VictimsGuide.com Forms Section
Colorado Auto Insurance Disclosure Request Forms and Compliance Support
These forms help an injured person document notice of claim, request complete auto policy disclosure, and create a clean written record for UM/UIM review, attorney review, or later compliance enforcement.
“The first step is a voluntary expedited request to the claims representative. The purpose is practical cooperation: identify available coverage quickly so the claimant can make informed medical, settlement, and UM/UIM decisions.”
If voluntary cooperation does not produce complete disclosure, the claimant may serve a formal C.R.S. § 10-3-1117 request on the insurer’s registered agent.
5 days: voluntary cooperation
30 days: formal statutory request
What the Request Is Designed to Obtain
- Insurer name and exact underwriting company.
- Each insured party as shown on the declarations page or policy records.
- Liability limits and policy period.
- Actual policy forms, endorsements, amendments, and exclusions.
- Umbrella, excess, commercial, employer, business-use, or additional-insured coverage.
- “Coverage position: accepted, denied, reserved, or under investigation.”
VictimsGuide does not request premium pricing, underwriting inputs, consumer scoring, rating factors, pricing strategy, discount structure, or other confidential underwriting data.
That information is not needed to adjust or resolve a bodily injury claim. The purpose of this process is to identify coverage, policy structure, policy limits, insured parties, policy forms, endorsements, exclusions, and the insurer’s coverage position. By excluding premium and pricing data, the request stays focused on claim-relevant information and avoids creating unnecessary confidentiality disputes.
Why a Claimant Can Ask
A claimant is a person who has provided notice to an insurer of a potential claim. A crash report, insurance card details from the crash scene, claim number, adjuster correspondence, or written claim notice can help show that the request is being made by a proper claimant.
“Best practice:”
include a copy of the crash report if available, or provide insurance card details, claim number, driver information, vehicle information, and the date notice was first given to the insurer.
How to Use These Forms
Confirm notice of claim
“Document how the insurer received notice: phone, email, U.S. Mail, claim portal, insurance card report, or other written notice.”
Send the voluntary expedited request
Ask the claims department to cooperate within five calendar days. This is not formal statutory service and does not replace service on the registered agent if formal enforcement becomes necessary.
Use the structured insurer response form
The response form asks the insurer to identify policy structure, limits, insureds, endorsements, exclusions, umbrella or excess coverage, and whether coverage is accepted, denied, reserved, or still under investigation.
Serve the formal request if voluntary disclosure is incomplete
A formal C.R.S. § 10-3-1117 request should be sent to the insurer’s registered agent. The 30-day response period applies to the formal request, not the voluntary cooperation letter.
Forward the response to the claimant’s insurer
The claimant may consent to delivery of the disclosure to the claimant’s own insurer for UM/UIM review and coordinated coverage evaluation.
This directory is a convenience tool only. The correct registered agent depends on the exact legal underwriting company, not just the brand name. Before formal service, verify the exact insurer, NAIC number, and registered agent against Colorado DOI or Colorado Secretary of State records.
