independent claims adjusters, claim managers, insurance temporary service providers, multi-line claims, fire and allied lines, workers compensation, surveillance professionals, Oak Hill Associates, Inc.

Oak Hill Associates, Inc.

General Liability Assignment

Report to:		Company:
Email:		Address:
Telephone:		Claim #:
Report via Email		Report via Regular Mail

Narrative Assignment Instructions
Full Investigation

Instructions for Assignment

Insured Recorded Statement

Copies of contracts or agreements

Claimant Recorded Statement

Identify potential contribution

Witness Recorded Statement

Photo/Diagram/Measurements of scene

	Digital Photography
	Regular Photography

Obtain Police Report

Canvass for witnesses

File Index

Obtain Medical Authorization

Rule out bodily injury

Obtain Wage Authorization

Determine comparative negligence

Other:

Loss Information

Producer/phone:		Policy Number:
Date of Loss
Effective Date:		Expiration Date:
Insured Name:		Address:
Telephone:		Contact Person:
Claimants Name:		Address:
Telephone:		Contact Person:
Loss Location & Description:
Authority contacted:		Report #
Policy Info: Prem/Op Med Pay Products/Compl'td Ops Contractual Other Coverage: Deductible:
Premises/Insured is: Owner Tenant Other Type of premises:
Products/Insured is: Manufacturer Vendor Other Type of product:
Manufacturer Name & Address: (If insured is not manufacturer)		Where can product be seen:
Owner Name & Address:		Telephone:
Description of injury or Property Damage:
Witness Name & Address:		Witness Telephone:
Remarks:

Oak Hill Associates, Inc.
2077 Burlington Ave.
Lisle, Illinois 60532-1788
Phone: 630.969.1999
Fax: 630.515.9554

Email: info@OakHillAssoc.com
URL: www.OakHillAssoc.com

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