Report an Auto Claim

Simply report your auto claim via the form below. Our in-house claims team will take it from there, offering personalized assistance throughout the process.

Report Your Auto Claim

Indicates required field

Reporting Information

Name of Insured Policyholder

You Are A(n)

Insured Contact Name

Insured Address

Insured Contact Phone

Insured Contact Email

Policy Number

Driver of Insured Vehicle Name

Driver's Address

Driver's Phone

Driver's Email

Date of Loss

Time of Loss

Location of Accident (include address, city, state)

Vehicle Information

Vehicle Make / Model

Vehicle Year

Vehicle VIN

License Plate Number

Owner of Vehicle

Was the vehicle drivable or towed?

If towed, where to?

Description of damage to vehicle

Other Involved Parties (If multiple vehicles, please list out separately in additonal comments)

Name of Driver

Involved Party Address

Involved Party Phone

Involved Party Email

Vehicle Make / Model

Vehicle Year

Names of Other Occupants

Description of Injuries

Was the vehicle drivable or towed?

If towed, where to?

Description of Damage to Vehicle

Responding Agency

Name of Police Department

Police Report Number

Other Responding Authority (e.g. Fire EMS, etc.)

Additional Comments

Any additional information to provide not captured above

Supporting Document(s)

Supporting Documents

Maximum 3 files.
1 GB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

By clicking this box and filling out the appropriate form, you certify that the above facts are true to the best of your knowledge and belief