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 a Homeowner Liability Claim

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
City
State
Were police notified?	Yes No	If yes complete the following
Name of Police Department

INJURED PARTIES

Was anyone injured?	Yes No	If yes complete the following
Name of injured party
Address
City
State
Daytime phone
Alternate phone
Describe injuries

Note If more than one person injured use the "Describe what happened" box

PROPERTY DAMAGE

Any 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

Describe what happened

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