Submit a Claim

24/7 Emergency Service

If this is an emergency, please call us at (614) 367-9611

To submit a claim online, complete the form below. Note the first section is about you and the rest is about your insured. If you’d prefer to provide information about your insured via a document, just upload it using the File field below.


Agent / Adjuster Info

Your Name *

Your Role *

Your Email *

Insurance Company / Carrier *

* Required Field


Insured Info

You can upload information by attaching a document:

Or you can complete the fields below:

Insured Name

Policy Number

Claim Number

Deductible

Insured Phone Number

Insured Email

Insured Street Address

Insured City

Insured State

Insured Zip Code