Authorization of Benefits

Please review the insurance process and complete this form so we can begin emergency work and coordinate directly with your insurance provider.

We handle the tree service portion of your claim directly with your insurance adjuster whenever possible. While we may need some information from you, our goal is to manage the process from start to finish to make it as easy as possible for you.

1. Policyholder Information


Name
Loss Location / Property Address

2. Insurance Information


Adjuster Information (If assigned)

(If not assigned yet, please call the Office at 423-760-8733 with the information once you have it.)

3. Authorizations & Agreements


Assignment of Benefits

I/We, the undersigned Homeowner(s) ("Assignor"), hereby assign, transfer, and convey all rights, benefits, and interest under my/our homeowners insurance policy to Lumberjacks Tree Service ("Assignee") for the purpose of performing tree removal, debris cleanup, and related services due to damage covered under my/our policy.


This assignment allows Lumberjacks Tree Service to:


  • Communicate directly with my insurance company regarding my claim.
  • Submit invoices and receive payment directly from the insurance carrier.
  • Negotiate and resolve claim disputes regarding services rendered.
  • Obtain necessary claim documents related to the scope of work.

I understand that I remain responsible for any deductible, uncovered amounts, or fees not paid by the insurance company.

Authorization to Discuss Claim

I hereby authorize Lumberjacks Tree Service to discuss, negotiate, and obtain information regarding my insurance claim directly with my insurance provider. This includes but is not limited to policy details, claim processing updates, and payment status.


I agree that Lumberjacks Tree Service may act on my behalf solely for the purposes of tree removal and related work. This authorization does not grant power of attorney or any rights beyond those required to fulfill the contract.

Homeowner’s Agreement

I agree to the terms outlined in the Master Service Agreement and acknowledge the Equipment & Service Rates.

This assignment allows Lumberjacks Tree Service to obtain necessary claim documents related to the scope of work.


  • I understand that this Assignment of Benefits (AOB) is voluntary.
  • I acknowledge that I am responsible for any portion of the invoice not covered by my insurer.
  • I agree to cooperate in providing any required information or documentation.
  • I understand that payments must be made directly to Lumberjacks Tree Service, even if issued to me first by the insurance company.

4. Digital Signature


Please sign below inside the box:

Clear Signature
By signing and submitting this document, I acknowledge that this electronic signature has the same legal validity and effect as a handwritten signature.