URB - Miscellaneous Forms

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Sample Letter List

First Party Letters Description

Acknowledge Proof of Loss

    Acknowledge Receipt
Acknowledging proof of loss neither accepting nor rejecting it pending completion of investigation. Reserve all rights and promise a status report at 30 day intervals.

    30 Day Update Letter Routine letter to insured on 30 day basis updating status of pending claim.

Appraisal

    Demand for Appraisal Insurer's request for appraisal.

    Accept Demand for Appraisal Acceptance of the Insured's request for an appraisal.

Examination Under Oath

    Demand Exam Under Oath Acknowledgement of Proof of Loss holding in abeyance pending scheduling of Examination under Oath, reserving all rights.

    2nd Demand Response to rejection of Examination under Oath citing pending criminal charges or Grand Jury action. Offer to reschedule at a specific date and time advising that policy will be irretrievably breached if insured doesn't show. Advise that fifth amendment rights do not take precedent over the insurer's right to examine insured under oath.

    Letter to Attorney Letter to outside attorney setting out just what is to be done, when and where.

Fidelity

    Acknowledge Fidelity Proof of Loss Acknowledge receipt of sworn proof of loss. Neither accepted nor rejected, pending outcome of investigation.

    Request Fidelity Proof of Loss Response to receipt of notice of a fidelity loss, enclose blank proof of loss and reserve all rights.

    Notice to Principal Letter to Principal to inform and request information or evidence.

Miscellaneous

    Letter to Investigator Letter to outside experts or investigators setting out just what is to be done, when and where.

    Duplicate Stock Issue Letter Letter on lost instrument matters directing insured to request reissue by registrar and agreeing to pay premium on lost instrument bond subject to policy limitations. Reserve all rights.

    Subrogation Notice Subrogation notice with or without subrogation receipt.

    Partial Loss Adjustment Letter enclosing check for agreed portion of loss but reserving rights to contest that part of the loss that is not agreed upon.

    Request for Access Letter requesting cooperation of the insured in arranging for inspection for processing of loss. Reserve all rights.

Rejection of Loss

    Peril Not Insured Rejection of claim as loss is not causally connected to any peril insured against.

    Policy Breach Rejection of Proof of Loss on the merits of the situation; very generalized citing only that breaches of the contract call for declination of coverage and/or loss or some similar basis without any substantial specifics.

    Coverage Not Triggered Rejection of claim as loss does not cross the threshold of policy, i.e. no risk of loss associated with cause of loss.

    Generalized Rejection of claim citing increase of hazard language.

    Coverage Excluded Rejection of claim as loss is excluded by policy; citing exclusion.

    Statue Expired Rejection of loss as statute expired.

Reject Proof of Loss

    Incomplete Rejection of Proof of Loss as being incomplete, citing the areas of incompletion, enclosing a blank proof of loss for completion and filing within 60 days as required and reserving all rights in connection with the loss.

    ACV Issues Letter on Broad Evidence Rule where ACV issues surface.

Request Proof of Loss

    Request Request proof of loss in compliance with lines 90-122 of Standard Fire Policy. Reserve all rights and enclose a blank proof of loss with instructions for its completion, attachment of validation records, sworn to before a notary and returned in its complete state within 60 days as required by the SFP.

    Request to Mortgagee Request for Proof of Loss from mortgagee when policy is void to insured but not necessarily to mortgagee. Reserve all rights.

Third Party Letters

Description

    Accident Report Request Cover letter to request police report for accident.

    Attorney Report Acknowledgement Letter of acknowledgement to attorney for third party claimant.

    Contact Letter Advise that contact has been unsuccessful, advises who is assigned adjuster and that follow up is needed to obtain statement from claimant.

    Denial Coverage Declination of coverage to insured on third party claim.

    Insured Acknowledgement Letter Acknowledges receipt of claim to insured.

    Non Waiver Agreement Bilateral agreement that coverage is not yet determined.

    Reassignment Letter Notice of adjuster reassignment.

    Request for Meds Cover letter to request medical records. Medical authorization needed.

    Reservation of Rights Letter Unilateral letter of carrier reserving its rights under the contract until coverage or other issues are determined.

    Subrogation Letter Notice letter for subrogation.

    Suit Acknowledgement Suit acknowledgement and excess letter to insured to advise suit papers are received, advise if excess, and request additional information on coverage.

