The Incident Information section contains fields used to enter the basics of the filing:

•Incident City: The city where the incident occurred.

•Incident State: The state where the incident occurred.

•Date of Loss: The date when the incident occurred.

•Claim / Policy Number: The claim or policy number associated with the filing.

•Insured Type: Used to indicate if filing is regarding a Personal or Commercial policy.

•Insured First Name (if Type = Personal): The first name of the insured individual.

•Insured Last Name (if Type = Personal): The last name of the insured individual.

•Insured Company Name (if Type = Commercial): The name of the commercial insurer.

•Injured Party First Name (Med Pay, PIP, Special only): The first name of the injured party.

•Injured Party Last Name (Med Pay, PIP, Special only): The last name of the injured party.

•Injured Party Status (PIP only): Used to indicate the injured party's relationship to the incident - Driver, Occupant or Pedestrian.

•Line of Insurance (Special only): Used to indicate the line of insurance involved in the loss from the perspective of Company 2.

Incident Information Section

The Administrative Requests section contains fields used to indicate requests pertaining to the filing:

•Accept Policy Limits: Used to indicate if policy limits will be accepted as final claim settlement.

•Request Deferment: Used to request a one-year deferment of hearing.

•Deferment Justification (if Request Deferment = Yes): Used to enter justification for deferment request.

•Personal Rep at Hearing: Used to indicate if a representative will attend the hearing.

•Select All That Apply (if Personal Rep at Hearing = Yes): Used to indicate the role of the representative who will attend the hearing - Member Representative, Insured, Expert, Witness.

•Automatic Counter Response (Auto, Med Pay, PIP, Property, Special only):  Used to automatically answer a potential counterclaim associated with the filing should one be filed.

•Return Photos: Used to indicate if printed photos should be returned once a decision has been rendered.

•Administrative Request: Used to enter a request not covered by the other options.

Administrative Requests Section

Use the following steps to complete the Incident Information tab:

1.Enter the information requested in the Incident Information section. The requested info will vary depending upon the type of filing.

2.Select the desired requests in the Administrative Requests section and enter any additional information that may be requested.

3.Click the Contentions tab to proceed with the filing.

Incident Tab Completion Steps