PCI Instruction Summary
PRODUCT LIABILITY CLAIMS ASSIGNMENT FORM (UNITED STATES AND CANADA)
YOUR INFORMATION
Your Name:
Your Email Address:
Claim Information
Date Assigned:
Claim Handler:
File #:
Claimant Name:
Product:
Brand:
Model Number:
Serial Number:
Date of Loss:
Claim Amount:
Allegation:
Appraisal Only
PD/BI
BI
PD
Unknown
Contacts
Claimant
Attorney
Sears
Other
Instructions
Determine liability. Settle with customer and obtain signed release agreement if liable; do NOT settle if not liable-call claims handler for further instructions.
Determine actual damages, including depreciation.
Reach agreed amount with claimant.
Liability accepted-determine alleged damages and settle with customer.
INFORMATION NEEDED
Model Number:
Serial Number:
Date purchased, date installed, name of installer and where purchased.
Two estimates
One additional estimate
Complete address and phone number of claimant.
Alleged defective part for non-destructive testing.
Alleged defective product for non-destructive testing. Call claims handler for shipping label.
Copy of medical records and expenses.
All service orders on product.
Copy of fire department report.
Color photos of damages and product.
Special Instructions
