For a copy of
our claim form, click on the link below.
For questions about claims, call 1-800-720-2784.
Since your claim cannot be processed until the carrier makes their $100
payment, we recommend you file a claim with the carrier as soon as
possible.
Claim Form
Attention:
Before you can view and print the claim form you will need to have
Adobe Acrobat Reader installed on your machine. You can download
Acrobat Reader for free from here:
