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REPORT CLAIMGET CERTIFICATEGET A QUOTE

Use this form to notify Insurhaus about a new insurance claim or loss. Please provide as much information as possible so we can direct your report to the appropriate insurance company.

Emergency or Urgent Claims

If anyone is injured or there is an immediate danger, call 911 first.

This form is monitored during regular business hours and should not be used for emergency assistance. For urgent claims, roadside assistance, emergency property damage, or towing, contact your insurance company directly using the claims telephone number listed on your insurance ID card or policy documents.

Contact Information

Person Reporting the Claim(Required)
Preferred Contact Method

Policy Information

Incident Information

MM slash DD slash YYYY
Time of Loss
:
Location of Loss(Required)
Include the events leading up to the incident and describe any resulting damage or injuries.
Were There Any Injuries?(Required)
Were Police, Firefighters, or Emergency Medical Services Contacted?(Required)
Were Any Citations Issued?

Other People and Property Involved

Were Other People, Vehicles, or Properties Involved?(Required)
Name and contact information; vehicle year, make, model and license plate; insurance company and policy information; description of property damage.
Were There Any Witnesses?

Documents and Photos

Drop files here or
Max. file size: 16 MB, Max. files: 20.
    Max. file size: 16 MB.
    Max. file size: 16 MB.
    Max. file size: 16 MB.
    Max. file size: 16 MB.
    Max. file size: 16 MB.
    Drop files here or
    Max. file size: 16 MB, Max. files: 10.

      Please do not upload Social Security numbers, bank information, passwords, or other unnecessary sensitive personal information.

      Important Claim Information

      Take reasonable steps to protect people and property from immediate danger and prevent additional damage. Take photos or videos before moving or repairing damaged property whenever it is safe to do so.

      Keep receipts for towing, temporary repairs, emergency services, or other expenses related to the loss. Do not dispose of damaged property or begin permanent repairs before speaking with the insurance company, unless action is necessary for safety or to prevent additional damage.

      Do not admit fault, promise payment, negotiate a settlement, or sign documents on behalf of the insurance company. Cooperate with law enforcement and exchange the necessary contact and insurance information with the other parties involved.

      Authorization and Confirmation

      (Required)
      (Required)

      What Happens Next

      After you submit this form, Insurhaus will review the information and forward it to the appropriate insurance company. A representative will contact you as soon as possible during regular business hours.

      Submitting this form does not guarantee coverage and does not mean that the claim has been officially accepted or filed by the insurance company. Your claim is officially established when the insurance company confirms receipt and provides a claim number.

      Coverage, liability, deductibles, and claim payments are determined by the insurance company according to the terms, conditions, limitations, and exclusions of the applicable policy.

      Claim Reporting and Legal Disclaimer

      Insurhaus is an independent insurance agency. We do not provide legal advice and do not have the authority to investigate, adjust, approve, deny, settle, or pay insurance claims. All claim and coverage decisions are made exclusively by the insurance company according to the terms, conditions, limits, deductibles, and exclusions of the applicable policy.

      Insurhaus may assist customers with reporting a claim, forwarding available information and documents, and contacting the appropriate insurance company. This assistance should not be interpreted as legal advice, claim handling, or a determination of coverage or liability.

      Submitting this form does not guarantee coverage or confirm that a claim has been officially filed or accepted. A claim is officially established only after the insurance company confirms receipt and provides a claim number. If you need legal advice, please consult a qualified attorney.