Assign a Claim Carrier InformationCarrierSelect a carrierAcuityAmerican International Group IncAllstate Ins GroupAmerica First InsuranceAmerican Capitol AssuranceAmerican Strategic InsuranceAmeriprise Auto and HomeAmerican Family Insurance GroupAuto-Owners Ins GrpBankers InsuranceCATO CorporationCentury Fire ProtectionCentury21-Ron LaughlinChubb Mitigation AssignmentChubb Reconstruction AssignmentCitizens Prop Ins CpCode Blue TPAColorado Casualty InsuranceCalif State Auto GrpCypress InsuranceEncompass InsuranceErie Ins GroupFarm Bureau Insurance of KentuckyFarmers Ins GroupFedNatFlorida Insurance Guaranty AssociationFlorida SpecialtyFiremans FundFirst Service BusinessGolden EagleHannahstown Mutual InsHartford Ins GroupHippo Insurance ServicesHomeOwners ChoiceHomesiteHomewise InsuranceIndiana InsuranceKettlerLiberty NorthwestMetLife Auto and Home GrMontgomery Insurance CoMount Morris MutualNA Risk Ins CoNarragansett Bay Insurance CoNationwide Allied Insurance CoOhio Casualty GroupOlympus Insurance CompanyPDN Select Commercial AccountsPeerless InsuranceSafeco Ins CosService AmericaStar and ShieldState AutoState Farm GroupSwyfftTravelers Ins CoUniversal North AmericaUSAA GroupUtica National Insurance GroupVault InsuranceWest Bend Mutual InsuranceYellow-RoadwayOTHERReferral TypeReferral Type Restoration Mitigation Appraisal Comparative Estimate Insured/Resident InformationFirst Name Last Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEvening PhoneEmail Is Owner Information Different? Yes THIS IS AN ATTORNEY REPRESENT FILE. DO NOT CONTACT THE INSURED DIRECTLY.If this is an attorney represent file, please check "yes" to fill out some information about the point of contact. Yes Attorney Contact InfoFirst Name Last Name PhoneEmail Owner InformationFirst Name Last Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEvening PhoneEmail Policy InformationClaim Reference #: Policy Number: Deductible Amount: Policy LimitsDwelling Contents Other Loss InformationLoss Date MM slash DD slash YYYY Loss TypePick Loss TypeWater or SteamSewerBackup or Drain BackupMoldFireFloodFreezingMechanical BreakdownIceWeight Or Snow WeightNon-Emergency RepairOther Casualty LossesHurricaneTest ProjectAnimal LiabilityAircraftBurglaryCollapseCollisionContamination or PollutionEarthQuakeExplosionFallingObjectGlassHailHeat Expansion or ContractionLandslideLightningMudslideMoving and StorageMysteriousDisappearancePowerInterruptionPowerSurgeRiotRobberySea WaterSinkhole or CollapseSmokeSubsidenceTheftTornadoTraumaVandalism or Malicious MischiefVehicleVolcanicWindstormAll Water CausesSmoke / Fire DamageEnvironmental (Mold / Asbestos)Sump Pump overflowUndefinedIs Emergency Yes Loss DescriptionAdjuster InformationFirst Name Last Name Independent Adjuster: E-mail address to send confirmation of assignment to: Assigned Franchise By clicking "Submit", you agree to our Terms of Use, which contain a mandatory arbitration provision.
