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Caller Information

Caller Name *

Telephone Number * 10 digits (or 11 digits starting with 1)

Email *

Title (Involvement)

Do you have an attorney representing you?

If "Yes", add representation details in comments

Insured Information

Insured Name *

Policy Number

Insured’s Contact Info

Name

Telephone

Email Address

Loss Details

Date of Incident *

Loss Location (address)

Description of Loss *

Describe Damages (Property Damage or Bodily Injury)

Vehicle Damage

Is there damage to a vehicle?

Claimant Information

Claimant Name

Telephone Number

Email Address

Any Comments

I acknowledge the https://corespecialty.com/privacy-policy/privacy policy. I acknowledge that any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit, or knowingly provides false, incomplete, or misleading information with intent to defraud or deceive an insurer, is guilty of a crime and may be subject to criminal and civil penalties, including fines, imprisonment, and denial of insurance benefits..

Additional supporting documents: If you need to submit supporting documents (pics), they can be emailed to claims@corespecialty.com. Please reference name of insured or policy number/date of loss/claimant name if available. Subject line can be “Additional Supporting documents for claim”.

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Caller Information

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Insured’s Contact Info

Loss Details

Vehicle Damage

Claimant Information

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