If you have provided services on more than one claim, more than one policy or have multiple vendor invoices, only one proof of claim form submission or one ClaimNet filing is required. The proof of claim form or ClaimNet filing becomes your master claim. However, a master claim itemization table and imaged copies of your invoices must be prepared and returned, either on a CD with your submitted proof of claim form or submitted as an attachment during the ClaimNet filing process, in order to provide supporting documentation for your master claim filing.
To properly complete and submit your master claim itemization table and imaged invoices, please carefully read and follow the instructions below.
STEP #1 – Create a master claim itemization table in a spreadsheet software program (Excel format is preferred to expedite the evaluation process). The spreadsheet should contain as many of the categories of information listed below as are applicable:
a. Original Company Claim or Policy #
g. Date Invoiced
b. Invoice or Reference #
h. Original Amount Invoiced
c. Claimant/Insured Name
i. Payments Applied
d. Date of Loss
j. Date Paid
e. Date Assigned
k. Total Amount Claimed
f. Date Completed
The total amount claimed on your master claim itemization table should equal the total amount claimed on your proof of claim form or the amount claimed within your ClaimNet filing.
Below is a sample of how your itemization table should be created:
STEP #2 – Create images of all of the invoices listed on the master claim itemization table in PDF format.
STEP #3 – If you file your claim in ClaimNet, you will be able to upload your master claim itemization table and imaged invoices during the electronic filing process.
If you complete and submit the paper proof of claim form, please copy (burn) the created master claim itemization table and all imaged invoices to a CD
and label the CD with
1) the name of your company (the claimant), 2) your RCN (unique number assigned to each claimant) and 3) the name and phone number of a contact
person at the company who can answer questions regarding the master claim being submitted.
Then mail the CD along with your completed proof of claim form to the following address:
Florida Department of Financial Services
Attn: Claims Section – Master Claims
Post Office Box 110
Tallahassee, FL 32302
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