Report a claim — INSURHAUS

Name*
First Last
Phone No. (xxx-xxx-xxxx)*
E-mail*
Insured name*
Policy No.*
Carrier (Insurance Company)
Claim Occured (mm/dd/yyyy)*
MM slash DD slash YYYY
Loss Amount Expected (xxx.xx)
Is insured at fault?*
- Yes
- No
Any injures?*
- Yes
- No
Details (please, describe how the loss/accident occurred)
Once You submit this claim it will be forwarded to our company for processing. Please allow 24 to 48 hours for a representative to contact You to discuss claim. Please take no other action or admit fault regarding claim till someone from our office contacts You.
Name
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