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Run: Insurer Deviation Documentation Form

Document insurer requests to deviate from an OEM repair procedure, capture the shop’s risk review, and record approval or rejection in one place. Use it to k...

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Claim and Vehicle Identification

Claim Number (required)

Repair Order Number (required)

Vehicle VIN (required)

Vehicle Year, Make, and Model (required)

Date of Insurer Request (required)

OEM Procedure Affected

OEM Procedure Name (required)

OEM Procedure Reference or Document ID (required)

Procedure Category (required)

Why is this OEM procedure required? (required)

Briefly describe the safety, structural, or manufacturer requirement that makes the procedure necessary.

Insurer Deviation Request

Insurer Name (required)

Adjuster or Representative Name (required)

How Was the Deviation Requested? (required)

Requested Deviation (required)

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 (required)

Risk Level (required)

Risk Summary (required)

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 (required)

Prepared By Title (required)

Acknowledgment (required)

Yes No N/A

Signature (required)

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Email (required)

Your name (optional)

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