RECORDED STATEMENT 2017 -1

RECORDED STATEMENT
GUIDE

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Table of Contents 2
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Table of Contents 4
Claims Handling Guidelines 2-04 Investigation 5
Recorded Statement
Preparing for a Statement 6-7
Components of a Statement 8
Helpful, Hints, Tips & Techniques 9
Flow Chart 10-11
General Recorded Statement Guide
Liability Questions 12-15
Coverage Questions 16-20
Witness 21-22

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Claims Handling Guidelines

2-04: Investigation
It is the responsibility of the claim professional to complete a full, fair, timely and objective
investigation of the claim, commensurate with the complexity of the matter, sufficient to bring the
claim to a prompt and fair resolution, consistent with our duty of good faith to our insured.
It is expected that the claim professional will demonstrate proactive handling and sound judgment
with respect to the nature and extent of the investigation conducted in proportion to the potential
exposure to the insured and as applicable, to the company. Coverage, liability and damages should
be investigated concurrently.
Consistent with the duties that guide appropriate investigations for the situation, it is important to
recognize the point at which an investigation needs to be concluded to establish that coverage is in
order or not, to determine liability or evaluate damages so that efforts can be focused upon the
timely conclusion of the claim. The claim professional shall consider the expectations for the
timeliness of concluding investigations as set forth in the Fair Claims Practices Acts and other similar
laws of the applicable state.
Often times, factual versus legal issues will have a significant impact on the final conclusions and
recommendations arising out of coverage, liability and damages investigations. Therefore, the claim
professional shall clearly and succinctly set forth the facts revealed during the investigation and the
conclusions that support the final decisions.

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Recorded Statements

One of the most important tools in a coverage or liability investigation are thorough, detailed,
and precise recorded statements of all involved parties, (e.g. this may include drivers,
passengers, witnesses, insureds, household members, agents). Recorded statements are
encouraged to be taken during the claim professional’s first contact with those who have
material information regarding an accident or loss. They should be considered in the following
situations:

• Coverage issues where the insured or their representative is disputing coverage; o In MMR
investigations, if there are factual issues in dispute, statements of insureds and the agent;

• Comparative negligence potential/questionable liability/no liability where it appears that the
claim will not be able to be resolved on a first call settlement;

• When parties to an accident allege injuries, other than just soft tissue injuries;

• Where the claim may be suspicious;
• Vehicle fires and thefts;
• Where injury claims are being presented and injuries or treatment appear
inconsistent, or treatment or providers appear suspicious;

• Subrogation potential;
• If an adverse carrier disputes liability;
• To allow pursuit of a claim against a manufacturer for a vehicle or other property or
system defect.

If there is any doubt as to whether a statement is necessary, err on the side of taking the
statement. After taking the statement, review it to ensure that it is audible and confirm that the
appropriate permissions were obtained. Where a statement is not necessary, a discussion
should still occur, addressing the pertinent issues regarding the facts, coverage, liability and
damages.

As discussed elsewhere in these Claims Handling Guidelines, whether a recorded statement or a
discussion occurs, a concise summary should be set forth in the file notes.

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Preparing For the Recorded Statement

•Know what the coverage, liability, damages and other issues are before taking the statement.
• Review the file (file notes, police report, scene investigation, other statements, etc.)
• Diagram/illustrate the loss before taking the statement to avoid digressing from pertinent
facts.
• The illustration should serve as a visual cue in extracting accurate information from the
statement giver. Prepare additional questions as necessary.
• Use open-ended questions. o An effective technique is to ask the person, “Tell me what
happened in the accident.” The person will give an unfiltered version. Take notes and when
s/he is finished, ask appropriate follow-up questions to obtain the necessary detail.
o Focus the questions on the evidence of duties owed and duties breached. The questions
should be of the type set forth in ClaimIQ.
• Identify the issues to be determined.
• Ensure the recording equipment is functional.