Rank Carrier / Group NAIC Code Claims Contact Registered Agent / Service Note
1 State Farm 25178 800-732-5246 Typically CT Corporation System; verify exact underwriting entity.
2 Liberty Mutual 23043 800-225-2467 CT Corporation System, Denver, CO; verify exact underwriting entity.
3 USAA 25968 800-531-8722 CT Corporation System may vary by underwriting entity; verify before service.
4 Progressive 24260 800-776-4737 Corporation Service Company (CSC), Denver, CO; verify exact underwriting entity.
5 Allstate 37907 800-255-7828 CT Corporation System, Denver, CO; verify exact underwriting entity.
6 Farmers Insurance Group 21652 800-435-7764 CT Corporation System, Denver, CO; verify exact underwriting entity.
7 Travelers 41769 800-252-4633 Corporation Service Company (CSC), Denver, CO; verify exact underwriting entity.
8 American Family Insurance 19275 800-692-6326 CT Corporation System, Denver, CO; verify exact underwriting entity.
9 GEICO 41491 800-841-3000 Corporation Service Company (CSC), Denver, CO; verify exact underwriting entity.
10 Nationwide 23787 / 25453 800-421-3535 CT Corporation System, Denver, CO; verify exact underwriting entity.
11 Chubb 12777 800-252-4670 CT Corporation System, Denver, CO; verify exact underwriting entity.
12 Auto-Owners Insurance 18988 800-346-0346 Corporation Service Company (CSC), Denver, CO; verify exact underwriting entity.
13 The Hartford 19682 800-243-5860 CT Corporation System, Denver, CO; verify exact underwriting entity.
14 CSAA Insurance Group / AAA 10921 800-922-8228 CT Corporation System, Denver, CO; verify exact underwriting entity.
15 Sentry Insurance 24988 800-473-6879 Corporation Service Company (CSC), Denver, CO; verify exact underwriting entity.
“Directory note: carrier groups often write policies through multiple legal entities. Always use the underwriting company shown on the declarations page, insurance card, claim correspondence, or DOI company lookup before formal registered-agent service.”
Confidentiality and Research Use
Claim-specific policy disclosures should be handled carefully. VictimsGuide’s research objective is to study coverage gaps, response delays, incomplete disclosures, and insurer practices using de-identified and aggregated data.
No claimant names, insured names, claim numbers, addresses, VINs, or identifying claim details should be published without separate written authorization and legal review.
Forms and Compliance Support
Use the forms below to prepare a voluntary request, a formal statutory request, and a structured insurer response form. Claimants who want administrative help can submit intake information, upload documents, and purchase the non-legal compliance support service.
Form 1
Initial Contact Letter & Voluntary Request for Insurance Disclosure and Coverage Confirmation
“Purpose:”
This letter confirms prior notice of claim and asks the claims department to voluntarily provide complete policy and coverage information within five calendar days. This is not formal registered-agent service.
Letter Header
Date
Insurance Company Name
Claims Department / Adjuster
Address / Email
Claim Information
Claimant Name
Date of Loss
Insured / At-Fault Driver
Claim Number, if known
Prior Notice of Claim
“This correspondence confirms that prior notice of claim and loss was provided by:”
Telephone
U.S. Mail
Online claim portal
Other written notice
Date Prior Notice Was Provided
Person / Department Notified
Voluntary Disclosure Request
The claimant requests voluntary, expedited disclosure of all insurance information reasonably necessary to evaluate available coverage, financial responsibility, and potential UM/UIM rights.
“The claimant requests disclosure of:”
- Complete policy forms, declarations information, endorsements, and amendments.
- Identification of all applicable coverages, including auto, umbrella, excess, commercial, employer, business-use, and additional-insured coverage.
- Coverage limits and applicable policy periods.
- “Confirmation of the insurer’s coverage position: accepted, denied, reserved, or under investigation.”
- Identification of any exclusions, limitations, or conditions being relied upon.
- Confirmation of all potentially relevant policies investigated or identified.
“Express exclusion:”
Claimant does not request premium pricing, underwriting inputs, consumer scoring, rating factors, discount structure, pricing strategy, or other confidential underwriting data.
Priority and Expedited Handling Request
Because the information requested is necessary for claimant to evaluate financial responsibility, determine whether UM/UIM claims may be required or triggered, preserve rights, and make informed settlement and medical-billing decisions, expedited handling is requested.
Requested Voluntary Response Date
“Suggested practice: request a voluntary response within five calendar days. The five-day request is a cooperation deadline, not the statutory 30-day deadline for a formal registered-agent request.”
Consent to Disclosure to Claimant’s Insurer
Claimant authorizes the responding insurer to provide copies of responsive disclosures and communications to claimant’s own insurer for UM/UIM evaluation and coordinated coverage review.
