Claim Supplement - USLI 2026

1. Click ‘Get Form’ to open the Claim Supplement - USLI in the editor.
2. Begin by entering the 'Name of Claimant' in the designated field. Ensure accuracy as this information is crucial for identification.
3. Next, specify 'When did the claim occur?' by providing the date in the appropriate section.
4. In the 'Details and background of Claim' section, provide a comprehensive account of the claim, including positions of involved persons and their employment status. If applicable, attach a copy of any harassment complaint.
5. Indicate whether the EEOC or State Human Rights Agency has ruled on this case. If yes, select the appropriate ruling option and attach a copy of that ruling.
6. State if the claim is open or closed by selecting the corresponding checkbox. If closed, provide the official close date.
7. Fill in 'Amount of Defense Costs paid' and 'Settlement amount (if any)' in their respective fields.
8. Answer whether the claim was covered by insurance and provide details regarding amounts paid or reserves set up by the insurer if applicable.
9. Finally, describe any remedial measures taken to prevent similar claims in future before signing and dating at the bottom.

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