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Components of a Statement

Before:

 5 P’s – Prior preparation prevents poor performance
1. Thoroughly review claim file contents (e.g. loss facts, location, vehicles,
parties, policy information, coverage flags, claim notes). Take notes or jot
down questions to remember to ask in recorded statement.
2. Ask preliminary questions to have a better understanding of the claim (e.g.
type of loss, location).
3. Confirm the interviewee has the necessary documentation to assist with the
statement process (e.g. driver’s license, vehicle, relevant party, police report,
other insurance information, ect.) Or ask them to get it before you start.

 Establish rapport
1. Introduce yourself
2. Address customer by name using the appropriate salutation (e.g. Mr., Mrs.,
ect.)
3. Be genuine and friendly, but professional
4. Try to establish trust – you’re going to give them the opportunity to tell what
they saw or did “unfiltered” and in their own words during the interview.
Remember this is their statement let them answer the questions.
5. Find common ground, when appropriate

 Be empathetic
1. Demonstrate empathy, care and concern appropriately

 Be informative
1. Explain what you are doing and why
2. Explain what you are trying to accomplish – “genuinely trying to understand
what actually happened” don’t assume

 Be the expert
1. Most people have never been involved in an accident before and they may be
apprehensive
2. Hold their hand and walk them through the process

During

 Listen effectively
1. Be silent after you ask a question – people may hesitate when they’re
thinking
2. Listen to the customer and, where needed ask appropriate follow-up
questions – do not interrupt them
3. Avoid typing when the interviewee is providing their version of the loss facts.
The Recorded Statement Guide is not a form to be completed – “in the
conversation”

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4. Consider taking notes rather than typing this will aid you in listening and
ease your ability in asking follow-up questions

 Control the conversation
1. Be prepared for interruptions
2. Show flexibility but don’t hesitate to re-direct and manage the call if the
conversation get too far off task

 Ask the questions, the right way
1. Open-ended questions to encourage a full, meaningful answer
2. Avoid leading questions that may lead the interviewee in how they are to
answer
3. Closed-ended questions to elicit short or one-word answers which effective
for clarifying facts
4. Don’t assume – if you do not know something or there is confusion, ask again
5. Summarize the statement to make sure what you heard is correct
6. Ask the customer if there is anything additional they want to add

After

 Educated the customer
1. Claim Status
2. Claim process
3. Coverage
4. Liability
5. Inspection process
6. Total loss process if applicable

 Set Expectations
1. Communication (e-mail, phone, text messages, letter)
2. Set expectations that are reasonable & time bond
3. Always meet or exceed the set expectations
4. Ask if the customer has any questions to assure all issues or concerns are
addressed
5. Make sure the customer has your contact info & work hours

 Preserve evidence
1. Immediately label the recorded statement
2. Summarize the recorded statement in the notes immediately

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Helpful Hints, Tips & Techniques

 Considerations
1. Stay Neutral
2. Don’t rush to judgement
3. Don’t have an “attitude”
4. Don’t interrupt
5. Don’t interrogate

 Build Rapport
1. Be adaptable – use experiences to build rapport o that they feel that you are
putting yourself in their shoes
2. Allow them to “get it all out” – When they are angry, allow them to vent without
interruption (use this time to assess what’s really driving their anger to see if it
can be resolved)
3. Repeat back – repeat sentences or important details back to reassure them that
you are paying attention while keeping them engaged in the process
4. Be respectful – talk to them with respect and common language – avoid using
insurance jargon or abbreviations

 Ways to show empathy
1. We’re glad you were alright
2. An auto insurance claim isn’t something that anyone wants to have
3. We’ll try to make this process as quick & efficient as we can
4. We’re really looking forward to having you tell us what happened

 Five W’s & one H
1. Who – “was involved in the accident” – “witnessed the accident” – “was injured”
2. What – “was the weather like” – “color was your traffic light” – “did you see”
3. When – “did the accident occur” – “did you leave your house” – “Did you put
your turn signal on”
4. Where – “were you going at the time of the accident” – “did the ambulance take
you”
5. Why – “were you using the vehicle that day” – “did you let (driver name) driver
the vehicle”
6. How – “did the accident occur” – “many times have you driven the vehicle before
this accident”

