Subrogation Authorization

  • In consideration of any and all amounts paid on behalf of the undersigned by Assurant Claim Management (hereinafter referred to as Subrogee), I/We, the undersigned, or duly authorized agent of (Customer's Name) (hereinafter referred to as the subrogor), do hereby assign, set over, transfer and subrogate to subrogee all the property damages rights, claims, and interest strictly pertaining to property damage expense including loss of use, diminution in value, and vehicle repair costs incurred as a result of claim # (listed above), which the subrogor may have against any party, person, or corporation who may be liable for the losses and expenses which occasioned the payment by subrogee, and hereby authorize subrogee to sue, compromise, or settle in the name of the undersigned or otherwise, and is hereby substituted in the placer of the undersigned and subrogated to all the rights of the undersigned. To the extent allowed by law, the subrogor hereby also assigns any and all of its rights in and to any insurance policy which the subrogor may have in these matters under the same terms and purposes as listed above to subrogee. Subrogor agrees to supply to subrogee a list of known parties against whom the subrogor has a potential claim. Further, subrogor shall supply the name of any and all known insurance carriers to subrogee. Subrogor further agrees to repay subrogee any funds which it may receive from the proceeds of any claim, action or insurance policy which it received subsequent to payments by subrogee on behalf of subrogor. It is hereby warranted that no settlement has been made or signed with those persons, parties or corporations by the signer hereof and that no insurance policy proceeds have been received.

    It is hereby further agreed that the undersigned shall provide all information, documents, or such other data necessary in order for subrogee to sue, compromise or settle any such claims as well as to cooperate fully with the subrogee and to make available any and all witnesses for providing testimony and all else necessary to assist subrogee in its actions against said persons, parties or corporations.

    It is also agreed that any action taken by subrogee shall be without charge or cost to the undersigned and the undersigned shall have no interest in and to any of the proceeds recovered by the subrogee as a result of any actions which the subrogee may endeavor.
  • Date Format: MM slash DD slash YYYY