AMFAM TPA Update
1.Please provide the date, time, and by what source that you received first notice of loss:
Date: {formdate: MM/DD/YYYY; name=Date Received} Time: {formtext: name=Time Received; default=00:00 am pm}{if: `time received` = "00:00 am pm"}{error: Update Time Received; block=yes}{endif}
2. Please provide the date and time that you contacted the customer:
Date: {formdate: MM/DD/YYYY; name=Date Contacted} Time: {formtext: name=Time Contacted; default=00:00 am pm}{if: `time contacted` = "00:00 am pm"}{error: Update Contact Time; block=yes}{endif} Was this customer contact time within 1 hour AMF Service Level Agreement? {formmenu: default=Yes; No; name=Contacted with 1 hour} If not, explain why: {if: `contacted with 1 hour`}{else}Insured not reachable{endif}
3. Please provide the date and time of the on-site arrival time:
Date: {formdate: MM/DD/YYYY; name=Arrival Date} Time: {formtext: name=Arrival Time; default=00:00 am pm}{if: `arrival time` = "00:00 am pm"}{error: Update Arrival Time; block=yes}{endif} Was this within the required 4 hours? {formmenu: default=Yes; No; name=Arrival with 4 hours} If not, explain why: {if: `arrival with 4 hours`}{else}Services scheduled for later time.{endif}
4. Assigned AMFAM adjuster’s name: {formtext: name=Adjuster}{if: adjuster = ""}{error: Add Adjuster Name; block=yes}{endif}
5. Cause of loss/source: {formtext: name=Source of Loss}{if: `source of loss` = ""}{error: Add Source of Loss; block=yes}{endif}
6. Category of loss: {formmenu: Cat 1; default=Cat 2; Cat 3; name=Cat} - {formtext: name=Cause of loss} {if: `cause of loss` = ""} {error: Add Cause of Loss; block=yes} // {endif}{formmenu: default=Category 1 - "Category 1 water originates from a sanitary water source and does not pose substantial risk from dermal, ingestion, or inhalation exposure. Examples of Category 1 water sources can include, but are not limited to: broken water supply lines\; tub or sink overflows with no contaminants\; appliance malfunctions involving water-supply lines\; melting ice or snow\; falling rainwater\; broken toilet tanks, and toilet bowls that do not contain contaminants or additives." - IICRC S500: 2021 Section B. Definitions - Page 15 Category of water may be obtained by objective means of testing water contamination level such as ATP testing. Please reference supporting documents and notes regarding the determination of the category level.; Category 2 - "Category 2 water contains significant contamination and has the potential to cause discomfort or sickness if contacted or consumed by humans. Category 2 water can contain potentially unsafe levels of microorganisms or nutrients for microorganisms, as well as other organic or inorganic matter (chemical or biological). Examples of Category 2 water can include, but are not limited to: discharge from dishwashers or washing machines\; overflows from washing machines\; overflows from toilet bowls on the room side of the trap with some urine but no feces\; seepage due to hydrostatic pressure\; broken aquariums, and punctured water beds." - IICRC S500: 2021 Section B. Definitions - Page 16 Category upgrade due to dwell time or odor - Made at the determination of the professional expertise of the franchise. Category may be determined by objective means of testing water contamination level such as ATP testing. Please reference supporting documents and notes regarding the determination of the category level.; Category 3 - "Category 3 water is grossly contaminated and can contain pathogenic, toxigenic, or other harmful agents and can cause significant adverse reactions to humans if contacted or consumed. Examples of Category 3 water can include, but are not limited to: sewage\; wasteline backflows that originate from beyond any trap regardless of visible content or color\; all forms of flooding from seawater\; rising water from rivers or streams\; and other contaminated water entering or affecting the indoor environment, such as wind-driven rain from hurricanes, tropical storms, or other weather-related events. Category 3 water can carry trace levels of regulated or hazardous materials (e.g., pesticides or toxic organic substances)." - IICRC S500: 2021 Section B. Definitions - Page 16 Category upgrade due to dwell time, presence of microbial growth, or odor - Made at the determination of the professional expertise of the franchise. Objective means of testing water contamination level such as ATP testing. Please reference supporting documents and notes regarding the determination of the category level.; name=Category}
