Report A Claim

Our job is to see that your claim is handled quickly, please provide after hours claim information on the form below. On the next business day we will let you know what the next steps are and what to expect along the way. Practices and procedures do vary depending on the type of insurance and insurance company but we will follow up with you to make sure your claim is moving along. Please note, by submitting this form you are not reporting the claim. If you plan to call your carrier to report the claim, please have your policy number and claim details available for the claims adjuster.

Type of Claim
- Auto
- Home
- Liability
- Workers Compensation
Download IL Form 45 here
Have you reported this directly to the insurance co. using their 800 number?*
- Yes
- No
Name*
First Last
Company Name (if applicable)
Best phone number to reach you*
Email
Date of incident*
Date Format: MM slash DD slash YYYY
Location of incident
Street Address City State ZIP Code
Short description of loss/injuries
Additional Comments / Information / Questions
Name
This field is for validation purposes and should be left unchanged.

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