Rated A Exceptional by Demotech, Inc
Call For Assistance: 800.342.2521 | 419.849.2521
Hours: Mon - Thu, 8:30 – 4:30 / Fri, 8:30 – 3:30

Submit a Claim

Complete the form to submit a claim for review.

INSURED NAME

INSURED ADDRESS

INSURED CONTACT

AGENT NAME

LOCATION OF LOSS

REPORTED BY

CONTACT NAME

By checking this box, I hereby certify that I have the authority to make this request by being the insured or an authorized representative of the insured.
Disclaimer

This claim will be reviewed and contact will be made as soon as possible on the next regular business day following receipt of this notice. We may not receive this claim promptly if the report is being completed after hours or on weekends or holidays. This reporting capability is solely for the convenience of filing a claim after hours or when it is not feasible to contact your agent during normal business hours.

Please do not hesitate to contact us with questions.

We're always here to help. 419.849.2521 | 800.342.2521