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Yes! You can use AI to fill out Uniform Arbitration Statement of Facts - Appendix XXII-A

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Uniform Arbitration Statement of Facts - Appendix XXII-A, page 1
Basic · 39/100Form Complexity Index

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What this form asks for

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The Uniform Arbitration Statement of Facts, also known as Appendix XXII-A, is a legal document used to provide a concise summary of a case's facts, liability, and damages for an arbitration proceeding. It is specifically used for all cases except commercial ones, helping to streamline the arbitration process by presenting key information to the arbitrator in a standardized format. Today, this form can be filled out quickly and accurately using AI-powered services like Instafill.ai, which can also convert non-fillable PDF versions into interactive fillable forms.
Fillable fields48
Pages2
Form Complexity IndexBasic, 39/100

The AI checks your answers before you download

12 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

Ensures Docket Number Format is Valid

This check validates that the 'Docket No' field conforms to the standard court-mandated format, which often includes letters, numbers, and hyphens (e.g., ABC-L-1234-23). Correct formatting is essential for accurate case filing and retrieval within the judicial system. A failure would prevent the form from being associated with the correct case file, causing administrative delays.

Verifies Arbitration Date is in the Future

This validation ensures that the 'Arbitration Date/Time' is set to a future date and time. Scheduling an arbitration for a past date is a logical impossibility and indicates a significant data entry error. If the date is in the past, the user will be prompted to correct it before submission is allowed.

Validates Signature Date is Not in the Future

This check confirms that the signature 'Date' is the current date or a past date, but not a future date. The signature certifies the accuracy of the information at the time of signing, so a future date is invalid and would call the document's authenticity into question. The form will be rejected if a future date is entered.

Ensures Exclusive Selection for Verbal Threshold

This validation confirms that exactly one option, either 'Yes' or 'No', is selected for the 'Verbal Threshold' question. A case cannot simultaneously meet and not meet the threshold, and leaving it blank fails to classify the case properly for the arbitrator. The form cannot be submitted without a single, valid selection.

Requires Case Type Selection (Auto or P.I.)

This check ensures that a case type, either 'Auto' or 'P.I.' (Personal Injury), has been selected. This information is critical as it dictates which sections of the form are most relevant and may trigger other validation rules, such as requiring injury details for P.I. cases. Submission is blocked until a selection is made.

Confirms Unpaid Medical Bill Amount is Logical

This validation checks that for each medical bill listed, the 'Unpaid Bills' amount is less than or equal to the 'Total Amount'. It is logically impossible for the unpaid portion of a bill to exceed the total amount of the bill itself. This check prevents common clerical errors and ensures the financial data presented to the arbitrator is accurate.

And 6 more checks
  • Validates Consistency of Medical Bill Entries
  • Ensures Miscellaneous Expense Data Integrity
  • Requires 'Attorney for' if Signed by Counsel
  • Mandates Injury Details for Personal Injury (P.I.) Cases
  • Verifies Completeness of Signature Section
  • Ensures Caption and Docket Number are Provided

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How to Fill Out Appendix XXII-A Online for Free in 2026

What the AI walks you through.

  1. Navigate to Instafill.ai and upload or select the Uniform Arbitration Statement of Facts form.
  2. Provide the case caption, docket number, arbitration date, and the party you represent.
  3. Use the AI assistant to briefly describe the incident and the basis for liability, referencing attached police or expert reports.
  4. Detail the damages by listing injuries, objective testing, current treatments, and itemizing economic losses like medical bills and lost wages.
  5. List any applicable workers' compensation liens and any other issues you want the arbitrator to consider.
  6. Review all the information populated by the AI across the form for accuracy and completeness.
  7. Certify the information by signing and dating the form before serving it to all parties as required.

Common Mistakes in Completing Appendix XXII-A

The ones the AI is built to catch.

