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
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: