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Auto Loss Report.

After you have submitted your claim online you’ll receive an email confirmation and we will respond by the next business day. If your policy needs to be changed or there are any injuries as a result of the accident you’re reporting, please call us right away at 1-800-387-2656.
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There are error(s) found in the information you submitted.

    Policy Holder Information

    * Inditcates mandatory field


    Loss Information

    (If you or your passengers are injured, we strongly recommend that you call us immediately at 1-800-387-3656)

    Location of Accident

    Your Vehicle Information

    Driver Information

    Passenger Information


    Other Vehicle Involved

    Other Involved Driver / Pedestrian


    Other Involved Passenger



    Additional Information

    Identity of Submitter

    By clicking submit, you agree that the foregoing statement is correct and accurate and you understand that we will establish a claim file in order to assign resources to respond to your needs.