Incomplete or Incorrect Case Identifiers
Users often forget or mistype the Docket Number, Arbitration Date/Time, or fail to check the correct case type (Auto/P.I.). This typically happens due to rushing or clerical error. The consequences are significant, as the form may be rejected, misfiled, or cause serious delays in the arbitration process while staff try to locate the correct case. To avoid this, meticulously double-check all identifiers against official court notices before submission. AI-powered tools like Instafill.ai can help by flagging empty required fields and ensuring data formats for dates are correct.
Ignoring Instructions on Attachments
The form explicitly states what to attach (e.g., 'police report,' 'expert reports,' 'hospital discharge summary') and what NOT to attach ('bills, deposition transcripts'). A frequent mistake is ignoring these instructions and either attaching everything or omitting required summaries. This can lead to the submission being deemed incomplete or frustrate the arbitrator with excessive, unrequested paperwork, reflecting poorly on the filer. Since this form is a non-fillable PDF, a tool like Instafill.ai can convert it into an interactive, fillable version, making it easier to navigate and notice these important instructions.
Vague or Overly Long Narrative Descriptions
In sections like 'Briefly describe the accident' and 'Liability,' users often write lengthy, argumentative narratives instead of the concise summaries requested. This occurs when they attempt to argue their entire case on the form itself. The consequence is that key facts become buried, and the arbitrator may overlook the main points. A proper summary should be a few clear sentences that reference the more detailed attached reports.
Incorrectly Calculating Economic Losses
The 'Economic Losses' section is highly prone to mathematical errors, especially when itemizing medical bills or calculating net wage loss. People often confuse gross vs. net wages or simply miscalculate the column totals for medical bills. These errors undermine the credibility of the damages claim and require correction later, causing delays and extra work. To prevent this, use a calculator and double-check all figures; advanced form-filling tools like Instafill.ai can be configured to perform these calculations automatically, reducing the risk of human error.
Failing to Disclose All Liens
In the 'Workers’ Compensation and Other Liens' section, filers sometimes forget or intentionally omit liens from health insurers, Medicare/Medicaid, or workers' comp carriers. This is a critical error, as these entities often have a legal right to be repaid from any settlement or award. Failure to disclose can lead to serious legal complications, sanctions, and significant delays in distributing funds to the client after the case is resolved.
Confusing Total Medical Bills with Unpaid Bills
The form specifically asks for both 'Total Amount' and 'Unpaid Bills' for medical expenses. A common mistake is to enter the same number in both columns or to list the gross amount billed by the provider as the 'Unpaid' amount. This confusion misrepresents the actual financial impact on the litigant and can weaken the damages argument by presenting inaccurate data to the arbitrator.
Listing Subjective Complaints Instead of Objective Findings
When asked to 'List injuries' or 'List objective testing,' filers may write subjective complaints like 'my back hurts constantly' instead of diagnosed injuries ('L4-L5 herniation') or specific tests ('MRI of lumbar spine, 01/15/2023'). This happens when filers misunderstand the need for formal medical evidence. This weakens the claim, as arbitrators give far more weight to objective, verifiable medical findings than to subjective statements of pain.
Forgetting the Signature and Date
It is surprisingly common for an attorney or pro se litigant to complete the entire two-page form but forget to sign and date the certification at the end. This simple oversight invalidates the entire submission. The form will be rejected by the clerk, requiring resubmission and potentially causing the filer to miss a critical deadline, which could have severe consequences for the case.
Submitting Prohibited Documentation
Despite a clear, capitalized warning on the second page, people frequently submit prohibited documents like copies of bills, full deposition transcripts, or photographs. This mistake often stems from a misguided desire to be 'extra thorough,' but it directly violates the form's instructions. This creates unnecessary administrative work and can signal to the arbitrator that the filer lacks attention to detail.
Neglecting the 'Verbal Threshold' Checkbox
The 'Verbal Threshold' (Yes/No) checkbox is a critical element in many auto accident cases, as it determines the type of damages that can be recovered. Filers, especially those without legal representation, may not understand its significance or simply overlook it. Failing to correctly indicate whether the case is subject to the threshold can lead to fundamental misunderstandings about the case's value and legal basis from the very beginning of the arbitration process.

Frequently Asked Questions About Appendix XXII-A

 

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This plan is for your Appendix XXII-A: your own AI agent fills it as often as 5 times a month. To fill other forms and upload your own, choose a Professional plan from your account.
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From your account, in two clicks, any time. No email, no call.
How does the AI fill out Appendix XXII-A?
You answer a few questions in plain words, or upload a document you already have. The AI reads what you give it and puts each answer into the right field of Appendix XXII-A, on every page, in seconds. It checks the answers against the form's own rules, and you review and change anything before you download, print or sign.
What happens to my information?
It is encrypted in transit and at rest, and it is never used to train AI.
How complex is Appendix XXII-A to fill out?
Appendix XXII-A has a Form Complexity Index of 39 out of 100, in the basic tier: 48 fillable fields across 2 pages. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.
What is the purpose of the Uniform Arbitration Statement of Facts form?
This form is used to provide a summary of the facts, liability, and damages of your case to the arbitrator before your hearing. It is required for most arbitration cases, except for commercial ones.
Who needs to fill out this form?
Each party involved in a non-commercial arbitration case, or their attorney, must complete and submit this form. This includes individuals representing themselves (Pro Se Litigants).
The form says 'Use for all but Commercial Cases.' What if my case is a commercial one?
You should not use this form for a commercial case. You will need to find the specific form designated for commercial arbitration in your jurisdiction.
What does the 'Verbal Threshold' checkbox refer to?
The 'Verbal Threshold' is a legal standard in auto insurance cases in some states that determines whether you can sue for non-economic damages like pain and suffering. You should consult with your attorney to determine if it applies to your case.
What information do I need to provide in the 'Liability' section?
In the 'Liability' section, you should briefly explain why you believe the other party is legally responsible for the accident or incident. You should also attach any expert liability reports if you have them.
What is the difference between 'Economic' and 'Non-Economic' losses?
Economic losses are your specific, out-of-pocket expenses like medical bills and lost wages. Non-economic losses refer to non-monetary damages such as pain, suffering, and emotional distress resulting from your injuries.
The form says to list medical bills but also says 'DO NOT SEND COPIES OF BILLS.' What should I do?
You must itemize your medical bills in the space provided on the form itself, but do not attach the actual bill documents when you submit the form. However, you should be prepared to bring copies of the bills with you to the arbitration hearing as evidence.
What does it mean that the form must be 'timely served on all adversaries'?
This means you are required to send a copy of your completed form to the opposing party (or their lawyer) by the deadline set by court rule R. 4:21A-4. This ensures all parties have seen the information before the arbitration.
Can this form be used as evidence if my case goes to trial later?
No, the form explicitly states that the information provided on it cannot be used for evidentiary purposes in any subsequent trial of the matter. It is intended for the arbitration hearing only.
Can I use an AI tool to help me fill out this form?
Yes, AI-powered services like Instafill.ai can help you fill out this form more efficiently. These tools can accurately auto-fill fields with your information, saving you time and reducing errors.
How can I fill out the Uniform Arbitration Statement of Facts online?
You can use a service like Instafill.ai to fill out the form online. Simply upload the PDF, and the platform will make it interactive, allowing you to type your information directly into the fields and save or print the completed document.
The PDF version of this form I have is not fillable. What can I do?
If you have a non-fillable or 'flat' PDF, you can use a tool like Instafill.ai to convert it into an interactive, fillable form. This allows you to easily type your answers instead of printing and filling it out by hand.
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