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Flow Chart

INTRODUCTION

1. Time & date
2. Permission

IDENTIFYING INFORMATION

1. State name & spell last name
2. Address & phone #
3. Date of birth
4. Social security #

5. Marital status & Spouses name
6. Employment info
7. Driver’s license #

LOSS INFORMATION

1. Vehicle information
2. Purpose of the Trip
3. Seat belt on or off
4. Speed limit in the area

5. Speed traveling
6. Location of the accident
7. How many lanes each direction
8. Which street and lane were you in
9. What happened in the accident

10. Injuries
11. Loss of income
12. Anything else you want to add

CONCLUSION

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General Recorded Statement

Introduction

This is ___(your first & last name)_____ speaking with __________ on __(date)___ at __(time)___.
Mrs./Mr. ______ can you state your full name and spell your last __________. Do I have our permission
to record our conversation? _______ And you know I am recording our conversation? ________

Identifying Information

What is your home address? _____________ Mailing address?_____
What is your phone # ?___________ home, work or cell?
What is your date of birth?
What is your social security number?
What is your marital status? ______ What is your wife/husband’s name?_____
What is your occupation? ________ For whom do you work for?______
What is your driver’s license number? _________ Are there any restrictions on your license? _(like
corrective lenses)___

Alabama Guest /Passenger

Who invited the guest/initiated the ride? _______________________________________________
What is relationship between parties?__________________________________________________
Social? Business ? Both? _____________________________________________________________
What was purpose of trip?____________________________________________________________
Distance? Stops? Was focus of trip social or business? _____________________________________
Trip made under what terms/agreements, if any? _________________________________________
Who paid for trip? Other tangible benefits to driver? ______________________________________
Have there been prior trips between parties? ____________________________________________
1st trip together? 2nd trip? Regular trips? Prior patterns/practices? ____________________________
Did guest “protest” driver’s operating abilities during ride? __________________________________
After accident, what is guest’s opinion about driver’s operating ability now? ____________________

Vehicle Information

What is the year make and model of the vehicle you were driving?
What is the license plate #? ______ What state is it licensed in?___ What is the VIN #? ___
Who is the owner of the vehicle? _________ What is the owners address? ____ What is the owners
phone #?___
Did your vehicle have to be towed? _____ By who? _____

Other drivers(s) Information

What was the other drivers name? ______ Address & phone #?
What kind of vehicle were they driving (year, make, model) ?
What color was the vehicle? ___ What was the license plate?
Who owns the vehicle? ____________ Address & phone#? __
Did the vehicle have to be towed? ____ by who? ____

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Did the other driver have any passengers?________ Any Car Seats?

Accident Information

When did the accident occur? ______ What time?____ am/pm What was the weather like?_____
Were the roads wet or dry? _______
Were there any obstructions?_________
What was the Purpose of your trip? _____(where were you going or coming from)____
Did you have any passengers?_________ What are the name(s) of the passengers?______ Address &
phone #(s) ____________
Did you have your seatbelt on or off? _______ Did your passengers? _____ Any car seats?____
Were there any witnesses outside the vehicles involved? _____ Name, address or phone #

What was the location of the accident? _____ How many lanes in each direction? ____
What lane were you in?
Where was the other vehicle? ____ What lane were they in? _____
What was the posted speed limit in that area? _______ How fast were you going? ______

Statement

In your own words tell me what happened in the accident?
_____________________________________________________________________________________
_____________________________________________________________________________________
What was the POI to your car? ______ What was the POI to the other car?_____
When did you first notice the other car?
Where did your car come to rest? _____ Where did the other car come to rest? ___

(re-cap what has been stated to you to make sure you have the facts correct)

Injuries

Were there anyone injured in the accident and who? ______ What were your injuries?___
Were you taken by ambulance? _____ What hospital or doctor’s office did you go to?
What did they diagnosis you with? ______ What kind of treatment did you received?
Did you or are you going to received treatment anywhere else? ____ doctors name?
Are you loosing time from work? ____ Did the doctor take you off of work? ___ how long?

Have you had any pre-existing injuries? __(other MVA’s or Sports injuries)____ If so what kind?

Closing

Is there anything else you would like to add that we have not gone over?
Have I had your permission to record our conversation?
Was the recording made with your permission?
Today is ______________ it’s approximately _____________ I am going to turn the recorder off with
your permission.

