Home Insurance Claim Record

Who this is for

One claim on one sheet, from the day of the loss to the day it is paid. The policy details at the top, the items claimed line by line underneath, and what was asked for set against what was offered and settled.

Anyone making a claim after a flood, a fire, a burglary or a burst pipe, and anyone who has had a claim drag on and wishes they had kept a note of every call.

What this helps you track

• The policy, claim and loss adjuster details in one place, ready to quote
• Every item claimed with its age, what it cost and what you are asking for
• What the insurer offered and what was finally settled, line by line
• The gap between claimed and settled, totalled, so the outcome is a figure
• What evidence has been sent and what is still outstanding

How to use it

1. Fill in the policy number, the insurer, the claim number and the date of the loss as soon as you have them — the claim number is what every later call starts with.
2. Describe the loss in the notes area while it is fresh, with the date and time if you know them.
3. List each item separately: what it is, roughly when it was bought, what it cost and the amount you are claiming.
4. Write the offer against each item as it comes, then the settled amount when it is agreed. The difference column is worked out for you in the browser and workbook.
5. Tick each piece of evidence off the list as you send it, and keep a copy of everything you send.
6. Keep the finished sheet with the policy documents; a settled claim is often asked about at the next renewal.

Formats

• Printable PDF (A4 and US Letter)
• Fillable PDF with form fields
• Fill in online, saved in your browser
• Excel / Google Sheets workbook

The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The workbook uses plain formulas only — SUM, IF, COUNTIF and the like — so it opens in Excel, LibreOffice and Google Sheets without anything breaking, and every calculated cell is grey so you can see which figures it worked out.

How to print

Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.

Questions

Will this sheet tell me what I am entitled to?

No, and nothing could without reading your policy. What is covered, whether you are paid new-for-old, and what excess applies are all in your own documents. This sheet records what you claimed and what happened.

What should I put for value if I have no receipt?

Your honest estimate of what the item cost, with a note of how you arrived at it — a bank statement, a photograph, a similar item on sale now. The evidence list has a line for that.

Why record the loss adjuster separately?

Because the adjuster is often a different company from the insurer, and claims stall when calls go to the wrong one. Names, numbers and dates of visits save repeating yourself.

Can I use it for more than one claim?

Use one sheet per claim. The claim number at the top is what ties the items, the evidence and the settlement together.