Farm Details

If you have been in an accident and have State Farm insurance, you will likely be sent a form called the "State Farm Authorization to Pay." This form gives State Farm permission to pay your medical bills and other expenses related to the accident. It's important to fill out this form as quickly as possible so that State Farm can begin paying your bills. If you don't fill out the form, State Farm may not be able to pay your bills at all.

We've compiled some technical information about the state farm authorization to pay. It is worth finding the time to study this before you start filling in your document.

QuestionAnswer
Form NameState Farm Authorization To Pay
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesfarm, state farm direction to pay form, authorization, state farm authorization form

Form Preview Example

STATE FARM

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INSURANCE

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Insured

_

Claim Number

_

Authorization To Pay

(To Be Signed Upon Completion of Services/Repairs)

TO: State Farm General Insurance Company

I understand this AUTHORIZATION TO PAY extends solely for the services or repair expenses covered by my State Farm General

Insurance Company insurance policy as a result of the loss occurring on. I agree to pay my indepen- dent contractor and/or independent service provider(s) for any services or repairs or additional improvements made at my direction that are not covered under my policy. I have received a copy of my independent contractor/service provider(s) final estimate(s), and written workmanship labor warranty on the building or structural services/repairs. All of the building or structural services/repairs by this contractor/service provider have been completed to my satisfaction.

I authorize payment on my behalf in the above referenced claim to_ for the amount shown on the final estimate(s) or the invoices sent to State Farm General Insurance Company from my independent contractor or independent service provider(s) and the material supplier(s). I understand that my property lender and/or its authorized representative, if there is a property lien, may perform its own inspection of my damaged property to verify that the building or structural services/repairs as disclosed on the final estimate(s) have been completed.

For your protection California Law requires the following to appear on this form: Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.

(Date)

(Year)

(Insured Signature)

105297.7 07-24-2008 California