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Liability Questions

Rear Ending Vehicle
1. Did the other vehicle have their turn signal on? If so, which one?
2. Did the other vehicle have brake lights? Where they on?
3. Did the other vehicle make a sudden stop? If so, describe?
4. Did the other vehicle cut in front of you? If so, describe?
5. Where were they at in relationship to you when they made the change or direction?
6. How many lanes did they cross before the impact occurred?

Rear Ended Vehicle
1. To the best of your knowledge, did your brake lights work properly?
2. Were your brakes applied at impact? If so, why?
3. Did you have a turn signal on? If so, which one?
4. Did you make a sudden stop? If so, why?
5. Did you change lanes in front of the other vehicle?
6. Did you cut the other vehicle off?

Backing Vehicle
1. Were there vehicles parked next to you? If so, describe the vehicles and where they
were in relationship to you?
2. Did these vehicle(s) obstruct either driver’s vision from seeing each other? If so,
describe how.
3. Were there any other obstructions to either driver’s vision of seeing each other?
4. How many vehicles passed before you started backing?
5. Did you turn around to look behind you? If so, describe how and what you did?
6. Did you use any mirrors? If so, describe which mirrors?
7. At the time of the impact, which direction were you looking?
8. At the time of the impact, where was your vehicle in relationship to when you started to
back? (e.g. relation to parking space)
9. From the time you started to back, how much time passed until the impact occurred?

Vehicle Moving Forward
1. When did you first see the vehicle backing? Where was it?
2. How far was the backing vehicle from you? (e.g. Distance, car lengths, land marks, ect.)
3. What was the position of your vehicle?
4. What was the position of their vehicle?
5. Did you see the other vehicle brake/backing lights? If so, when? Where were you in
relationship to the vehicle? How far away?
6. Were there any obstructions to your vision of seeing the other vehicle? If so, describe?
7. Were there any obstructions to the vision of the other driver from seeing you? If so,
describe?
8. Did you attempt to alert the other driver? If so, how? (e.g. honk, flash lights)

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Liability Questions – continued

Uncontrolled Intersection
1. Did you have a turn signal on? If so, which one?
2. Did the other vehicle have a turn signal on? If so, which one?
3. What was your speed as you approached the intersection?
4. What was your speed as you entered the intersection?
5. What was your intention when you entered the intersection? Going straight? Turning?
Describe?
6. Did you ever top before you entered the intersection? If so, how long were you stopped
before you proceeded?
7. How many lanes did you cross before the impact occurred?
8. How many lanes did they cross before the impact occurred?
9. Who had the right of way? Why?
10. Who entered the intersection first?

Controlled Intersection with Traffic Light
1. How far were you from the intersection when you first saw the traffic light?
2. What color was the traffic signal at that time? What type of signal was it?
3. How fast were you going as you approached the intersection?
4. Did you ever stop for the traffic light?
5. How long were you stopped at the light?
6. If stopped at red light, what did you do when the light changed to green?
7. How long did you wait until you proceeded?
8. Who entered the intersection first?
9. What were your intentions when you entered the intersection? (e.g. turning, straight,
ect.)
10. If turning, did you have your turn signal on? If so, which one?
11. How fast were you going when you entered the intersection?
12. Did the other vehicle have a turning signal on? If so which one?
13. How many lanes did you cross before he impact occurred?
14. How many lanes did they cross before the impact occurred?
15. Who had the right of way?

Controlled Intersection with Stop Sign
1. Where in relationship to the intersection were you when you saw the other vehicle?
2. Did you have a stop sign?
3. Did the other vehicle have a stop sign?
4. Who entered the intersection first?
5. Who had the right of way?

