General Liability Claim

Your Name:
Date of Loss:
Location:
Description of Alleged Incident:
Exact Location of Incident:

Name:
Phone:
- -
Address:
City:
State:
Zip:
Extent of Injury:
Extent of Property Damage:
Enter answer to the math question:
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INSTRUCTIONS TO INSURED:

  1. Provide all documents you have regarding this incident.
  2. Provide a copy of the lawsuit immediately
  3. Obtain and provide all documents available to the claimant, including medical bills.
  4. Provide all internal documents including accident investigation, repair and maintenance records, etc.
  5. Maintain a list of names and addresses of any witnesses to the incident or employees who may be able to provide details on the product or location involved in the incident.
  6. If a product is involved and you have the product, save it for inspection by the claims adjuster or an expert named by the insurance company.
  7. The claims adjuster will work directly with the claimant or his/her attorney; you should not interact with the claimant yourself.
  8. Expect to be contacted by the claims adjuster within 48 hours.
  9. If there is any reason that you need to be contacted immediately, please let us know.

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(702) 877-1111


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