7. Class of loss: {formmenu: Class 1 - Less than 5% of chamber affected; default=Class 2 - 5% - 40% of chamber affected; Class 3 - More than 40% of chamber affected; Class 4 - Specialty Drying Situation; name=Class Explanation} // {formmenu: default=Class 1 - "(least amount of water absorption and evaporation load): Water intrusion where wet, porous materials (e.g., carpet, gypsum board, fiber-fill insulation, concrete masonry unit (CMU), textiles) represent less than ~5% of the combined floor, wall and ceiling surface area in the space\; and where materials described as low evaporation materials or assemblies have absorbed minimal moisture (see definitions for Class 4 and low evaporation assemblies)." - IICRC S500: 2021 Section B. Definitions - Page 16; Class 2 - "(significant amount of water absorption and evaporation load): water intrusion where wet, porous materials (e.g., carpet, gypsum board, fiber-fill insulation, concrete masonry unit (CMU), textiles) represent ~5% to ~40% of the combined floor, wall and ceiling surface area in the space\; and where materials described as low evaporation materials or assemblies have absorbed minimal moisture (see definitions for Class 4 and low evaporation assemblies)." - IICRC S500: 2021 Section B. Definitions - Page 16; Class 3 - "(greatest amount of water absorption and evaporation load): water intrusion where wet, porous materials (e.g., carpet, gypsum board, fiber-fill insulation, concrete masonry unit (CMU), textiles) represent more than ~40% of the combined floor, wall and ceiling surface area in the space\; and where materials described as low evaporation materials or assemblies have absorbed minimal moisture (see definitions for Class 4 and low evaporation assemblies)." - IICRC S500: 2021 Section B. Definitions - Pages 16-17Class 3 - "(greatest amount of water absorption and evaporation load): water intrusion where wet, porous materials (e.g., carpet, gypsum board, fiber-fill insulation, concrete masonry unit (CMU), textiles) represent more than ~40% of the combined floor, wall and ceiling surface area in the space\; and where materials described as low evaporation materials or assemblies have absorbed minimal moisture (see definitions for Class 4 and low evaporation assemblies)." - IICRC S500: 2021 Section B. Definitions - Pages 16-17; Class 4 - "(deeply held or bound water): water intrusion that involves a significant amount of water absorption into low evaporation materials (e.g., plaster, wood, concrete, masonry) or low evaporation assemblies (e.g., multilayer wallboard, multilayer subfloors, gym floors, or other complex, built-up assemblies). Drying may require special methods, longer drying times, or substantial water vapor pressure differentials." - IICRC S500: 2021 Section B. Definitions - Page 17; name=Class}
8. Was mold, asbestos, and/or lead paint found? {formmenu: Yes; default=No; name=Mold, Asbestos or Lead} If so, what did the adjuster advise: {if: `mold, asbestos or lead`}NA{endif}
9. What direction was given by the AMFAM claim adjuster/rep regarding the deductible: {formtext: name=Deductible; default=NA}
10. Room(s) affected: {formtext: name=Rooms Affected; cols=200; trim=yes}{if: `rooms affected` = ""}{error: List All Affected Rooms; block=yes}{endif}
11. Flooring type(s) affected: {formmenu: default=Carpet; Vinyl; Laminate; Tile; Hardwood; name=Flooring; multiple=yes}
12. Is flooring salvageable? {formmenu: Yes; default=No; name=Flooring Salvageable}
13. Was the ITEL sample sent directly to ITEL per program guidelines: {formmenu: default=Yes; No; name=ITEL}
14. If not, what were the adjuster’s directions? {if: itel}{else}Samples left on site{endif}
15. Number of air movers and dehumidifiers placed: {formtext: name=Equipment; default=00 airmovers / 00 dehus}{if: equipment = "00 airmovers / 00 dehus"}{error: Add equipment totals; block=yes}{endif}
16. Specialty drying equipment (if applicable): {formmenu: default=NA; Airscrubber; Wood Floor Drying System; Wall Cavity Drying System; Heat Drying; Portable Furnace; Dessicant Dehu; name=Specialty Equipment; multiple=yes}
17. Description of demo work (if applicable): {formmenu: default=NA; Removal of all moisture binding and damaged materials in order to dry substructure; Removal of all affected materials due to category of water; name=Demo}
18. Is there evidence of subrogation? {formmenu: Yes; default=No; name=Subrogation} Explain: {if: subrogation}There is evidence of subrogation. See file notes for details related to subrogation opportunity.{else}No evidence of subrogation{endif}
19. Was the adjuster notified that the loss will exceed 4 days to dry: {formmenu: default=Yes; No; name=4 Day Notification}
20. Estimated date of job completion: {formdate: MM/DD/YYYY; name=Completion Date}
21. Mitigation estimate total: {formtext: name=Mit Estimate; default=$; trim=yes}{if: `mit estimate` = "$"}{error: This field is required; block=yes}{endif}
22. If over the $3,000 threshold ($1500 sewer and drain/sump pump/townhouse/condo), was the adjuster notified: {formmenu: default=Yes; NA; name=Monetary Threshold}
23. Additional details (as applicable): {formtext: name=Additional Details; default=NA; cols=200}