Important Report the accident to us immediately with whatever information you have. Do not wait until you gather all the information. Many times we can start to process your claim with very little information.

Important Never admit fault. Never reveal your limits of liability. Never try to settle the loss yourself. Be sure any injured people get immediate medical help.

Report an Auto Claim

Note If you need help for auto body repairs, glass replacement, or auto rentals, perhaps a member of our Helper Network could help you. Click here for the list

IDENTIFY YOUR POLICY

Policy number, if available
Date of loss

IDENTIFY THE NAMED INSURED

First name *
Last name *
Daytime telephone number
Alternate telephone number
Email address *

LOCATION OF THE ACCIDENT

Address where accident happened
Nearest intersection
City
State
Was loss reported to Police?	Yes No	If yes complete the following
Name of Police Department

IDENTIFY OUR INSURED VEHICLE

Year of our vehicle
Make
Model
Describe damage

IDENTIFY THE DRIVER OF OUR VEHICLE

Was our vehicle being driven?	Yes No	If yes complete the following
Name of Driver
Was driver a member of the household?	Yes No	If no complete the following
Address
City
State
Daytime phone
Alternate phone

IDENTIFY THE OTHER VEHICLE

Was another vehicle involved in the accident?	Yes No	If yes complete the following
Name of owner
Address
City
State
Daytime phone
Year of our vehicle
Make
Model
Describe damage

IDENTIFY THE DRIVER OF THE OTHER VEHICLE

Was other vehicle being driven?	Yes No	If yes complete the following
Name of Other Driver
Address
City
State
Daytime phone
Alternate phone

INJURIES

Was anyone injured?	Yes No	If yes complete the following
Name of injured party
Describe injuries
If other people are injured please enter info below.
Describe injuries to other people

DAMAGE TO PROPERTY OTHER THAN A VEHICLE

Was Other Property Damaged?	Yes No	If yes complete the following
Name of property owner
Address
City
State
Daytime phone
Alternate phone
Describe the property damaged

BRIEFLY DESCRIBE WHAT HAPPENED

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