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Run: Initial Supplement Request Form

Document hidden damage found during teardown and submit the first insurer supplement request with the claim details, line items, photos, and approval fields ...

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Claim and Repair Order Details

Repair Order Number (required)

Claim Number (required)

Insurer Name (required)

Vehicle VIN

Optional if the repair order already links the vehicle. Avoid collecting more PII than needed.

Vehicle Year / Make / Model (required)

Teardown and Hidden Damage Findings

Teardown Completed Date (required)

When was the damage discovered? (required)

Hidden Damage Summary (required)

Describe the additional damage found, using clear, observable details. Include affected components and why the damage was not visible on the original inspection.

Primary Damage Category (required)

Safety or Drivability Impact (required)

Supplement Line Items

Supplement Line Items (required)

Parts Needed

Labor Operations Needed

List additional labor operations, such as R&I, structural repair, diagnostics, calibration, or refinish steps.

Estimated Additional Labor Hours

Estimated Additional Cost

Photo Evidence and Attachments

Damage Photos (required)

Upload clear photos showing the hidden damage, teardown state, and any related components. Include wide shots and close-ups where helpful.

Supporting Documents

Optional estimate pages, scan reports, measurement sheets, or OEM procedures.

Photo Notes

Add brief captions or reference numbers that match the uploaded images.

Submission and Approval Details

Urgency Level (required)

Insurer Contact Name

Insurer Contact Email

Ready to submit for insurer approval (required)

By checking this box, you confirm the supplement request reflects the current teardown findings and attached evidence.

Yes No N/A

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Email (required)

Your name (optional)

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