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Report A Claim
To report a new claim on-line, please complete the form below. Note that some information is mandatory in order to complete the claim reporting process. Click on the Report Claim button when complete.
All fields marked with an asterisk (*) are required.

Person Reporting the Claim

Is the vehicle drivable?
Name, address, and phone number of repair shop or towing company (if applicable).

Policy Holder

Is the vehicle drivable?
Name, address, and phone number of repair shop or towing company (if applicable).

Other Vehicle Involved in Accident

Is the vehicle drivable?

Accident Information

*Time Zone
*State

Additional Information

*Did the police respond?
This is required.
*Did an ambulance respond?
This is required.
*Were any citations issued?
This is required.
*Were there any injuries?
This is required.
*Were any vehicles towed?
This is required.
*Was weather a factor?
This is required.
*Do you need a Spanish speaking representative?
This is required.