Auto Claim Form

Incident Details

Use this form to report vehicle accidents which you believe could reasonably result in a claim against you. Do not use for General Liability or Worker's Compensation claims.

Keep In Mind:

  • Remain calm, get to a safe place, check for injuries, administer First Aid, and call the police or EMT.
  • Things NOT to say:
    • "It's all my fault." (Even if it is)
    • "My insurance will pay for everything."
    • "It's okay, I have full coverage."

When describing the incident, please use as much information as possible.

Insured Vehicle Information

Use this form to report vehicle accidents which you believe could reasonably result in a claim against you. Do not use for General Liability or Worker's Compensation claims.

Other Vehicle Information

Use this form to report vehicle accidents which you believe could reasonably result in a claim against you. Do not use for General Liability or Worker's Compensation claims.

If no other vehicle was involved, move on to the next step.

Documentation

Use this form to report vehicle accidents which you believe could reasonably result in a claim against you. Do not use for General Liability or Worker's Compensation claims.

When adding documentation, please be sure to upload original copies when possible. Photocopies are rarely adequate.

If you have no documentation for upload, move on to the next step of the form.


Contact Information

Use this form to report vehicle accidents which you believe could reasonably result in a claim against you. Do not use for General Liability or Worker's Compensation claims.