XX 11am. Police report for Paul Insured case received.

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Gabriella McCormick
6 years ago
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1 INSURCO File Notes: Julian Claimant XX 4pm. Call from Paul Insured. Paul Insured reported that he d been involved in a MVA that was his fault. He hit another vehicle as he was pulling out of a parking lot onto Frontage Road. He says he was cited and will get us the police report. He reports minimal damage to his vehicle, no injuries to anyone, minimal damage to other vehicle driven by Julian Claimant. Advised Paul Insured that an appraiser will contact him to inspect the vehicle XX 11am. Police report for Paul Insured case received XX 10am. Rec d call and fax from John Attorney reporting that he represents the claimant in the Paul Insured Case, Julian Claimant. Caller s phone XX 2pm. Call from claimant Julian Claimant. Rec'd a call from Julian Claimant who said several people have tried calling him, attorneys etc. He wants to know who he should be talking to. I let him know that John Attorney reported he is representing him so I can no longer discuss this w/ him. He wanted to know if he should be going to the Dr appt. Told him he needs to talk to his atty. We do not have any say in that. He said he was fine now. Told him he needs to go thru the atty office if he signed agreement w/them. I did let him know that our appraiser would be contacting him to make arrangements to inspect his vehicle XX 10am. Call from Julian Claimant. Obtained recorded statement from Julian Claimant with atty present on phone. Claim Rep: Was anyone injured in the loss? Claimant: Yes, I was (Julian Claimant). Claim Rep: What body part is injured? Claimant: Rt arm and shoulder area. Claim Rep: Are you planning to seek additional treatment? Claimant: Yes, has appt for this afternoon. Claim Rep: What is the name of the facility(s) or doctor(s)? Claimant: Does not know name of Dr or facility XX. Appraiser photos of both vehicles received XX 8am. Received bill and progress notes from E. Harrington Physician for services rendered to Julian Claimant in July XX. Received bill for July services to Julian Claimant, from Rock City Rehabilitation.

2 Revised Report CRASH Police Crash Report Crash Day of Week MILITARY Time (24 hr clock) County of Crash Official DMV Use Date GPS Lat. GPS Long. Page of City of City or Town Name Landmarks at Scene Town of Location of Crash (route/street) Railroad Crossing ID no. (if within 150 ft.) Local Cas N S E W Location of Crash (route/street) Mile Marker Number Number of Vehicles At Intersection With or Miles Feet of DRIVER VEHICLE # Driver Fled Scene Driver s Name (Last, First, Middle) Gender VEHICLE # DRIVER Driver s Name (Last, First, Middle) Driver Fled Scene Gender Birth Drivers License Number State DL CDL Date Safety. Used Air Bag Ejected Date of Death Injury Type EMS Transport Summons Issued As Result of Crash VEHICLE Vehicle Owner s Name (Last, First, Middle) Offenses Charged to Driver Y Same as Driver N Birth Drivers License Number State DL CDL Date Safety. Used Air Bag Ejected Date of Death Injury Type EMS Transport Summons Issued As Result of Crash VEHICLE Vehicle Owner s Name (Last, First, Middle) Offenses Charged to Driver Y Same as Driver N Vehicle Year Vehicle Make Vehicle Model Disabled CMV Towed Vehicle Year Vehicle Make Vehicle Model Disabled CMV Towed Vehicle Plate Number State Approximate Repair Cost Vehicle Plate Number State Approximate Repair Cost VIN Name of Insurance Company (not agent) PASSENGER (only if injured or killed) Codes POSITION IN/ON VEHICLE 1. Driver 2-6. Passengers 7. Cargo Area 8. Riding/Hanging On Outside All Other Passengers SAFETY EQUIPMENT USED 1. Lap Belt Only 2. Shoulder Belt Only 3. Lap and Shoulder Belt 4. Child Restraint 5. Helmet 6. Other 7. Booster Seat 8. No Restraint Used 9. Not Applicable Oversize Cargo Spill Override Underride Speed Before Crash Speed Limit Maximum Safe Speed ALL Passengers Age Count Under Over VIN Name of Insurance Company (not agent) Oversize Cargo Spill Override Underride Speed Before Crash Speed Limit Maximum Safe Speed ALL Passengers Age Count Under Over PASSENGER (only if injured or killed) Name of (Last, First, Middle) Name of (Last, First, Middle) EMS Transport Date of Death EMS Transport Date of Death MM DD YY MM DD YY Position Safety Airbag Ejected Injury Type Birthdate Gender Position Safety Airbag Ejected Injury Type Birthdate Gender In/On In/On Vehicle Used Name of (Last, First, Middle) EMS Transport Date of Death Name of (Last, First, Middle) EMS Transport Date of Death MM DD YY MM DD YY Position Safety Airbag Ejected Injury Type Birthdate Gender Position Safety Airbag Ejected Injury Type Birthdate Gender In/On In/On Name of (Last, First, Middle) EMS Transport Date of Death Name of (Last, First, Middle) EMS Transport Date of Death MM DD YY MM DD YY Position Safety Airbag Ejected Injury Type Birthdate Gender Position Safety Airbag Ejected Injury Type Birthdate Gender In/On In/On AIRBAG 1. Deployed Front 2. Not Deployed 3. Unavailable/Not Applicable 4. Keyed Off 5. Unknown 6. Deployed Side 7. Deployed Other (Knee, Air Belt, etc.) 8. Deployed Combination EJECTED FROM VEHICLE 1. Not Ejected 2. Partially Ejected 3. Totally Ejected SUMMONS ISSUED AS A RESULT OF CRASH 1. Yes 2. No 3. Pending INJUR Y TYPE 1. Dead Before Report Made 2. Visible Signs of Injury, as Bleeding Wound or Distorted Member or Had to be Carried From Scene. 3. Other Visible Injury, as Bruises, Abrasions, Swelling, Limping, etc. 4. No Visible Injury, But Complaint of Pain, or Momentary Unconsciousness. 6. No Injury (driver only) Investigating Officer Badge/Code Number Agency/Department Name and Code Reviewing Officer Report File Date

3 DOCUMENT XX hrs 1

4 From Insurco Claim file for Paul Insured Vehicle photos by appraiser from MVA of 7-2-XX Unit 1: Paul Insured Unit 2: Julian Claimant

5 DOCUMENT 20 Weldon Paindoctor, MD, PA 75 Medical Plaza Rock City, IA Date: XX Patient: Julian Claimant DOB: 8-17-XX Referring Physician: E. Harrington Physician, MD Page 1 of 3

6 DOCUMENT 20 Julian Claimant, 10/02/XX, continued Page 2 of 3

7 DOCUMENT 20 Julian Claimant, 10/02/XX, continued Page 3 of 3

XX 11am. Police report for Paul Insured case received.

XX 11am. Police report for Paul Insured case received. INSURCO File Notes: Julian Claimant 1. 7-2-XX 4pm. Call from Paul Insured. Paul Insured reported that he d been involved in a MVA that was his fault. He hit another vehicle as he was pulling out of a parking