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Liability Questions – Continued

Vehicle Entering Roadway
1. Were you backing or moving forward?
2. Where were you entering the roadway from? (e.g. private drive, public area, ect.)
3. Did you have a traffic control device where you were entering from? If so, describe?
4. Did your lights work? (e.g. Headlights, backup lights)
5. Did you stop before you entered the roadway? If so how long?
6. Did you ever see the other vehicle? If so, describe?
7. How much time passed between the point that you started to enter the roadway to the
time of impact?
8. What distance did you travel up to the point of impact? (e.g. distance, car lengths, lanes
ect.)
9. Who controlled the lane? Why?
10. Who had the right of way? Why

Vehicle with Right of Way – Turning Loss
1. Was their turn signal on? If so, what one?
2. How far from the vehicle were you when they began to turn?
3. What speed were you traveling when the vehicle began to turn?
4. What did you do when you saw the vehicle begin to turn?
5. Who entered the intersection first?
6. Who had the right of way?
7. How much time passed from the moment the vehicle began turning to the time of
impact?
8. How many lanes did you cross before the impact occurred?
9. How many lanes did they cross before the impact occurred?
10. Did you ever stop for the traffic light? If so, how long were you stopped before
proceeded into the intersection?
11. What were intentions when you entered the intersection? (e.g. turning, straight, ect.)
12. If turning, did you have your turn signal on? If so, what one?

Turning Vehicle
1. When did you first see the vehicle? (e.g. Distance, car lengths, land marks, ect.)
2. How far were you from it?
3. What position was the vehicle in?
4. Was there turn signal on? If so, which one?
5. How far from the vehicle were you when you began to turn?
6. What direction were you turning?
7. Was your turn signal on? If so, what one?
8. What speed were you traveling when you began to turn?
9. What did you do when you saw the other vehicle continuing?
10. Who entered the intersection first?

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Liability – Continued

11. Who had the right of way?
12. How much time passed from the moment you began turning to the time of impact?
13. How many lanes did you cross before the impact occurred?
14. How many lanes did they cross before the impact occurred?
15. How fast was the other car going?
16. Did you ever stop for the traffic light? If so, how long were you stopped before

proceeding?

Passing Vehicle
1. When did you first see the other vehicle? (e.g. Distance, car lengths, land marks, ect.)
2. How far were you from it?
3. What position was the other vehicle in?
4. Was the other vehicle’s turn signal on? If so, what one?
5. Why did you decide to pass?
6. How far from the other vehicle were you when you began to pass?
7. Did you signal? If so, how? Turn signal? Honk your horn? Flash you lights?
8. What speed were you traveling when you began to pass?
9. How fast was the other vehicle going?
10. Was it legal to pass in this area of the roadway?
11. Did any other vehicle pass in front of you or behind you?
12. How fast were you going as you were passing the other vehicle?
13. How much time passed from the moments you began to pass to the time of the impact?

Vehicle Being Passed
1. Did you see the passing vehicle? (e.g. Distance, car lengths, land marks, ect)
2. What position was the other vehicle in at first sight? (e.g. Behind, passing, ect.)
3. What was the distance from the passing vehicle at first sight?
4. What was the speed of the passing vehicle at first sight?
5. How fast were you traveling before being passed?
6. Did you see or hear the other driver’s intent to pass?
7. Was it legal to pass in this area of the roadway?
8. How far from the other vehicle were you when they began to pass?
9. What were your intentions? (e.g. Straight, turning, stopped/stopping, ect.)
10. Did you have a turn signal on? If so, which one?
11. Did any other vehicle pass in front of you or behind you?
12. How fast were you going as the other vehicle attempted to pass?
13. How much time passed from the moment you first saw the other vehicle until impact?

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Coverage Question

PERMISSIVE USE/LAWFUL POSSESSION

Questions for the Insured

 How was permission given?
 Was it expressly given?
 Was it implied?
 What was the purpose of loaning the vehicle?
 Had they ever asked to use the vehicle before? What was the outcome of that scenario?
 Was there a time frame given that the vehicle had to be returned?
 How did they come in possession of the keys?
 Did they advise the person not to loan vehicle to a third party?
 Was a theft report filed?

Questions for the User of the vehicle

 How was permission given?
 Have you ever used or borrowed the car before?
 Was it expressly given?
 Was it implied?
 Had you ever used or asked to use the vehicle prior?
 What were you told by the insured?
 Do you have a valid license? (Secure this information)
 Do you live in the insured’s household?
 If no, what is your relationship to the insured?
 Do you have a set of keys? How did you come in possession of them?
 If permission was given, was there a time frame given as to when the vehicle had to be

returned?
 Were you advised not to loan the vehicle to anyone else?