Claimant’s Insurance Company
NAIC Code
Claim Number
Address
Return Materials To
Claimant Name
Address
Phone
Reservation of Rights
This request is made voluntarily and without formal registered-agent service. Claimant reserves all rights and remedies under Colorado law, including the right to serve a formal request under C.R.S. § 10-3-1117 if voluntary cooperation is incomplete or not timely provided.
Signature
Claimant / Authorized Representative
Title / Role, if applicable
Date
Form 2
Formal C.R.S. § 10-3-1117 Insurance Disclosure Request and Insurer Response Form
“Important:”
The 30-day statutory period applies to a formal written request sent to the insurer’s registered agent. The correct legal underwriting company and registered agent should be verified before formal service.
Formal Request Header
Date
Insurance Company Legal Name
NAIC Code
Registered Agent Name
Registered Agent Address
Claimant Information
Full Name
Address
Phone
“Claimant status:”
Driver
Passenger
Pedestrian
Bicyclist
Other Status
Loss Information
Date of Incident
Location
Crash Report Number, if known
Investigating Agency
At-Fault Driver / Insured, if known
Vehicle Information, if known
Brief Description of Incident, Injuries, and Damages
Notice of Claim
“The claimant has provided notice of a potential claim. Notice was provided by:”
Telephone
U.S. Mail
Claim portal
Other written notice
Date Notice Was Provided
Person / Department Notified
Formal Statutory Disclosure Request
Claimant requests disclosure of all information required by C.R.S. § 10-3-1117 for each known policy of insurance of the named insured, including excess or umbrella insurance, that is or may be relevant to this claim.
“For each known relevant policy, provide:”
- Name of the insurer.
- Name of each insured party as the name appears on the declarations page or policy records.
- Limits of liability coverage.
- Copy of the actual policy, including all applicable forms, endorsements, amendments, and exclusions.
Policies and Coverage to Be Investigated and Disclosed
Personal passenger auto policy
Commercial auto policy
Employer, business-use, non-owned, hired, or vicarious-liability coverage
Umbrella policy
Excess policy
Additional insured or permissive-use coverage
Rideshare, delivery, contractor, or commercial-use endorsement
Other Potential Coverage
Information Expressly Not Requested
Claimant does not request and does not authorize production of premium pricing, premium discounts, underwriting inputs, rating factors, consumer scoring, risk scoring, pricing strategy, internal pricing models, or other confidential underwriting data.
Those categories are not useful to claim adjustment, UM/UIM evaluation, or claim resolution. The request is limited to policy identity, policy structure, insured identity, coverage limits, policy language, endorsements, exclusions, and coverage position.
Insurer Response Section: Policy Identification
Responding Insurance Company Legal Name
NAIC Company Number
Policy Number
Policy Period
Named Insured(s)
Additional Insureds / Listed Drivers / Other Relevant Insureds
Insurer Response Section: Vehicle and Use
Vehicle Year / Make / Model
VIN
Listed Use
Other Use Description
Insurer Response Section: Liability Limits
“Bodily injury liability:”
$25,000 / $50,000
$50,000 / $100,000
$100,000 / $300,000
$250,000 / $500,000
Other Bodily Injury Limit
“Property damage liability:”
$15,000
$25,000
$50,000
$100,000
Other Property Damage Limit
“Combined single limit:”
$100,000 CSL
$300,000 CSL
$500,000 CSL
$1,000,000 CSL
Other CSL Limit
Insurer Response Section: Additional Coverage
Medical Payments Coverage
MedPay Limit
Umbrella / Excess Coverage
Employer / Business / Commercial Coverage
Description of Additional Coverage
Insurer Response Section: Coverage Position
Does any identified policy provide liability coverage for this loss?
