Account/Loss Information

• Caller's phone number and extension
• Caller's title and name
• Garage state (state where vehicle is garaged)
• Subsidiary name and address
• Subsidiary mailing address (if different from above)
• Did the loss occur at the location address? (if no, address where loss occurred)
• Date and time of loss
• Full description of loss
• Parent company/insured's name
• Location code
• Policy symbol and number

Insured Vehicle and Injury Information

• Does insured own vehicle? (if no, owner's name, address and phone number)
• Insured vehicle year, make, model, vehicle identification number, plate state and number
• Insured vehicle driver name, address, phone number, relationship to the insured, date of birth, driver license state and number
• Insured vehicle used with permission?
• Was the insured vehicle damaged? If yes, description of damage.
• Is there a written estimate or repair/replacement bill for the damage? If yes, amount.
• Is vehicle drivable?
• Did air bag deploy?
• Attorney information (if represented)
• Was anyone injured in the insured vehicle? If yes, provide the following information for each injured person in insured's vehicle:
  • name
  • business and home phone numbers
  • address
  • relationship of the injured to the accident (insured driver, member of insured household, guest in insured vehicle, or pedestrian)
  • date of birth
  • gender
  • description of injury
  • medical facility (if treatment received)
  • attorney information (if represented)

Other Property Damage and Injury Information

• Was any other vehicle damaged? If yes, provide the following information:
  • owner's name
  • business and home phone numbers
  • address
  • damaged vehicle information (year, make, model, vehicle identification number, color, plate state and number )
  • description of damage
  • Is there a written estimate or repair/replacement bill for the damage? If yes, amount.
  • Did air bag deploy?
  • Other insurance carrier information (name and policy number)
  • Attorney information (if represented)
• Was any other property damaged? If yes, provide the following information:
  • name
  • business and/or home phone numbers
  • address
  • description of damaged property
  • location of damaged property including address
  • Is a written estimate or repair/replacement bill for damage available? If yes, amount.
  • attorney information (if represented)
• Was anyone injured in any of the other vehicles involved? If yes, provide the following information:
  • name
  • business and home phone numbers
  • address
  • relationship of the injured to the accident (driver or occupant of other vehicle, pedestrian)
  • date of birth
  • gender
  • description of injury
  • medical facility (if treatment received)
  • attorney information (if represented)
• Witnesses (names, addresses, and phone numbers)
• Authorities (name, report/case number, county, any violations/citations)

Contact Information

• Contact name and phone number, best time to contact and where to contact
• Additional notes/comments or customer specific information

Report your claim
directly - we'll get to
work immediately.

24 / 7 / 365

---

Business Insurance Claims:

800.238.6225

National Accounts Claims:

800.832.7839

Constitution State Services Claims:

800.243.2490

Construction Claims:

877.828.4132