VEHICLE NOT LISTED ON POLICY AT TIME OF ACCIDENT

(Questions for the Insured)

 When did you purchase the vehicle?
 Where did you purchase the vehicle?
 From whom did you purchase the vehicle?
 Do you have a bill of sale? Copy of title?

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 Is the new vehicle a replacement or additional vehicle?
 If replacement, which vehicle are you replacing?
 What coverage(s) are to be added for the new vehicle?
 Is there a lienholder?
 Did you contact your agent? Company?
 Did they complete the endorsement in person or in phone
 If in person, did they inspect the vehicle?
 Did the dealership advise they would handle contact?

(Questions for the agent)

 Was the loss reported to the agent?
 Was an endorsement written on the new vehicle?
 Who took endorsement?
 Who requested the change? Date? Time? By phone or in person?
 Was it a replacement or additional vehicle?
 What is the effective date of the endorsement?
 Was the vehicle inspected?

COVERAGE INVESTIGATION – NEW APP; NO $ RECEIVED

(Questions for the Insured)

 When was the coverage requested? In person or by phone?
 Was money paid? How much? Cash or check? Request copy of check
 Did agent give a receipt?
 Who was your last carrier?
 Last agent?
 Why a change of insurance carriers?
 Did agent inspect vehicle?

(Questions for the Agent) Secure if facts are questionable

 Who took the application?
 Who requested coverage? Insured? Lienholder? Dealership?
 Was coverage taken out in person or by phone? If in person, what day and time was

application signed?
 What types of coverage were requested?
 Was money paid? How much? Cash or check? Was a receipt given? If not, why?
 Was premium financed? With whom?
 If physical damage coverage, was vehicle inspected?
 Was insured or agency check sent? When?
 Did the insured report the loss
 Is this new business for the agent? Who was the insured previously insured with?

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MATERIAL MISREPRESENTATION

(Unlisted driver investigation)

Questions for the named insured

 How long have you resided at this address?
 Who resides in the household with you? What are their names and ages?
 How long have each of them resided in your household?
 Please give me your previous address? How long have you resided at your present address?
 What is your relation to ____________ UD/UL?
 How long have you known ______________ UD/UL?
 Has this person ever lived in your household?
 If yes, when and how long?
 Did the UD/UL have permission to drive the vehicle in the loss?
 Who gave the UD/UL permission?
 Does this person have a valid driver’s license?
 If no, why was the vehicle given?
 What was the nature of the trip?
 Who is the titled owner of the vehicle?
 How many times has this person driven the vehicle?
 Do they have a set of keys to this or any of your vehicles? Who has possession of keys to the

vehicle, where are they located in the home?

 Do they have a vehicle of their own
 Why were they driving your vehicle?
 Have they ever driven any of your vehicles in the past?
 How many times? For what purpose?

If the UD/UL resides in the insured’s household, proceed with the following questions.

 Did the insured call in or go in person to secure the application?
 If by phone, where did the insured call from?
 Does agent know relatives of insured?
 Why were they not listed?
 If insured went into agent’s office, was the insured alone? If no, who went with insured?
 When is effective date of the application?
 Did agent complete application for the insured?
 If no, did insured complete application himself?
 Did agent review entire application with insured?
 Before or after application was completed?

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 Before or after insured application?
 Did the agent discuss the section regarding listed drivers and household members with

insured?
 If yes, what was discussed?
 Did agent ask if anyone resided in insured’s household other than driver’s listed?
 If yes, what was insured’s response?
 Did insured mention other household members at any time before or during the application?
 If yes, when?
 What was discussed?
 Did agent have any reason to know there were additional household members that insured

failed to list on the application?
 If yes, ask insured to explain.

