Insurer Deviation Documentation Form

Estimator form for documenting any insurer request to deviate from a required OEM procedure, capturing the request, the affected procedure, approval status, and liability acknowledgment.

Claim and Vehicle Identification

• Claim Number
• Repair Order Number
• Vehicle VIN
• Vehicle Year, Make, and Model
• Date of Insurer Request

OEM Procedure Affected

• OEM Procedure Name
• OEM Procedure Reference or Document ID
• Procedure Category
• Why is this OEM procedure required?
  Briefly describe the safety, structural, or manufacturer requirement that makes the procedure necessary.

Insurer Deviation Request

• Insurer Name
• Adjuster or Representative Name
• How Was the Deviation Requested?
• Requested Deviation
  Describe exactly what the insurer asked the shop to do differently from the OEM procedure.
• Insurer's Stated Reason
  Record the insurer's explanation if provided. Do not infer or editorialize.

Shop Review and Risk Assessment

• Shop Position
• Risk Level
• Risk Summary
  Summarize the safety, quality, warranty, or liability concerns created by the requested deviation.
• Alternative Repair Option Offered
  Document any OEM-compliant alternative proposed by the shop.

Supporting Evidence and Communication Log

• Supporting Files
  Upload relevant photos, OEM procedure pages, emails, or estimate notes.
• Communication Log
  Add dated notes for each insurer or internal communication related to the deviation request.

Submission Acknowledgment

• Prepared By
• Prepared By Title
• Acknowledgment
• Signature