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This is Jane Jones with All State insurance company. Today’s date is March 15th, 2007. And I am speaking with Mr. Jack Black, the policy holder and insured. This recorded statement is regarding claim number 12345678.
- Mr. Black, are you aware we are recording this conversation?
- Is that with your permission? o Here you should say, yes but if and only if I am provided with copy of the tape and the transcription of the actual statement.
- Mr. Black, I understand that the accident happened in or at about 1394 Waterway Road, Lansing Michigan. Is that correct?
- In what date did the accident occur?
- At what time?
- Was it day light?
- What vehicle were you driving? Make and model?
- What color of vehicle?
- Do you recall the license plate?
- How long have you own this vehicle for?
- Do you have a car loan and if so which bank? Can you give me their number and the loan number?
- Are you having any financial difficulties?
- Have you given an actual statement to any other insurance company?
- Are you going to give an actual statement to other insurance company?
- How fast where you going?
- How many passengers in your vehicle? What are their names and ages? How do I contact them?
- Did your passanger give an actual statement to the police or the authorities?
- Where is your car today? Telephone number?
- How did you get out of the scene of the accident?
- Can you drive your car?
- Has your vehicle ever been in an accident?
- Were you wearing the seatbelt?
- What kind of car was the other vehicle? Make and model?
- What color?
- Who was driving? Their name and number?
- Any passengers? Names and numbers?
- In which road were you driving?
- Where you headed north, south, east or west?
- In which street was the other vehicle? In what direction was that vehicle headed?
- How many lanes of traffic did your street have?
- How many lanes of traffic did his street have?
- What traffic controls, like stop signs, yield signs, speed limits, were in that intersection?
- Have you been contacted by any insurance company to give them an actual statement?
- What is the speed limit?
- Did you call the police? If not, then who?
- How long did the police take to get there?
- Did the police take an actual statement?
- What did you tell them?
- Did you tell them in the actual statement that this was your fault?
- Did paramedics come to the scene? How long did it take them?
- Were there any injuries in your vehicle?
- Were there any injuries in the other vehicle?
- Was the other vehicle towed from the scene?
- Who drove the other vehicle after the accident?
- When you were waiting for the police what happened?
- What did you say to the other driver?
- Did the other driver tell you that he was sorry?
- Did you tell the other driver that you were sorry?
- What else was said? Did you say it was your fault? Did the other party said it was his?
- Did any one stop to help? If so what are their names and numbers? Do you know any of these people?
- Did the other party give an actual statement to the police?
- Were you under the influence of alcohol, drugs, or medication at the time of the accident?
- Are you pregnant?
- Where was your vehicle hit? Front door? Front bumper?
- Please rate the impact from 1 to 10. 10 being a bad accident (a roll over accident).
- How big is the damage in your car? Like a dime, a quarter, a basketball size, the entire vehicle?
- Did you hear any explosions?
- Was there any smoke?
- Was there any breakage of glass?
- How many miles does your vehicle have?
- Did the airbags deploy?
- Where you coming from?
- Where were you going?
- At what time did you have to be there?
- At what time was the accident?
- At what speed where you traveling?
- At what speed was the other person traveling?
- Were you smoking or talking in the cell phone?
- Did the other party tell you where were they going?
- Did you see the other vehicle prior impact?
- What did you do when you saw the other vehicle?
- What part of your vehicle came in contact with his vehicle
- How much damage is there to his vehicle?
- Where is that damage?
- Did the other vehicle try to avoid you?
- Did you slow down before you went into the intersection?
- Did you stop completely?
- In what direction did your vehicle end up facing?
- In what direction did his vehicle end up facing?
- How fast were you going?
- Did you apply the breaks?
- Were there any skid marks left by the vehicles?
- When you saw the other vehicle, what did you do?
- Did anything fly inside the vehicle?
- Were any drinks spilled?
- What party of your body hurt first?
- Describe your symptoms?
- Have you ever been in an accident before?
- When was the last time that you saw a doctor?
- For what reason did you see the doctor?
- Do you take any medication?
- Were you talking medication the day of the accident?
- Did you go to the emergency room?
- Who drove you there?
- What did the emergency room doctor say?
- Did you go to work afterwards?
- Were you in the clock, or performing a job related task when the accident occurred?
- Were do you work? Who is your supervisor?
- How much money do you make per hour?
- What is your position?
- Did you miss anytime away from work because of your injury?
- Where you prescribe any medications?
- How do you feel today?
- Have you gone to the doctor, since the visit to the emergency room physician?
- How many days were you release from work?
- When are you planning to go back to work?
- Are you at fault for the accident?
- Closing: Mr. Black, were you aware that we were recording this conversation?
- And was that with your permission?
- Is there anything you would like to add before I get off the tape?
- Can we share your actual statement with other adjusters?
- With your permission, can I turn off the recording?
This is how an adjuster will control the actual statement. The example above is a simple accident without any kind of coverage issue, severe injuries, and a simple layout of streets. More difficult accidents will require more extensive statements.
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