Submit a Claim Please use this form to submit a Claim: Type of Claim Accident and Personal InjuryMotor Vehicle Property DamageNo-Fault/PIP Litigation And ArbitrationUM/SUM ClaimsOther Client Information: Name or Company Name Assigned By / Client Rep Date Assigned Claim Number Policy Number Address City State Zip Code Phone Number Email Address Date of Accident Description of Loss/Accident Party 1 - Plaintiff or Claimant: First Name Last Name Address City State Zip Code Phone Number Email Address Party 2 - Defendant or Adverse: First Name Last Name Address City State Zip Code Phone Number Email Address Referring Claims to us is easy. No gimmicks, complex contracts or agreements. Claims can be sent to us via email, fax or regular mail. Please upload a copy of your pertinent documents of your claim and we will take it from there! Upload Documents
