Yes – Coverage Questionnaire

USE NOTE: This Questionnaire is for an insurer that has accepted full coverage and has not reserved any rights to later deny coverage to the plaintiff or to the policyholder. If the insurer has reserved rights, consider hyperlinking to the pdf form of the Coverage Questionnaire instead. To customize a Questionnaire, download it in Word or WordPerfect and make any changes you wish.


Please answer the following questions by checking the appropriate “Yes” or “No” box that most accurately responds to each question and furnish complete explanations to all of your responses based on the facts now known by you.

Do you unconditionally waive all bases upon which you may deny coverage to me?

If a judgment includes punitive damages, will you pay all compensatory damages?

Will you solicit and accept an offer to settle the lawsuit within my policy limit?

Have you completed an investigation of each claim asserted against me?

Have you attempted in good faith to effectuate a prompt, fair, and equitable settlement of each claimant’s claim against me?

Have you adopted written standards for the prompt investigation of claims?

Have you adopted written standards for the prompt processing of claims?

Are you the insurer under each policy issued to me?

Am I an insured under each policy?

Have I satisfied the notice provisions of each policy?

Have I violated any policy provision?

Have you been prejudiced by my conduct?

Did all alleged loss happen during the policy period of each policy?

Did all alleged loss happen within the coverage territory of each policy?

Have I paid the premium?

Will you please provide me with a copy of all writings evidencing or constituting the following:

  • Your claim file?
  • Your claims manual?
  • Your litigation guidelines?
  • Your investigation of all claims?
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