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Sample Letter List
First Party Letters	Description
Acknowledge Proof of Loss
Acknowledge Receipt	Acknowledging proof of loss neither accepting nor rejecting it pending completion of investigation. Reserve all rights and promise a status report at 30 day intervals.
30 Day Update Letter	Routine letter to insured on 30 day basis updating status of pending claim.
Appraisal
Demand for Appraisal	Insurer's request for appraisal.
Accept Demand for Appraisal	Acceptance of the Insured's request for an appraisal.
Examination Under Oath
Demand Exam Under Oath	Acknowledgement of Proof of Loss holding in abeyance pending scheduling of Examination under Oath, reserving all rights.
2nd Demand	Response to rejection of Examination under Oath citing pending criminal charges or Grand Jury action. Offer to reschedule at a specific date and time advising that policy will be irretrievably breached if insured doesn't show. Advise that fifth amendment rights do not take precedent over the insurer's right to examine insured under oath.
Letter to Attorney	Letter to outside attorney setting out just what is to be done, when and where.
Fidelity
Acknowledge Fidelity Proof of Loss	Acknowledge receipt of sworn proof of loss. Neither accepted nor rejected, pending outcome of investigation.
Request Fidelity Proof of Loss	Response to receipt of notice of a fidelity loss, enclose blank proof of loss and reserve all rights.
Notice to Principal	Letter to Principal to inform and request information or evidence.
Miscellaneous
Letter to Investigator	Letter to outside experts or investigators setting out just what is to be done, when and where.
Duplicate Stock Issue Letter	Letter on lost instrument matters directing insured to request reissue by registrar and agreeing to pay premium on lost instrument bond subject to policy limitations. Reserve all rights.
Subrogation Notice	Subrogation notice with or without subrogation receipt.
Partial Loss Adjustment	Letter enclosing check for agreed portion of loss but reserving rights to contest that part of the loss that is not agreed upon.
Request for Access	Letter requesting cooperation of the insured in arranging for inspection for processing of loss. Reserve all rights.
Rejection of Loss
Peril Not Insured	Rejection of claim as loss is not causally connected to any peril insured against.
Policy Breach	Rejection of Proof of Loss on the merits of the situation; very generalized citing only that breaches of the contract call for declination of coverage and/or loss or some similar basis without any substantial specifics.
Coverage Not Triggered	Rejection of claim as loss does not cross the threshold of policy, i.e. no risk of loss associated with cause of loss.
Generalized	Rejection of claim citing increase of hazard language.
Coverage Excluded	Rejection of claim as loss is excluded by policy; citing exclusion.
Statue Expired	Rejection of loss as statute expired.
Reject Proof of Loss
Incomplete	Rejection of Proof of Loss as being incomplete, citing the areas of incompletion, enclosing a blank proof of loss for completion and filing within 60 days as required and reserving all rights in connection with the loss.
ACV Issues	Letter on Broad Evidence Rule where ACV issues surface.
Request Proof of Loss
Request	Request proof of loss in compliance with lines 90-122 of Standard Fire Policy. Reserve all rights and enclose a blank proof of loss with instructions for its completion, attachment of validation records, sworn to before a notary and returned in its complete state within 60 days as required by the SFP.
Request to Mortgagee	Request for Proof of Loss from mortgagee when policy is void to insured but not necessarily to mortgagee. Reserve all rights.

Third Party Letters	Description
Accident Report Request	Cover letter to request police report for accident.
Attorney Report Acknowledgement	Letter of acknowledgement to attorney for third party claimant.
Contact Letter	Advise that contact has been unsuccessful, advises who is assigned adjuster and that follow up is needed to obtain statement from claimant.
Denial Coverage	Declination of coverage to insured on third party claim.
Insured Acknowledgement Letter	Acknowledges receipt of claim to insured.
Non Waiver Agreement	Bilateral agreement that coverage is not yet determined.
Reassignment Letter	Notice of adjuster reassignment.
Request for Meds	Cover letter to request medical records. Medical authorization needed.
Reservation of Rights Letter	Unilateral letter of carrier reserving its rights under the contract until coverage or other issues are determined.
Subrogation Letter	Notice letter for subrogation.
Suit Acknowledgement	Suit acknowledgement and excess letter to insured to advise suit papers are received, advise if excess, and request additional information on coverage.