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Report a Claim

The following questions should take you about 5 minutes to complete.

Please have the following information ready.
Vehicle and Driver Details
VINs, Registration Numbers, Driver Names, Licenses.
Incident information
Loss date/time, road conditions, police report number.
Supporting Reports, Images and Videos
Reports, images and videos related to the incident.
Start

Reporter Information

Draft
Contact Information
Please verify that the contact details are correct. We will use these details to get in touch with you about the claim.
First Name
Last Name
Phone
Email Address
Insured Information
Insured Company Name *
Notice Type
Let us know if you want to just report this incident or initiate a claim.
Proceed

Incident Details

Draft
Incident Time and Location
The date and time of the incident, and where it occurred.
Time of Incident *
State *
Location Details
Policy Information
Policy Number *
Vehicle Information
Was your vehicle involved?
Insured Vehicles (VIN)
Were other vehicles involved?
Other Vehicles (License Plate)
Law Enforcement
Was law enforcement present at the scene of the incident? *
Was anyone injured? *
Law Enforcement Agency Name
Report Number
Incident Description
Share as much detail as possible to speed up the claim process.
What happened?
Supporting Reports, Images and Videos
Upload any documentation that you have about this incident so far: images, police reports, receipts, other documents.
Choose Files to Upload
JPEG, PNG, PDF, and MP4 formats, up to 50 MB.
File-name.pdf
60 KB of 60 KB
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Proceed

Review & Submit

Draft
Provider Override
Reporter Information
Name
Name and last name here
Email
Email here
Phone
-
Insured Name *
Missing Insured Name
Notice Type
Initiate Claim
Reporter Information
Date & Time *
-
State *
-
Location Details
-
Policy Number *
Missing Insured Name
Was your vehicle involved?
Yes
Was another vehicle involved?
Yes
Was there police at the scene? *
No
Was anyone injured? *
Yes
Police Agency Name
-
Police Report Number
-
Incident Description
-
Attachments
File-name.pdf
60 KB of 60 KB
Previous
Submit
Is all your information correct?

Once you submit, you won’t be able to edit your details.
Please double-check that all names, registration numbers, licenses, and documents are accurate before continuing.

Claim submitted successfully

Your claim has been received. Our team will review the details and contact you if additional information is needed.

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