Claims Customer Care Request Form

Please select the reason for your escalation

General update on claim
Need adjuster name and contact information
Policyholder needs help understanding an estimate
Policyholder received a check without a settlement letter, or a check in an amount less than expected
Need a preferred vendor/contractor
Clarification on settlement letter received by policyholder

When was the claim filed

Claim was filed fewer than 30 days ago
Claim was filed more than 30 days ago

Please fill out the existing claim inquiry form to receive an update on this issue.

This claim inquiry is not handled by the Claims Customer Care team. This form is reserved for true escalations to expedite the response to issues in need of resolution.

Updates on claims filed within the last 30 days, requesting the assigned adjuster information, or a preferred vendor contact need to be requested through the existing claim inquiry form to receive an update on this claim.

Requesting agency name

Requester name

First name

Last name

Email address

Requester phone

Who in your agency should be contacted regarding this request?

Same as requester
A different person

Who at the agency should receive this update?

First name

Last name

Email to send update to

Policyholder name

First name

Last name

Policyholder phone number

Claim number

Description of escalation

Confirmation email

Send me a confirmation email