Kentucky Assigned Claims Plan__________________
Stephen M. Hillis, Manager
Email Address: KyAuto@KAIP.org
www.kyinsplans.org
Status Form - Version 1.2020
Claimant Name:
Assignment Control #:
Kentucky Assigned Claims Plan
PO Box 436509, Louisville, KY 40243
502-327-7105
Date:
Adjuster Name:
Company Name:
Claim #:
The Plan of Operation requires servicing insurers to promptly report the disposition of claims assigned to it for handling
and to make such other reports, records and information available upon request.
Please provide the following information as it pertains to the above noted claim:
1- Status of Claim
Comments:
2- Status of Subrogation
If open, please check all of the following that apply:
Judgment Obtained:
Date of Judgment:
Judgment Amount:
Pursuing Claimant Insurer
Pursuing Uninsured Owner
Subro Attorney Involved
Suit Filed to Protect Subrogation
Gross Amount Collected:
Comments:
3- Has final billing been sent to Kentucky Assigned Claims Plan?
4- Has final subrogation recovery been sent to Kentucky Assigned Claims Plan?
Name of person completing this form: Date:
