Senior Living Centers
Church & Non-Profit

Claim Information

Available Claim Forms

To submit a claim use one of the appropriate links below. If none are available for your particular claim, please contact us directly.

Many of the insurance companies that we represent will accept claims by phone or fax or the claim my be reported on-line.  We have supplied you with phone numbers of your insurance company and a link to the company web site. This gives you 24 /7 service as long as you know your policy number and the insurance company.  If you do not know your policy number, you can report AUTO, PROPERTY, LIABILITY OR WORKERS COMPENSATION claim(s)  by clicking the PROPER Loss Notice Form above:  All Claims, may also be reported to our agency by phone, fax or email.

Automobile Loss: If you are involved in an accident with another vehicle or pedestrian, call the police.  In some cities, the police will not come out to the accident scene unless there are injuries.  Take down the name and address and phone number of the other drivers as well as any witnesses.  Ask for the other party's drivers license number and Auto ID card.  From the auto ID card, write down the year, make and model, license number and Vehicle Identification Number (VIN) and expiration date of coverage. If you have a camera, take a photo of the vehicle damage, the person, drivers license and auto ID card.

Property Loss: 
  • Fire Damage: Do what you can to mitigate the loss without injuring yourself.  Board up the property before you leave.  If you cannot spend the night in your home, go to a hotel and keep all receipts including meals and clothing.
  • Lightning Damage:  Unplug the item and set it aside for the adjuster to see.  
  • Water Damage:  Do not leave water running if an appliance or pipe is leaking.  Shut off water to the home and make any necessary repairs to prevent further damage.  Call a water damage restoration company such as Blackmon Mooring, PuroClean, Servpro or Stanley Restoration to have the water extracted and begin the drying process. 

Liability Claim: If a person is injured or your premises, seek medical attention as soon as possible.  If necessary call 911.  Obtain the address and  phone number of the injured party and any witness.  Do not admit liability
or volunteer any payment but request that the injured party call you and let you know how they are doing.

Workers Compensation Claims: Workers Compensation and Employers Liability claims should be reported by the employers directly to the insurance company.  You may report by phone, fax or at the insurance company website or by the First Report of Injury form from this website.

Disclaimer: Please note that the online forms are for notification purposes only and do not constitute making an actual claim, but are rather a notification to our office of an existing loss or claim.  Always follow up by phone call if you have not been contacted by one of our representatives. 

Chartered Life Underwriter
Independent Insurance Agent
Trusted Choice
CPCU Society
Porter-Brandenburg Agency, Inc.
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