“If coverage is denied, limited, reserved, or under investigation, identify the basis:”
Policy not in effect
Driver not an insured
Vehicle not covered
Business-use exclusion
Commercial-use exclusion
Delivery / rideshare exclusion
Named-driver exclusion
Permissive-use dispute
Cooperation issue or late notice
Other Exclusion, Limitation, or Condition
Policy Language Relied Upon
Completeness Certification Requested
Response is based on review of actual policy records.
Policy copy provided is the actual applicable policy, not merely a specimen form.
All relevant endorsements and amendments are included.
All known relevant policies have been identified.
Umbrella and excess coverage were investigated.
Employer, business-use, commercial, and additional-insured coverage were investigated.
Any redactions are identified and explained.
Person Completing Response
Title
Email / Phone
Date
Return Materials To
Claimant / Representative
Address
Authorized Disclosure Agent, if applicable
Agent Email
Administrative Compliance Support
Insurance Disclosure Compliance Support
“VictimsGuide offers a non-legal administrative compliance service for claimants who need help preparing, serving, tracking, and organizing insurance disclosure requests. The goal is to create a clean written record: what was requested, when it was sent, how it was served, what the insurer produced, what appears incomplete, and whether the response is ready for claimant, UM/UIM carrier, or attorney review.”
This is not a legal service.
VictimsGuide does not act as a law firm, does not represent claimants as legal counsel, does not value injury claims, does not negotiate settlement, does not threaten litigation, and does not interpret policy coverage as legal advice.
What the Service Can Do
- Review claimant-provided intake data for completeness.
- Prepare a voluntary expedited disclosure request.
- Prepare a formal C.R.S. § 10-3-1117 request if selected.
- Identify likely insurer contact information and registered-agent service target.
- Track delivery, service method, and response deadlines.
- Receive, log, and organize insurer responses.
- Prepare a non-legal compliance report.
- Package the record for claimant, UM/UIM carrier, or attorney review.
What the Service Does Not Do
- Provide legal advice.
- Represent the claimant in litigation.
- Determine liability or damages.
- Negotiate settlement.
- Make final coverage opinions.
- Disclose or request premium, pricing, underwriting, scoring, or rating data.
- Publish claim-specific policy information.
Recommended Documents to Upload
- Police crash report, if available.
- Insurance card photographs or insurance information exchanged at the scene.
- Any claim number or adjuster letter.
- Emails confirming notice of claim.
- Photos of vehicle damage or crash scene, if helpful.
- Claimant’s own declarations page, especially for UM/UIM or MedPay review.
- Any denial, reservation-of-rights, or coverage-position letter already received.
Limited Agent Authorization
By purchasing the service and signing the intake authorization, claimant authorizes VictimsGuide or its disclosure compliance service to act as claimant’s limited administrative agent for the purpose of preparing, transmitting, tracking, receiving, organizing, and forwarding insurance disclosure requests and responses.
Claimant authorizes secure retention of disclosure requests, proof of service, insurer responses, and related policy materials for the claimant’s file and for transmission to claimant’s insurer or attorney.
“Research use:”
Claimant may authorize de-identified and aggregated use of response data to study Colorado auto insurance disclosure practices, coverage gaps, delay patterns, and incomplete disclosures. No claimant name, insured name, claim number, address, VIN, or identifying claim detail should be published without separate written authorization and legal review.
Start the Compliance Support Process
Complete the intake form first, attach supporting documents, then purchase the compliance support service through Shopify. After purchase, the submitted intake record and uploaded documents are used to prepare the disclosure packet.
Compliance Report Output
“The final administrative report may include:”
- Claimant and loss identifiers.
- Insurer and claim contact information.
- Notice-of-claim proof summary.
- Voluntary request transmission record.
- Formal request service record, if selected.
- Response deadline calculation.
- Documents received.
- Missing items checklist.
- Whether the insurer response appears complete, incomplete, late, or nonresponsive.
- Referral-ready packet index for claimant, UM/UIM insurer, or attorney review.
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