Proof of Loss Worksheet
A proof of loss is a sworn statement of what you lost and what you're claiming. It has a deadline, it's signed under oath, and the figure you put on it sets the ceiling of your claim.
Most people fill one in under pressure, with incomplete information, days after a disaster. This worksheet is for working it out properly before you commit anything to the real form.
We're Insurance Claims Consultants. Call (864) 497-2151 — first conversation is free, and if a deadline is close, call today.
Read This Before You Use It
This worksheet is not a proof of loss. It's a tool for preparing one.
Your carrier will provide their own form, or accept a standard sworn statement in proof of loss. NFIP flood claims have their own mandatory federal form and nothing else will do. Use this to assemble your figures and check nothing's missing, then transfer them to whichever document your claim actually requires.
Two things to keep in mind while you work through it:
Don't guess. You're swearing to this. "To be determined" on a supplemental is better than a number you can't stand behind.
Don't rush to meet the deadline with a low figure. If the damage isn't fully understood yet, request an extension in writing. Carriers grant them more often than people expect, and a sworn understatement is far harder to correct than a late filing is to explain.
Full background on how the document works: Proof of loss explained.
Policy and Claim Details
| Insured name(s) as shown on the policy | |
| Property address | |
| Insurance company | |
| Policy number | |
| Claim number | |
| Policy period — from / to | |
| Date and time of loss | |
| Date the claim was reported | |
| Date the carrier requested proof of loss | |
| Proof of loss due date | |
| Cause of loss | |
| Who occupied the property at the time | |
| Any mortgagee or lienholder | |
| Any other insurance covering this property |
The due date is the line to fill in first. Everything else works backwards from it.
Coverage Limits From Your Declarations Page
Copy these from the policy before you start. You need to know what the ceiling is on each coverage, and whether each pays replacement cost or actual cash value.
| Coverage | Limit | RCV or ACV |
|---|---|---|
| A — Dwelling / building | ||
| B — Other structures | ||
| C — Personal property / contents | ||
| D — Loss of use / additional living expense | ||
| Ordinance or law | ||
| Debris removal | ||
| Deductible |
Watch for a separate windstorm or hurricane deductible, and for a roof surfacing endorsement that pays actual cash value on the roof only.
The Loss Itself
| Item | Amount |
|---|---|
| Dwelling / building repair or replacement | |
| Other structures | |
| Contents — replacement cost total | |
| Contents — less depreciation | |
| Additional living expenses incurred to date | |
| Additional living expenses anticipated | |
| Emergency mitigation — tarping, board-up, extraction, drying | |
| Debris removal | |
| Code-required upgrades | |
| Professional fees — engineer, hygienist, specialist reports | |
| Other | |
| Total amount claimed | |
| Less amounts already paid by the carrier | |
| Less deductible | |
| Net amount now claimed |
Supporting Documents Checklist
A proof of loss with a bare figure invites a low counter-offer. One with a documented scope behind it is much harder to reduce. Tick what you're attaching:
- ☐ Itemised repair estimate, broken down by trade
- ☐ Contents inventory — room-by-room checklist here
- ☐ Photographs of the damage, ideally taken before any cleanup
- ☐ Receipts for emergency mitigation and temporary repairs
- ☐ Receipts and records for additional living expenses
- ☐ Any engineer, hygienist or specialist report
- ☐ Fire department or police report where applicable
- ☐ Copy of the declarations page
- ☐ Mortgagee details if there's a lien on the property
Before You Sign
- ☐ Every figure is one I can support with a document
- ☐ Nothing claimable has been left off — mitigation, debris, code, living expenses
- ☐ Damage that may still emerge is noted, or a supplemental is reserved
- ☐ I've kept a complete copy of the form and everything attached
- ☐ The form is going in before the deadline, or an extension has been requested in writing
- ☐ No field on the form is blank where a figure belongs
- ☐ I have not signed anything described as a release
Never sign a partly completed form on an assurance that the rest will be filled in later.
Or Let Us Do It
Preparing a proof of loss properly means a full scope, a contents inventory, and every ancillary coverage identified — while the clock runs and you're dealing with a damaged property.
That's the job. When you hire us we prepare it, document it, and request extensions where the figures genuinely aren't ready yet.
No hourly billing. No upfront cost.
Our fee is a percentage of what you recover.
We work for you, not for the insurance company.
Anywhere in North Carolina, South Carolina or Georgia, call (864) 497-2151.
