Claim Assignment Form

Submit A Claim

Please click one of the links below to submit a claim using our automated claim submission form. Your assignment will be sent to our HOTLINE.

Electronic claims will be forwarded immediately upon receipt to the appropriate branch. The assigned branch will then follow up with the client the next business day. Any questions, please call 855 - 712 - 7210.

Attention: If this is an emergency assignment, please call 888-287-8237 for immediate dispatch.

Submit a claim using your own Loss Form -

If you have a completed Loss Form ready to submit, you may upload it here:
We are not accepting submissions with ZIP files attached at this time. You are able to select multiple files to upload with IE 10 or greater as well as Chrome, Firefox, Edge, Safari, and Opera.
Please fill in all information when using this form