Traders Insurance Company

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Automobile Insurance Claim

All claims are handled by our seasoned Claims professional. To facilitate the processing of automobile claims, claimants should submit the required documents enumerated below. As much as we would like to speed up claims processing, we could not process claims with
incomplete documentation. Automobile Notice of Accident Form

Documents needed to process automobile insurance claims:

I. Own Damage (Comprehensive/Collision or Upset) - Pertains to accidental damage to the insured vehicle.

1. Original copy of the Incident Report/Traffic Crash Report
2. Duly accomplished Automobile Notice of Accident
3. Copy of current vehicle registration
4. Copy of driver's license of the authorized driver using the insured vehicle at the time of the accident
5. Three (3) repair estimates
6. Pictures showing the plate no. of the insured vehicle and the extent of damage (To be taken by Traders Insurance Company)

II. Third Party Claim - pertains to property damage, bodily injury, or death suffered by third parties in an accident

A. Property Damage Claim

1. Original copy of the Traffic Crash Report
2. Duly accomplished Automobile Notice of Accident
3. Copy of current vehicle registration
4. Copy of driver's license of the driver using the vehicle at the time of the accident
5. Three (3) repair estimates
6. Pictures showing the plate no. of the third party vehicle and the extent of damage (To be taken by Traders Insurance Company

B. Bodily Injury

1. Original copy of the Traffic Crash Report
2. Duly accomplished Automobile Notice of Accident
3. Medical Certificate/Doctor's Report
4. Original copy of hospital bills, receipts, professional fees

C. Death

1. Original copy of the Traffic Crash Report
2. Duly accomplished Automobile Notice of Accident (To be accomplished by the heir)
3. Death Certificate
4. Funeral/Burial Receipt
5. Birth Certificate, if deceased is minor.
6. Marriage Contract, if deceased is married
7. Medical Certificate
8. Original copy of hospital bills, receipts, professional fees
9. Other documents pertinent to the claim

Workers Compensation Insurance Claim:

Claim Forms Procedure Claim Forms

1. WCC-200A - Authorization for Medical Examination and/or Treatment. (Employer will prepare the Authorization for medical treatment, to be given to the treating facility)

2. WCC-200B - Attending Physicians initial report of injury and treatment.

3. WCC-201 - Physician’s Report for subsequent treatment

4. WCC-202 - Notice of Employee’s Injury or Illness. (to be completed by Employee)

5. WCC-203 - Employer’s Report of Occupational Injury or Illness. (to be completed by Employer)

6. WCC-204 - Employee Claim for Compensation. (to be completed by Employee)

7. WCC-205 - Authorization to Release Information. (to be completed by Employee)

8. WCC-206 - Notice by Employer to Controvert the Right to Compensation. (to be completed by Employer) if the employer or carrier believes the injury is not work-related and denies liability for compensation)

9. WCC-207 - Employer’s Supplementary Report of an Injury. (to be completed by Employer)

10. Employer’s Incident/Accident Report of the Injury
11. Copy of Illness Certification Slip from the Physician
12. Copy of approved Leave Application related to the injury
13. Copy of Time Attendance Record for the period of the Injury
14. Original medical claims.

1. WCC-200A	-	Authorization for Medical Examination and/or Treatment. (Employer will prepare the Authorization for medical treatment, to be given to the treating facility)
2. WCC-200B	-	Attending Physicians initial report of injury and treatment.
3. WCC-201	-	Physician’s Report for subsequent treatment
4. WCC-202	-	Notice of Employee’s Injury or Illness. (to be completed by Employee)
5. WCC-203	-	Employer’s Report of Occupational Injury or Illness. (to be completed by Employer)
6. WCC-204	-	Employee Claim for Compensation. (to be completed by Employee)
7. WCC-205	-	Authorization to Release Information. (to be completed by Employee)
8. WCC-206	-	Notice by Employer to Controvert the Right to Compensation. (to be completed by Employer) if the employer or carrier believes the injury is not work-related and denies liability for compensation)
9. WCC-207	-	Employer’s Supplementary Report of an Injury. (to be completed by Employer)
10. Employer’s Incident/Accident Report of the Injury 11. Copy of Illness Certification Slip from the Physician 12. Copy of approved Leave Application related to the injury 13. Copy of Time Attendance Record for the period of the Injury 14. Original medical claims.