DV Assignment – Specialized Claims Synergy™

01 Assignment Contact

Company / Organization *

Contact Name *

Email Address *

Phone Number

Assignment Type *

Requested Due Date

02 Claim Information

SCS / Client Claim Number

Insurance Carrier

Carrier Claim Number

Policy Number

Date of Loss *

State / Jurisdiction of Loss *

Claim Type

Liability Status

Loss Description *

03 Vehicle Information

Year *

Make *

Model *

Trim / Series

VIN *

Mileage at Loss / Repair *

Body Style

Engine / Powertrain

Drivetrain

Exterior Color

Interior Color

Owner / Claimant Name

Vehicle Market Type

Agreed Value, Appraisal, or Known Pre-Loss Value

Factory Options / Significant Equipment / Modifications

04 Pre-Loss Condition & History

General Pre-Loss Condition

Prior Accident / Damage History

Prior Damage, Repairs, Missing Components, or Pre-Existing Conditions Examples: prior collision, stolen tailgate, cracked windshield, prior repaint, mechanical issue, salvage/rebuilt title, or aftermarket modifications.

Title Status

Number of Owners (if known)

05 Repair Information

Repair Facility

Total Repair Cost *

Estimate / Supplement Number

Repair Status

Airbags Deployed?

Vehicle Drivable After Loss?

Check All Repair Categories That Apply

Major Components Repaired or Replaced

Known Structural, Frame, or Safety-System Involvement

06 Post-Repair Condition

Has the Vehicle Been Inspected After Repairs?

Repair Quality

Post-Repair Concerns or Deficiencies

Field Inspector / Appraiser Findings

07 Market & Diminished Value Information

Claimed Diminished Value Amount (if any)

Opposing Appraiser / Company

Vehicle Sold After Repair?

Post-Repair Sale Price (if applicable)

Known Dealer Offers, Trade-In Bids, Buy-Bids, or Market Evidence

08 Documents & Photographs

Upload the documents available for this assignment. Examples include repair estimates, supplements, photographs, opposing diminished value reports, CARFAX or AutoCheck reports, window stickers, prior appraisals, dealer bids, field-inspection reports, subrogation demands, and completed repair invoices.

Repair Estimate / Supplements

Damage / Repair Photographs

Opposing DV Report

Vehicle History Report

Field Inspection Report

09 Special Instructions

Questions You Want SCS to Address

Additional Notes / Special Handling Instructions

10 Submission Confirmation

I confirm that the information submitted is accurate to the best of my knowledge and that I am authorized to provide these claim materials to Specialized Claims Synergy. *