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Truck Insurance
Agents Portal
Agent Payment Options
The Trucker’s Network
Resources
FMCSA Safer
VIN Decoder
Web MVR
File a Claim
Agency Information
Agent's Name:
*
Agency Email:
Agency:
*
Policy Holder Information
Policy Number:
Insured's Name:
*
Insured's Primary Phone:
*
Insured's Email Address:
*
Insured's Mailing Address (include City, State, Zip):
*
Contact Information for Person Filing
Contact Name for Person Filing Claim: (if different from Insured)
Contact Phone Number for Person Filing Claim: (If different from Insured)
Claim Information
Date of Loss (mm/dd/yyyy):
*
Time of Loss (hh:mm):
Loss Type(s):
*
Physical Damage
Motor Truck Cargo
Trailer Interchange
Non-Trucking Liability
Trucker's General Liability
Driver's Full Name:
*
Does the claim involve more than one Truck and Trailer?
*
Yes
No
Enter Any additional Units (Include Year, Make, & VIN# for each)
*
Location where vehicle can be inspected
*
Truck Year:
*
Trailer Year:
*
Truck Make:
*
Trailer Make:
*
Truck VIN#:
*
Trailer VIN#:
*
Accident Location (Street, Hwy, Address, City, State):
*
Towing Company:
Commodities Hauled:
*
Anyone Injured?
*
Yes
No
Describe Injuries:
*
Description of Accident: (Cause, Citation Issued? Rain or Snow?)
*
Documents Upload
Below is a list of required information that we need to process the claim:
Date of Loss
Location of accident (City, State)
Full Name of Driver involved in claim
Contact Information for Insured (Name, Phone Number, & Email Address)
Copies of Registration (for insured vehicles involved, including tractor and/or trailer)
Driver’s statement - Must include drivers full name and a description of events
Location where vehicle can be inspected
Bill of Lading (Cargo claim only)
If available, please provide the following additional documents:
Pictures of damage (if available)
Police Report (if available, when available)
Vehicle estimate (if available)
Copy of Towing bill (if vehicle towed or load transferred or recovered)
Trailer Interchange Agreement (if applicable)
*
Maximum File Size allowed for all files combined is 7MB
If combined total of all files is over 20MB, please email all documents to
[email protected]
.
We will not receive email notification of claims reported online if the combined total size of all files is over 7MB.
Who is Filing this Claim?
Agent
Insured
Other
Other:
*
Payment options
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Payment options
Submit Documentation
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