Recorded Statement from the Agent

 Was the insured a new customer or previous customer?
 Did the agent know the insured prior to application?
 How long has the agent known insured?
 Did agent discuss insurance/premium/quotes, etc. with insured prior to date of application?
 If yes, when? What was discussed?
 Did insured call by phone or come in person?
 If by phone, where was the insured calling from?
 When did the insured sign application? If after effective date, why did agent allow this?
 How did insured pay?
 Does agent know relatives of insured?
 Do any of them reside in the insured’s household?
 What are their names and ages?
 Are they listed on the application?
 If no, who is not listed?
 Why were they not listed?
 If the insured came into agent’s office, was the insured by himself?
 If not, who came with insured?
 Did insured transfer from another carrier?
 Name, address and phone # of carrier
 How long was insured with previous carrier?
 Who is listed on previous carrier’s application? Dec pages?
 Who is excluded?
 Who are the listed driver’s on the application? Dec pages?
 What is agent’s standard procedure when completing new applications?
 Was this procedure followed with this insured?
 Did agent complete application for insured?
 If yes, did agent read all of the questions to the insured?
 If no, have agent explain.

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 Did insured complete application himself?
 Did agent review entire application with insured?
 Before or after application was completed and signed?
 To agent’s knowledge, at the time of app how many people resided in the insured’s

household?
 Does agent normally discuss section regarding listed drivers/household members with

applicants?
 If yes, how did agent explain this section?
 Did agent ask if anyone resided in insured’s household other than driver’s listed?
 If yes, what was agent’s response?
 If no, why didn’t agent ask?
 Did insured mention other household members at any time before or after the application?
 If yes, when?
 What was discussed?
 Did agent have any reason to know there were additional household members that insured

failed to list on the application?
 If yes, ask agent to explain.

Recorded statement of the UL/UD

 Did you have permission to drive the vehicle involved in the loss
 Who gave you permission
 If no valid license, why did insured give you permission to drive?
 What is your present address?
 How long have resided at this address?
 Please give me your previous address. How long at that address?
 What is your relation to the N/I?
 How long have you known the N/I?
 Have you ever lived in the same household as the N/I?
 If yes, please state exact dates. Get as specific information as possible.
 Describe the vehicle you were driving at the time of the loss
 Who is the titled owner of the vehicle?
 What was the nature of your trip?
 Why were you driving the vehicle?
 How many times have you driven the vehicle before?
 Do you have your own set of keys to any of our insured’s vehicles? If yes, which one(s)
 Do you own a vehicle? If yes, describe.
 Do you have insurance on any vehicle you own? If yes, get carrier, policy number and phone

number.
 Are you listed on anyone’s insurance policy? If yes, get same as above.
 If you own a vehicle, why were you driving N/I’s vehicle?
 Have you ever driven any of N/I’s vehicles in the past?
 If yes, describe the vehicle(s). When did you drive them.
 How many times? For what purpose?

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WITNESS

Introduction:

Good morning/afternoon, this is _______________ and I am speaking with ____________ at
phone #___________ who is the owner/operator of a __________ who witnessed a motor
vehicle accident on ________________. Today’s date is _________ and the time is
approximately _____________.
Mr./Mrs. _____________, do you realize this interview is being recorded? Is it being recorded
with your permission?

Identification/Background:

 Full name
 Address
 Phone #
 Date of birth

Location/Accident Scene:

 Date, time and place of accident
 Weather and road conditions
 Visibility/obstructions
 Light conditions
 Description of location/scene (# of lanes, etc)
 Traffic control devices
 Traffic conditions (heavy or light)
 Speed going vs. speed limit
 Compass directions
 Curved, hilly, straight road
 Driver familiar with area
 When did you first notice vehicles
 Have them describe, with as much detail, everything they witnessed before during and after

the accident
Is the witness independent of all parties involved?
Where was the witness positioned or located at the time of the accident?
Describe the cars seen and how many parties in each vehicle?
Post accident:

 Damage to vehicles
 Location of debris
 Res Gestae (anything they heard from either party)
 Did police investigate? Who called police? Did they speak to police? If no, why not? Who

appeared to be liable for the loss? Why?

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 Any injuries?
General Questions:
 Did they know either party
 Do you wear glasses?hearing aid?
 If applicable, was there any alcohol involved
Closing:
Mr./Ms. _____________, do you have any additional information about the accident that you
would like to add at this time?
Has all of the information that you have given been true and correct to the best of your
knowledge?
Do you understand that this interview has been recorded?
Has it been recorded with your permission?
The time now is _______________, do I have your permission to turn off the recorder?

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