ADOBESIGN TEMPLATE -POL & ESTIMATE

Adobe Sign-style Proof of Loss and estimate transmittal language for Carrier review and payment consideration.

Hello POLICYHOLDER,

We are sorry this catastrophic event affected you, and we wish you the best as you work to restore normalcy.

As previously discussed, we have concluded our claim evaluation pursuant to the terms and conditions of your policy. The enclosed documents are being prepared for submission to your insurance carrier for review and consideration of payment. Please note: as the field adjuster, I do not have authority to approve or deny coverage or authorize payment. All coverage and claim decisions are made solely by the carrier.

 

Our evaluation reflects undisputed damages based on the information available at this time. If you believe additional covered items were omitted or underpaid, these may be considered through a Request for Additional Payment (RAP), sometimes referred to as a supplement, subject to the policy and the carrier’s review. Please contact me promptly and provide any supporting invoices, documents, lists, and photographs for consideration. You may reach me at 330-437-9168 or by email at gutflood@outlook.com <mailto:gutflood@outlook.com> .

 

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⚡ ADOBESIGN SIGNATURE INSTRUCTIONS

1.	Please sign and date the bottom of the first page (Proof of Loss / POL).
2.	Follow the AdobeSign prompts to complete the signing process. Once completed, I will automatically receive a signed copy for submission to the carrier, and you will automatically receive a signed copy for your records.

 

📄 EXPLANATION OF THESE DOCUMENTS

1.	PROOF OF LOSS (POL) | Signature Required
	The first document (the one you are signing and dating) is the Proof of Loss (POL). It states the total amount of covered loss being presented to your insurance carrier for review. The “Net Claim” amount reflects the total payment being requested to repair and/or replace covered, flood-damaged property, subject to the policy and the carrier’s review. The SFIP requires that a signed and sworn Proof of Loss (POL) be submitted within 60 days of the Date of Loss, unless FEMA issues a written extension for the event.
2.	ESTIMATE | No Signature Necessary
	The remaining pages are the estimate (length varies based on the size of the loss). You do not need to sign any of the estimate pages. The estimate is provided for your review and records and details, room-by-room, the damages observed and the allowances being requested for each repair. It also supports and explains the totals shown in the Proof of Loss. If you have a mortgage, your lender may refer to this document as the “adjuster’s worksheet” (or similar) and may require it when endorsing and/or releasing the settlement funds.

 

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🛡️AUTHORITY CLARIFICATION:  As the field adjuster, my role is to inspect, document, and prepare an estimate and report for the claim file. I cannot approve or deny coverage, authorize payment, or bind coverage. All coverage determinations, payments, and final decisions are made solely by the carrier based on the policy and applicable guidelines.

 

 

Thank you very much for your patience and assistance.  If you have any questions at all, please don’t hesitate to contact me.

 

 

Christopher T. Gutshall

Insurance Adjuster

NFIP FCN 0070008289

 

M 330.437.9168  |  E  gutflood@outlook.com <mailto:gutflood@outlook.com> 

 

Authority & Disclaimer: Field adjusters cannot approve/deny coverage or authorize payment. Final claim decisions are made only by the carrier. 

Confidentiality Notice: This email may contain privileged or confidential information intended only for the recipient. If you received it in error, please delete it and notify me.