Get Fl Dfs-i0-510 2012-2025

Filling out the FL DFS-I0-510 form online is a straightforward process designed to help you request mediation for automobile insurance claims. This guide provides step-by-step instructions to ensure your submission is accurate and complete.

Follow the steps to successfully complete the FL DFS-I0-510 form.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering your personal information in the designated fields. Provide your full name, address, and phone number as the applicant. This information ensures that your request is accurately processed.
3. Next, enter your claim number and policy number. These numbers are crucial for identifying your case and the associated insurance policy.
4. In the section labeled 'FULL NAME OF INSURANCE COMPANY,' write the name of the insurance provider involved in your claim. Additionally, include the insurance company's address and phone number to facilitate communication.
5. Indicate whether the problem relates to 'Property Damage' or 'Personal Injury.' If the issue involves personal injury, ensure that the claimed amount is $10,000 or less to qualify for mediation.
6. In the next section, clarify the reason for requesting assistance. Choose between 'Unsatisfactory Settlement offer' or 'Other' to specify your situation.
7. Provide a brief statement of the problem, including the amount disputed. If necessary, attach additional sheets for a comprehensive explanation.
8. Sign and date the form to verify the accuracy of the information provided. Your signature is essential for the submission process.
9. Prepare to send the completed form to the Department of Financial Services at the specified address. Include a $100 fee for mediation, to be paid via certified check, money order, or insurance company check or draft.
10. Once all steps are complete, save your changes, and download or print a copy of the form for your records.

Start filling out the FL DFS-I0-510 form online to request mediation and resolve your insurance dispute.