Insurance Claim Feedback Survey Template

Insurance claim satisfaction survey with 5 questions on ease of filing, communication, fairness, and resolution. Print, hand out, and scan for results.

This is a ready-made survey template you can use two ways. Print it on paper and hand it out, then scan the completed forms and PaperSurvey reads the answers for you automatically, no manual typing. Or share the very same template as an online web survey. The preview below shows the printable paper version.

Use this template

Copy this template into your account, then customize it to suit your needs.

This insurance claim satisfaction survey template gathers honest feedback from policyholders after a claim, with 5 questions covering how easy the claim was to start, how well they were kept informed, whether the process felt fair, and how satisfied they were with the outcome. It prints on a single sheet and takes about two minutes to complete.

What this survey measures

The rating grid captures the parts of the journey that shape satisfaction: ease of filing, communication at each step, perceived fairness, settlement time, and the helpfulness of your staff. An overall ease-of-resolution scale gives you a single number to track across claim types, a satisfaction question flags where outcomes fell short, and an open comment box surfaces the specific frictions your fixed questions miss.

How to use it on paper

Hand the form to claimants at a branch or adjuster visit, include it with a claim settlement letter, or leave copies at your service desk with a drop box. Respondents fill the checkboxes with a blue or black pen. Collect the completed forms and scan them in batches with PaperSurvey, which reads the checkbox answers with optical mark recognition and converts the handwritten comments to text automatically, so results reach your dashboard without any manual data entry.

Customize this template

Reword the statements to match auto, home, health, or travel claims, add questions about specific touchpoints such as the adjuster or the app, or drop the claim reference field for anonymous feedback. The paper layout reflows automatically as you edit, and every copy you print stays scannable.

Preview the PDF above, or use this template to start collecting claims feedback today.

Paper and web from one template

Every PaperSurvey template is a hybrid survey: run it on paper and scan the forms, share it online as a web survey, or do both at once and collect all the responses in one place. to see how it looks online, or open it in a new tab. It is a live preview only, so nothing you enter is saved.

Questions in this template

  1. Claim reference (optional)
  2. What type of claim was this?
  3. How did you file your claim?
  4. Please rate your agreement with the following statements.
  5. How easy was it to get your claim resolved?
  6. Was your claim resolved to your satisfaction?
  7. How likely are you to recommend us to a friend or colleague based on this claim?
  8. How would you rate the responsiveness of your claims handler?
  9. How many times did you have to follow up before your claim was resolved?
  10. Which parts of the process caused you the most frustration? (Select all that apply)
  11. How fairly do you feel your settlement amount reflected your loss?
  12. How could we improve the claims process?

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