When reporting a claim, please include all pertinent information gathered to date including correspondence and incident reports. It is required that a loss reporting form is completed and attached to any new claim report (even if an Acord form is used). The loss reporting form is designed to give the handling adjuster the information necessary to provide the best claims handling service possible.

SEVERE PROPERTY CLAIMS - If the loss is being reported during normal business hours, the producer should report the claim as outlined above. In the event the loss occurs after normal business hours or on a holiday and requires immediate attention, use CAG's emergency number for assistance (818) 645-1079.

NON-LITIGATED CLAIMS - The producer should report the claim as outlined above. CAG will open a file, assign the loss to an adjuster and report it to the appropriate carrier. A courtesy copy of the initial report to the adjuster will be faxed to the reporting producer for their records.

LITIGATED CLAIMS - The producer should report the claim as outlined above. Included with the loss report should be the date service was effected, the method of service (in person, by mail, etc.) and whom service was effected upon. This information is necessary as the carrier and /or the member have thirty (30) days in which to respond to any lawsuit. CAG will open a file, assign the loss to an adjuster and report it to the appropriate carrier. A courtesy copy of the initial report to the adjuster will be faxed to the reporting producer for their records.

Once you have opened the "Loss Reporting Form" in Adobe Acrobat Reader, you may tab through the fields and fill in the form or you may print out the form to complete by hand. Once completed, please fax the form to our claims department at (818) 638-8530 or email the form to: claims@claimsadjustgrp.com.

Claims Adjusting Group Loss Reporting
PDF Forms Download

PROPERTY

LIABILITY

POLLUTION

TIP: To save your completed application, select
"Save As" from the File menu. Remember
to give your file a different name when you save it.

You will need Adobe Acrobat Reader version 4.0 or greater. If you do not have this program you can download a free version of the program from their Web site at www.adobe.com.