those are determinations for the adjuster, the examiner and, where appropriate, coverage counsel — on the facts of the file and the wording of the policy actually issued.

Policy wording governs

Where a page refers to a policy provision — a proof of loss condition, an appraisal clause, a repeated-seepage exclusion — it is describing how such provisions are commonly written, not what any particular policy says. Forms differ between carriers, between states, and between editions of the same form. The policy in front of you is the only one that governs the claim in front of you.

State law varies, and it varies a lot

Claim handling is regulated state by state. Acknowledgment and response deadlines, prompt-payment requirements, adjuster licensing, and the standards for unfair claims practices and bad faith all differ, and they change. Where a page cites a statute, model act or regulation, check the primary source and confirm what applies in the state where the loss occurred and where you are licensed.

Worked examples are fictional

Every filled-in example describes an invented loss, written to show how a section reads when populated. No real claim, insured, carrier or adjuster is described, and any resemblance is coincidental. The figures, readings and dates are illustrative. The examples show drafting, not model determinations, and should not be copied into a live file.

Templates require judgment

A template cannot tell you whether the cause is established, whether the scope is complete, or whether the evidence supports the conclusion you are about to write. A well-structured document filled in badly is a well-structured bad report, and it is more persuasive than a messy one — which makes it worse, not better. Where a claim is large, contested, or heading toward litigation, get the file in front of someone qualified to review it.

No warranty

These materials are provided as-is, without warranty as to accuracy, completeness or fitness for any purpose. They are updated periodically, and the date shown on each page is the date it was last reviewed.