phone

800-257-5590

Home / Submit Claim

IMPORTANT NOTICE!

It is your contractual responsibility to report any claim, loss or lawsuit, or any incident or event which could reasonably lead to a claim, loss or lawsuit, directly to us as set forth in the policy. If for any reason you are unable to use our Online Claims App for this purpose, it is still your responsibility to report any such claim, loss, lawsuit, incident, or event to us as set forth in the policy by another method such as by telephone at 1-800-257-5590 or by facsimile at 1-877-452-6909. Your failure to do so may jeopardize any coverage as set forth in the policy.

Form Downloads

Automobile Loss Notice
Incident Reporting Form – Services
Incident/Accident Reporting Form
Property Loss Notice
Witness Statement

Online Incident Reporting Form

Please complete the form below. Fields marked with an asterisk are required (*).

  • MM slash DD slash YYYY
  • Name Email Phone Actions
         
  • If you would like to submit photos with this claim, please add them below. Photos should have the "jpg" extension. Up to five (5) images can be attached to this claim.
    Drop files here or
    Accepted file types: jpg, png, pdf, tiff, bmp, heic, Max. file size: 25 MB, Max. files: 5.
    • This field is for validation purposes and should be left unchanged.

    *All claims are managed by Claims Direct Access (CDA), a Prime affiliated company.

    IMPORTANT NOTICE!

    It is your contractual responsibility to report any claim, loss or lawsuit, or any incident or event which could reasonably lead to a claim, loss or lawsuit, directly to us as set forth in the policy. If for any reason you are unable to use our Online Claims App for this purpose, it is still your responsibility to report any such claim, loss, lawsuit, incident, or event to us as set forth in the policy by another method such as by telephone at 1-800-257-5590 or by facsimile at 1-877-452-6909. Your failure to do so may jeopardize any coverage as set forth in the policy.

    Form Downloads

    Automobile Loss Notice
    Incident Reporting Form – Services
    Incident/Accident Reporting Form
    Property Loss Notice
    Witness Statement