To File a Claim Online Please fill out the form at the bottom of this page.

If you have a questions, please contact:

Donna Quaranta

To reach a Liability Claims Examiner directly, please click below:
Candice Clare
Cheryl Joyner
Dan Siegel
Joseph Clarke
Peter Marini
Robert Horn
William Andrejko


Ilona Ring
Liability Supervisor

*** If you need assistance after hours or on the weekend, please call our 800# which is active 24hours:

General Liability Claim Form

  • Insured Information

  • Description of Occurance

  • MM slash DD slash YYYY
  • Claimant Information

  • Reported by Name / Contact Number:

  • Please attach the following:
    1. Acord Forms
    2. Summons
    3. Letter of Representation
    4. Medical Records (if available)
    5. Estimates for property damage (if applicable)
    6. Photos
    7. Statements/Incident reports
  • Max. file size: 256 MB.