Get Claims Reporting Form

Filing a Claims Reporting Form online is an essential process for reporting legal malpractice claims. This guide will help you understand how to complete each section of the form accurately and efficiently.

Follow the steps to successfully fill out the Claims Reporting Form.

1. Click ‘Get Form’ button to access the Claims Reporting Form and open the document for editing.
2. In Section A, start by entering the insurer’s name, which is the legal name of the insurance company associated with the claim.
3. Provide the NAIC group and company code. This includes a four-digit group code and a five-digit company code for the insurer listed.
4. Fill in the insurer claim file number using both alphabetic and numeric characters, avoiding any hyphens, slashes, or spaces.
5. Enter the city, state, and ZIP code for the insured. Use the official two-letter postal code for the state.
6. Indicate the status of the claim by selecting A for new claims, B for closed claims, C for corrected new claims, or D for corrected closed claims.
7. Provide the state code where the claim originated.
8. Select the appropriate population code for the city where the claim was made.
9. Indicate how many lawyers were insured under the policy.
10. Provide information on the relationship of the insured to the claimant by selecting the corresponding option.
11. Answer whether the claim arose after an attempt was made to collect a fee by selecting yes or no.
12. Complete the date of occurrence and the date first reported to the insurer, following the specified MM YY format.
13. In Section B, complete this section only for closed claims, starting with the closure date.
14. Fill out the claim disposition by selecting the correct alpha code for how the claim was resolved.
15. Enter the amounts paid to the claimant, loss expenses, and the established reserve amounts, rounding to the nearest dollar.
16. In Section C, provide the area of law code that corresponds to the case.
17. Indicate the major activity code that describes the primary action taken by the legal professional at the time of the alleged error.
18. Describe the alleged error or omission that relates to the claim by selecting the most significant code.
19. Once all sections are completed, you can save changes, download, print, or share the form as necessary.

Complete your Claims Reporting Form online today to ensure your claim is submitted efficiently.