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MOTOR VEHICLE INSURANCE CLAIM FORMS 

You may be asked to fill out motor vehicle insurance claims forms if your vehicle has been stolen or damaged as a result of the accident. It is required by your insurer to complete various insurance forms in order to process and support your motor vehicle insurance claim.

Among them is a Proof of Loss Form and  Accident Benefit Statutory Declaration that must be is signed and sworn to by the policyholder in the presence of a Notary Public. 

Reliance Notary Public can notarize the completed Proof of Loss Form or Accident Benefit Statutory Declaration for you  either in person or remotely. 

A Proof of Loss Form

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A proof of loss  Form is a formal document that is filed with an insurance company regarding the scope of damage to your property or destroyed items in order to initiate a claim process after a property loss.

The policyholder must fill out the proof of loss form to receive benefits and compensation from the claim.

On the form, you will be asked to indicate:

  • Coverage amounts at the time of the loss

  • Date and cause of the loss

  • A complete list of all damaged, destroyed or stolen items

  • Documents that support the value of the property and the amount of loss claimed (i.e. estimates, inventories, receipts, e proof of purchase, receipts, police reports, owner’s manuals and warranties, if possible.

  • Photos of damaged items. It is important to keep damaged items until you are reimbursed by the auto insurer.

  • Parties claiming the loss under the policy

  • Parties having an interest in the property – such as the bank holding the mortgage

  • Policy number

If you do not fill out this form accurately, it can lead to an increase of a car insurance premiums in the future or a delay or denial of your claim. 

Accident Benefit Statutory Declaration

Under Statutory Accident Benefit Schedule (SABS), your insurer may require you to complete Accident Benefit Statutory Declaration that must be signed and commissioned in the presence of a Commissioner of Oath. 

It may be required for various reasons such as determining priority between insurers, entitlement for Income Replacement Benefit, Non-Earner Benefit or Attendant Care Benefit. 

Priority dispute occurs when there is disagreement over which insurer has the highest priority to be responsible for statutory accident benefits (SABS) or other insurance coverage when a claim is made.

Income Replacement Benefit is available to individuals who are unable to return to work as a result of the accident and who have suffered a physical and psychological impairments. In order to be eligible for IRBs, you must be either employed or self-employed for at least 26 out of 52 weeks before the accident. The amount received in IRBs is 70% of your gross pre-injury income, up to a maximum of $400.00 per week. 

Non- Earner Benefit is available to individuals who suffers a complete inability to carry on a normal life as a result of and within 104 weeks after an accident and who do not qualify for income replacement benefits. You may qualify for non-earner benefits if you were unemployed, full-time student/ recent graduate or retired at the time of the accident. For accidents that occurred after June 1, 2016, the non-earner benefit of $185 per week is payable after a four week waiting period to a maximum of two years post-accident. 

Attendant Care Benefit - is payable by insurer for all reasonable and necessary expenses “incurred” on behalf of an insured person for services provided by an aid or attendant. If injuries are characterized as “non-minor injury” or “catastrophic”, as defined under the SABS, an individual may be entitled to Attendant Care Benefit to a maximum of $3,000 per month (non-minor injury) or $6,000 per month (catastrophic). An Occupational Therapist prepares a Form 1 – Assessment of Attendant Care Needs for an injured person and sets out the services and amount of attendant care required by an individual as well as the monthly amount payable by the insurer.

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