Get Claim/incident Supplemental Application - Tokio Marine Hcc

Filling out the Claim/Incident Supplemental Application is an essential step in reporting a claim for professional liability insurance. This guide will provide clear instructions to help you complete the application accurately and efficiently online.

Follow the steps to complete the application online.

1. Click ‘Get Form’ button to obtain the form and open it in the designated platform.
2. In the first section, enter the name of the applicant, which can be an individual or a firm. Ensure that this is the legal name as it appears in official documents.
3. Provide the full names of any individuals or firms involved in the claim or incident in the next field. This information is crucial for identifying the parties related to the claim.
4. List any additional defendants involved in the claim, if applicable. This should include any other parties that may be implicated in the incident.
5. Enter the full name of the claimant or plaintiff. This is the individual or entity that has filed the claim against you.
6. Specify the date of the claim. Ensure that the date is accurate, as it is vital for the processing of the claim.
7. Provide a detailed description of the type and scope of services you provided. This section is important for understanding the context of the claim.
8. Outline the allegations and/or nature of the claim or incident. Be as detailed as possible to give the underwriter comprehensive insight into the situation.
9. Indicate the date the claim was reported to your insurance company. Maintaining a timeline is crucial for effective management of the claim.
10. Specify which insurance company the claim was reported to. This information helps in tracking the claim within the appropriate channels.
11. Choose the present status of the claim from the options provided: Open, In Suit, or Closed. This status assists the underwriter in assessing the claim's current condition.
12. If your claim is open or in suit, provide details about the total damages claimed, settlement demand, settlement offer, and total amounts paid in defense costs to date.
13. In this section, if the claim is open or in suit, enter your current valuation, including damages and expenses. This provides an overview of the financial implications of the claim.
14. If the claim is closed, input the total amount paid, inclusive of any deductible. It's essential to reflect the complete financial resolution of the claim.
15. Address any current outstanding deductible obligations related to this claim by selecting Yes or No and providing the necessary details if applicable.
16. Explain the actions you have taken to prevent similar claims or incidents in the future. This demonstrates your commitment to risk management.
17. Sign and date the application where indicated. This must be completed by a principal, partner, officer, or director of the firm.
18. Once all sections are complete, save your changes. You can also download, print, or share the form as necessary according to your needs.

Complete your Claim/Incident Supplemental Application online today to ensure prompt handling of your claim.